Medicaid: Care Worker Wages

If this bill passes, it will add a new part to South Carolina law that sets a rule about the lowest amount direct care workers can be paid.

• Direct care worker: a professional whose job is to meet someone else’s personal care needs, like eating, bathing, getting dressed, or using the bathroom.

• This rule is only for workers who get paid through a specific Medicaid program for in-home care.

  • Medicaid: Health insurance from the state government for people who do not have money for doctor and hospital visits, or medicine. It’s especially important for disabled people who might need medical care that costs more money.

• The rule makes it so that workers have to get raises over time. 

• This bill explains the following important words:

  • "Compensation" : all payments and benefits for direct care workers. 

    • Includes insurance, time off, retirement, school payments, and taxes.  

  • "Department": the South Carolina Department of Health and Human Services.  

    • This is the government office in South Carolina in charge of programs to make sure people in South Carolina are healthy and have what they need to live full lives

  • "Direct care worker" 

  • "HCBS": Medicaid Home and Community-Based Services provided through a:

    • State health plan

    • special paperwork called a 1915(c) waiver

    • managed care: separate agencies who get medicaid money to provide services.

  • "Personal care services": services offered through HCBS waiver programs for disabilities, injuries, HIV/AIDS, or medically complex kids. 

  • "HCBS provider agency": an office that has a Medicaid provider agreement, can get medicaid to give them money back, and employs direct care workers for people who get Home and Community Based Services.

• If this bill passes:

  • By the  start of 2026, HCBS agencies getting money back for Medicaid services need to use most (at least 70%) of that money to pay direct care workers. 

    • This amount of money they have to use for pay goes up again by January 1, 2028, and another time after that by January 1, 2030,

  • All HCBS provider agencies must tell each direct care worker about when the pay change  starts and what their pay and benefits will be.  

  • HCBS providers must check with the Department that they are following the new rules right. 

    • They have to keep track of what they are paying workers through the correct paperwork.  

    • Proof of the money used for paying direct care workers must be kept and shown if asked.  

• This law takes effect once the Governor says so.

  • Governor: The leader of a whole state.