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SC Medicaid - SCDHHSMedicaid · Reimbursement · Claims & Billing · SC · Pediatrics, Occupational Therapy, Physical Therapy +2 moreMedium impact

Rate Updates for State Plan Services and Home and Community-based Services

Act
by Dec 1, 2026
Effective date
Dec 1, 2026
Identified
Oct 31, 2026

Summary

South Carolina Department of Health and Human Services is increasing reimbursement rates for state plan services and home and community-based services (HCBS) through 1915(c) waiver programs. Rate increases range from $1–$15.23 per unit across personal care, nursing, and residential habilitation services for Healthy Connections Medicaid members. All billing systems and fee schedules will be updated by the effective date.

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What to do

by Dec 1, 2026 · 4 steps
01Billing team must verify that all billing software, fee schedules, and claims submission systems reflect the updated reimbursement rates for affected services.
02Confirm that claims for dates of service on or after December 1, 2026, are billed at the new rates specified in the bulletin (e.g., T1019 increases from $25/hour to $26/hour; T1002 from $50/hour to $51/hour; S9123 from $47/hour to $48/hour; T2016 residential habilitation rates increase across all modifiers U1–U8).
03Verify that all claims billed prior to December 1, 2026, continue to be processed at the current rates.
04Direct any implementation questions to MedicaidWaiver@scdhhs.gov.

Codes mentioned

T1019T1002S9123T2016

Original notice

Rate Updates for State Plan Services and Home and Community-based Services
scdhhs.gov · Always check the source before changing claims.
View original ↗

Related changes

See all SC Medicaid - SCDHHS changes →
Residential Habilitation Service Rate Increases for the Intellectual Disability/Related Disabilities and Head and Spinal Cord Injury WaiversMediumEffective Nov 1, 2025 · Claims & BillingBrowse every SC Medicaid - SCDHHS change in the policy list

Related policy hubs

SC Medicaid - SCDHHS policiesSC policy changesPediatricsOccupational TherapyPhysical TherapySpeech TherapyGeriatricsCode T1019Code T1002Code S9123Code T2016

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