South Carolina Home Care Market at a Glance
1,079,000 (19.7% of total population)
Senior Population
28.9% (2020-2030)
Projected Growth
3.5x - 5.5x
Typical Multiples
$1.7 Billion
Market Size
Key Market Facts
South Carolina was the fastest-growing state in the U.S. in 2023, with a population increase of 1.7%, driving demand for senior services.
The 65+ population is projected to grow by 28.9% between 2020 and 2030, significantly outpacing the national average.
Major metropolitan areas like Charleston, Columbia, and Greenville are experiencing rapid in-migration, creating dense, high-value service areas.
The state has a favorable tax environment for retirees, with no state tax on Social Security benefits and significant deductions for other retirement income.
South Carolina is a Certificate of Need (CON) state for home health agencies, which limits new market entry and protects existing agency market share.
The state's coastal and mountain regions present unique geographic challenges and opportunities for service delivery and expansion.
Market Opportunities
High senior population growth and in-migration of retirees create a continuously expanding private-pay market, especially in coastal and Upstate regions.
The CON barrier for home health creates a high-value asset, making licensed agencies attractive acquisition targets for regional and national platforms.
Opportunities exist for agencies specializing in chronic care management and post-acute care to partner with major health systems in Charleston and Columbia.
The fragmented nature of the personal care market allows for strategic roll-ups and consolidation by private equity-backed platforms.
Expansion into underserved rural areas, particularly through technology-enabled care models, can capture new Medicaid and private-pay clients.
Agencies with strong clinical outcomes and a focus on value-based care models are highly attractive to strategic buyers seeking to optimize payer contracts.
Market Challenges
The state faces a critical shortage of qualified direct care workers (CNAs, HHAs), leading to high turnover and increased labor costs.
Navigating the Certificate of Need (CON) process for home health expansion is complex, time-consuming, and a significant barrier to organic growth.
Reimbursement rates for Medicaid HCBS waivers can be challenging, requiring agencies to maintain a strong payer mix with a focus on Medicare and private insurance.
Competition is intensifying in high-growth metros like Charleston and Greenville, demanding sophisticated marketing and recruitment strategies.
Geographic dispersion in rural counties makes efficient scheduling and travel time management a logistical challenge.
The state's susceptibility to severe weather (hurricanes, flooding) requires robust disaster preparedness and continuity of care planning.
South Carolina Regulatory Environment
Home Health Agencies (HHAs) require a Certificate of Need (CON) from the South Carolina Department of Public Health (SCDPH) before licensure.
In-Home Care Providers (non-medical) are licensed and regulated by the SCDPH under Regulation 60-122.
All direct care staff must undergo a Criminal Record Check as mandated by state law (Section 44-7-2910 et seq.).
Medicaid Home and Community-Based Services (HCBS) are administered by the South Carolina Department of Health and Human Services (SCDHHS).
HHAs must meet Medicare certification requirements to participate in the federal program, which is a key driver of revenue.
The state has specific regulations for the supervision and training of home health aides and personal care aides.
Data Sources
Market Size: Estimated from IBIS World Home Care Providers Industry Report and state-level Medicare/Medicaid expenditure data.
Valuation Multiples: Derived from M&A transaction databases and industry broker reports for home care and home health agencies.
Growth Projections: Based on 65+ population projections from the U.S. Census Bureau (2020-2030).
Senior Population: U.S. Census Bureau American Community Survey estimates.