South Carolina Medicaid income limits work differently from those in most states. The state draws a hard line: if a long-term-care applicant's gross monthly income tops $2,982 in 2026, the state does not let them spend down the difference. They have to route the excess through an income trust, and a spouse who stays home is protected far less generously than in almost any other state.
This guide walks through the 2026 income and asset rules for South Carolina Medicaid (Healthy Connections) long-term care: the income cap, the income trust that over-income applicants must set up, the asset limit, what a nursing-home resident keeps, and the unusually low cap on what a spouse at home can hold.
How South Carolina Medicaid income limits work: the income cap
South Carolina sets its 2026 income limit for nursing-facility and home- and community-based waiver coverage at $2,982 per month, which is 300% of the 2026 SSI Federal Benefit Rate of $994. The figure took effect January 1, 2026.
Here's what makes the state different. South Carolina is an income-cap state. It does not run a medically needy spend-down for long-term care. In a spend-down state, being over the income standard isn't disqualifying: you incur medical costs equal to the excess and Medicaid covers the rest. South Carolina has no such pathway for long-term care. The $2,982 figure is a true ceiling, and a single dollar of monthly income above it shuts an applicant out, unless they take one specific step.
The income trust: how over-income applicants still qualify
The step is a Qualified Income Trust, also called a Miller Trust or an income trust. It's the workaround the federal rules build in for income-cap states, and in South Carolina it is the only way an over-income applicant gets long-term-care Medicaid.
The mechanics are narrow but specific. Each month, the applicant deposits the income above the cap into the trust. Money inside the trust doesn't count toward the $2,982 limit, so the applicant qualifies. The trust then pays out under tight federal rules, mostly toward the cost of care, with the state named as remainder beneficiary to recover what it spent after the applicant dies.
An income trust has to be set up correctly and funded every single month, or eligibility breaks. This is one of the clearest cases where an elder-law attorney earns their fee. The trust is irrevocable, the language has to satisfy the state, and a missed monthly deposit can cost a month of coverage.
The asset limit
Long-term-care Medicaid in South Carolina holds a single applicant to $2,000 in countable assets. When both spouses apply, the limit is $4,000. These are the long-standing federal baseline figures, unlike a handful of states that have raised their asset limits well above $2,000.
"Countable" is the load-bearing word. South Carolina, like every state, exempts a long list of assets from the count: the primary home (subject to a home-equity limit of $752,000 in 2026), one vehicle, household goods and personal effects, and a prepaid irrevocable burial arrangement. So the $2,000 applies to bank accounts, investments, and second properties, not the roof over the applicant's head.
The five-year look-back
South Carolina reviews asset transfers made in the 60 months before a long-term-care application. Giving away money or property for less than fair market value inside that window, signing a house over to a child for a dollar, gifting a grandchild a down payment, can trigger a penalty period during which Medicaid won't pay for long-term-care services, even after the applicant is otherwise eligible.
There are legitimate exceptions (transfers between spouses, transfers to a disabled child, certain caregiver-child home transfers) and legitimate planning approaches. But anything done inside the five-year window deserves an elder-law attorney's review first. If long-term care is on the horizon for someone in your family, talk to a professional before moving assets. For the broader toolkit, see our guide to Medicaid planning strategies.
Long-term care: what a nursing-home resident keeps
When South Carolina Medicaid pays for nursing-facility care, the resident contributes almost all of their monthly income toward the cost of care. What they keep is the Personal Needs Allowance (PNA), money reserved for the resident's own small expenses such as clothing, a haircut, or a phone bill. South Carolina raised its PNA to $60/month, effective October 1, 2025, up from the long-standing $30.
For an over-income resident, the income trust and the PNA work together: trust income pays toward care, while the $60 allowance and certain deductions (a spousal allowance, health-insurance premiums) come off the top. For the national picture on how the PNA is set, see our explainer on the Medicaid personal needs allowance.
Protecting the spouse who stays home
When one spouse needs long-term care and the other remains in the community, federal spousal-impoverishment rules keep the at-home spouse from being left destitute. This is where South Carolina diverges sharply from most of the country.
Most states use a federal range and let the community spouse keep up to $162,660 in countable assets in 2026. South Carolina does not. Under State Plan Amendment SC-25-0011, effective October 1, 2025, the state sets a single fixed Community Spouse Resource Allowance of $66,480. That's the most an at-home spouse can protect, period, and it's roughly $96,000 below the federal maximum many other states apply.
| Protection | South Carolina 2026 amount | Federal maximum (most states) |
|---|---|---|
| Community Spouse Resource Allowance (CSRA) | $66,480 (single fixed standard) | Up to $162,660 |
| Community Spouse Maintenance Needs Allowance | $4,066.50/month | $4,066.50/month |
| Home-equity limit | $752,000 | $752,000 |
The income side is more generous than the asset side. The community spouse may keep up to $4,066.50/month in income (the maintenance needs allowance), and income can be shifted from the applicant spouse to reach that floor. But on assets, a married South Carolina couple is in a notably tighter spot than a couple in a state that uses the federal CSRA range. If your countable assets sit between $66,480 and $162,660, that gap is real money, and it makes early planning worth a conversation with an attorney.
After death: estate recovery
Like every state, South Carolina runs a Medicaid estate-recovery program. After a recipient who was 55 or older and received long-term-care services dies, the South Carolina Department of Health and Human Services may seek repayment from the estate. Federal exceptions apply (a surviving spouse, or a minor, blind, or disabled child), and an undue-hardship waiver exists. For how estate recovery works and where families have room to plan, see our Medicaid estate recovery explainer.
How to apply in South Carolina
South Carolina Medicaid runs under the brand Healthy Connections, administered by the South Carolina Department of Health and Human Services (SCDHHS). There are three ways to apply:
- Online through the Healthy Connections portal at apply.scdhhs.gov.
- By phone at 1-888-549-0820.
- By paper application, submitted to SCDHHS.
Long-term-care applicants also go through a level-of-care screening to confirm they need nursing-facility-level services. If income runs over the $2,982 cap, get the Qualified Income Trust set up before or alongside the application, because South Carolina won't approve an over-income applicant without it.
Frequently Asked Questions
For nursing-facility and home- and community-based waiver coverage, the 2026 income limit is $2,982/month, equal to 300% of the SSI Federal Benefit Rate. South Carolina is an income-cap state, so an applicant whose gross income exceeds that figure must route the excess through a Qualified Income Trust to qualify.
Yes, for over-income applicants. Because South Carolina is an income-cap state with no medically needy spend-down for long-term care, an applicant earning more than $2,982/month can only qualify by establishing a Qualified Income Trust (also called a Miller Trust) and depositing the excess income into it each month.
$2,000 in countable assets for a single applicant, and $4,000 for a couple when both spouses apply. The home (up to $752,000 in equity), one vehicle, household goods, and a prepaid irrevocable burial arrangement are exempt from the count.
South Carolina sets a single fixed Community Spouse Resource Allowance of $66,480 in 2026, far below the $162,660 federal maximum most states use. The community spouse may also keep up to $4,066.50/month in income.
A Personal Needs Allowance of $60/month, raised from $30 effective October 1, 2025. The rest of the resident's monthly income goes toward the cost of care, after deductions for a community spouse and certain health-insurance premiums.
Learn More
- Medicaid Planning Strategies
- How Medicaid Estate Recovery Works
- The Medicaid Personal Needs Allowance, Explained
Find personalized help working through South Carolina Medicaid income limits and the income trust for your family at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.