South Carolina Medicaid Income Limits 2026: Eligibility

South Carolina Medicaid income limits come in two versions, and which one applies depends on why you need coverage. For long-term care in 2026, a single applicant's monthly income must be at or below $2,982, and an applicant over that line can still qualify by routing income through an Income Trust.1 For children, pregnant women, and parents or caretaker relatives, a different test applies instead: Modified Adjusted Gross Income (MAGI), written as a percentage of the poverty level, with no asset test at all.2,3

This guide covers both tests for South Carolina Medicaid (Healthy Connections): the 2026 long-term-care rules, including what the spouse at home is entitled to protect, and the 2026 MAGI limits.1,2

In This Guide

• South Carolina Medicaid income limits in 2026: the numbers that matter
• How South Carolina Medicaid income limits work: the income cap
• The income trust: how over-income applicants still qualify
• South Carolina Medicaid income limits under MAGI: the other income test
• The asset limit
• What a nursing-home resident keeps
• Protecting the spouse who stays home
• After death: estate recovery
• How to apply in South Carolina
• Frequently Asked Questions
• Learn More

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, 300% of the 2026 Supplemental Security Income (SSI) Federal Benefit Rate of $994, effective January 1, 2026.1,5

SCDHHS calls that limit the Medicaid Cap. An applicant whose income is over it may use an Income Trust, and South Carolina's approved State Plan recognizes people who had to set one up to become eligible.1 So a dollar over $2,982 is not the end of the road, but it does mean one extra legal step before coverage can start.

The income trust: how over-income applicants still qualify

The step is a Qualified Income Trust, also called a Miller Trust, which federal law authorizes for income-cap states.1 SCDHHS calls it an Income Trust: a special trust the applicant funds by depositing their income each month, and income that flows through it does not count toward the Medicaid Cap.1 Ask the eligibility worker how much has to go through the trust on your case. Federal law also requires that the state receive whatever is left in the trust at death, up to the total Medicaid paid on the person's behalf.1

Sign it early: the trust does not reach backward. SCDHHS's own form says eligibility cannot be established before the month the trust document is signed. Every month of delay is a month of nursing-facility or waiver care the trust cannot cover, and there is no way to recover it afterward. The applicant also has to appoint a trustee and cannot serve as their own.1

After that, income has to go into the trust every month.1 Getting the document and the deposits right is where an elder-law attorney earns their fee.

South Carolina Medicaid income limits under MAGI: the other income test

Everything above sits on the SSI-related aged, blind, and disabled (ABD) side of the system, and $2,982 is the right number only for someone seeking long-term care.1,5

The other test is MAGI, or Modified Adjusted Gross Income. It governs children, pregnant women, and parents or other caretaker relatives, and it is written as a percentage of the Federal Poverty Level (FPL) rather than a flat dollar cap. Household size under MAGI generally follows the federal income-tax household rather than who lives under the roof, so the same family can be counted differently on the two tracks. Generally, not always: CMS sets the tax-household rules aside entirely for someone who does not expect to file and will not be claimed as a dependent, and uses non-filer rules instead. You do not have to file a tax return to apply.6,3,2

Those percentages convert to dollars against the 2026 federal poverty guidelines: 100% of FPL is $15,960/year for one person and $33,000/year for a family of four in the 48 contiguous states and DC.7

Two sets of numbers, one standard. South Carolina's chart states these limits as gross percentages of FPL, before the 5-percentage-point MAGI disregard: 213% for children, 199% for pregnant women, 67% for parents and caretaker relatives. The medicaid.gov national table reports the same standards net of that disregard, so every figure there sits exactly 5 points lower. Neither source is wrong. Read the disregard narrowly, though: the rule applies it only when testing income against the highest MAGI standard available for the family size, not group by group, so do not assume it adds 5 points to whichever standard you are checking.8,2

South Carolina covers children up to age 19 through Partners for Healthy Children and runs CHIP as a Medicaid expansion rather than a separate program, which is why the separate-CHIP column reads N/A. Pregnant women and infants under age one qualify at 199% FPL gross, and that coverage continues for 12 months postpartum.2 Both figures sit well above the federal floor, which requires states to cover children under 19 at a minimum of 133% FPL.9

Parents and caretaker relatives: 67% of the poverty level

For readers of this guide, this is the pathway that matters before 65, and a grandparent raising a grandchild is the classic case. South Carolina covers the group at 67% of FPL gross, about $22,110 a year for a family of four against the 2026 federal poverty guidelines ($33,000/year for four). HHS publishes those guidelines as annual figures only, so treat any monthly version as your own arithmetic, and ask SCDHHS how it counts your income before concluding anything.2,7 Whether a particular grandparent, aunt, or older sibling meets the caretaker-relative definition is SCDHHS's call.

Why a standard can sit below the poverty line comes down to how federal law builds this group. Parents and caretaker relatives are federally mandatory, but unlike children (a floor of 133% FPL) and the ACA new adult group (effectively 138% FPL), they are covered at the state's own standard, set between a federal floor and a federal ceiling. The floor is the state's old AFDC cash-welfare income standard from May 1, 1988, converted to a MAGI equivalent, not a percentage of the poverty level, and in a non-expansion state like this one, the state-set standard is what decides whether a working parent qualifies. Read it off the SCDHHS chart for your household size.10,9,8

Adults without dependent children

South Carolina has not adopted the ACA Medicaid expansion, which created the new adult group: people under 65, not pregnant, and not enrolled in Medicare, with income up to an effective 138% FPL. In the 41 states including DC that adopted it, that group covers a low-income adult who is not disabled and has no dependent children. South Carolina is one of the 10 that did not, so there is no statewide expansion pathway here.8,2

That "No" is not quite the whole answer. The footnote attached to it on the national table records that South Carolina runs a section 1115 demonstration providing Medicaid to some additional low-income adults, with limits on who qualifies, what is covered, where it is offered, and how many may enroll. It is worth an application rather than an assumption.2 Short of that, adults below the poverty level can fall into the coverage gap: too much income for Medicaid, too little for Marketplace premium subsidies.2

The MAGI groups have no asset test

Federal law bars a state from applying any asset or resource test to the MAGI groups, and expressly excepts the SSI-related ABD and long-term-care pathways from that bar. So a parent or caretaker relative is judged on income alone: a savings account, a second vehicle, or an investment does not count against them at any amount, and the resource limits described elsewhere on this page never reach them.3

What changes at 65 in South Carolina

In an expansion state, turning 65 closes the new adult group, which is written for people under 65 who are not enrolled in Medicare.8 South Carolina has no such group, so the transition runs the other way here. At 65 the aged, blind, and disabled track opens on the basis of age, and for nursing-facility and waiver coverage the income test becomes 300% of the SSI Federal Benefit Rate of $994/month, or $2,982/month in 2026.5,1 A resource test appears too, the one federal law bars on the MAGI side.3,1

The asset limit

Get this figure from SCDHHS by name. The only resource limit SCDHHS states on a page we can cite is $9,950, and it belongs to the agency's Aged, Blind or Disabled coverage group, not to nursing-facility or waiver coverage. An applicant who takes $9,950 as the nursing-home limit will overstate what they may keep.1

For a married applicant, SCDHHS's Notice of Resource Assessments states that the spouse in the facility may keep up to $2,000 in countable resources. Where one spouse needs care and the other stays home, the couple's countable resources are totaled and the at-home spouse's protected amount is worked out under the federal spousal-impoverishment formula. The next section covers that amount.1

The home sits under a separate federal rule. Under 42 U.S.C. 1396p(f) the equity test does not apply at all while a spouse, a child under age 21, or a blind or permanently and totally disabled child lawfully lives in the home, whatever the house is worth. Where nobody in that list lives there, equity above the 2026 federal minimum of $752,000 bars long-term-care coverage, unless the state has elected a higher limit (up to $1,130,000). Being over it is not permanent: the same statute preserves the use of a reverse mortgage or home equity loan to bring equity below the line, and requires a waiver process for demonstrated hardship.11

The five-year look-back

Federal law has Medicaid review asset transfers made in the 60 months before a long-term-care application, counted back from the application, not from the transfer.1,11 Giving away money or property for less than fair market value inside that window, signing a house over to a child for a dollar or gifting a grandchild a down payment, can trigger a penalty period during which Medicaid won't pay for long-term care even after the applicant is otherwise eligible. There are real exceptions (transfers between spouses, to a disabled child, certain caregiver-child home transfers), but anything inside the five-year window deserves an attorney's review first.11 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, most of the resident's monthly income goes toward the cost of care. What they keep is the Personal Needs Allowance (PNA), money reserved for clothing, a haircut, a phone bill. South Carolina raised its PNA to $60/month, effective October 1, 2025, up from the long-standing $30, with $100 instead for a resident in a work-therapy program under the plan of care.1,3

Not everything above the $60 goes to the facility. South Carolina's approved State Plan deducts, on top of the allowance, the health-care expenses the resident incurs and no third party pays: Medicaid, Medicare, and other health-insurance premiums, deductibles, coinsurance, and copayments.1 Federal rules also require a maintenance allowance for a spouse or family still at home, and permit a home-maintenance allowance for up to six months where a physician certifies the resident is likely to return home. Ask for each one by name; they are subtracted, not volunteered.3 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.1,4

Under State Plan Amendment 25-0011, effective October 1, 2025, South Carolina elects a community-spouse resource standard of $66,480, which its own plan page describes as neither the federal minimum nor the federal maximum but an amount between the two.1 Under federal law, that standard is a floor, not a cap. Federal law makes the Community Spouse Resource Allowance the greatest of four amounts: the state's standard; the lesser of the spousal share (half the couple's countable resources at the start of institutionalization) or the 2026 federal maximum of $162,660; an amount set at a fair hearing; and an amount transferred by court order. The last two carry no dollar limit at all. Read by the statute alone, a couple with $260,000 in countable resources would protect the $130,000 half-share, not $66,480.4

SCDHHS's own form reads it the other way. Its Notice of Resource Assessments says the at-home spouse may retain up to $66,480 of the couple's countable assets and that everything above that limit is presumed available to the spouse in the facility. No SCDHHS source we have read shows the agency computing a half-share, so do not count on the larger figure. If your half-share is more than $66,480, ask SCDHHS to show its computation in writing, and know that the fair-hearing route exists.1,4

On the income side South Carolina elected the federal maximum outright: its State Plan sets the maintenance needs standard for every community spouse at $4,066.50/month, the ceiling §1924(d)(3)(C) permits, so income can be shifted from the applicant spouse up to that figure. The plan also preserves two other ways to set that allowance: at a fair hearing that finds exceptional maintenance needs, or at the amount of any court-ordered support.1,4 One catch rides with the fair-hearing route on assets: the mandatory "income first" rule requires the state to treat all of the institutionalized spouse's available income as made available to the community spouse before it allocates any extra resources, which narrows how often a hearing yields more.4

After death: estate recovery

After a recipient who was 55 or older when they received long-term-care services dies, SCDHHS may seek repayment of what Medicaid correctly paid from the estate.1 The survivor protections are a timing bar, not a permanent exemption: recovery may be made only after the death of a surviving spouse, and, in the statute's own words, only when the decedent has "no surviving child under age twenty-one or no child who is blind or permanently and totally disabled." SCDHHS describes this as a deferral: recovery waits while a protected survivor is living, and no source we have read says the claim is cancelled.12,1

South Carolina defines the recoverable "estate" by cross-reference to its Probate Code, which reaches the decedent's property and expressly names trust property. Do not assume a joint account, a transfer-on-death designation, or a funded trust puts an asset out of reach here; ask SCDHHS or an attorney about the specific asset rather than acting on a general rule.12

The hardship waiver is mandatory, and SCDHHS publishes three grounds. Recovery must be waived on proof of undue hardship, claimed by an heir or devisee. The grounds are a home of modest value (50% or less of the county average) still lived in by a sibling with an equity interest who was there a year before institutionalization, or by a child who was there two years and gave care that delayed it; the home and one acre where an immediate family member has lived two years, still lives there, owns no other real property (or agrees to sell it and give SCDHHS the proceeds), and has income at or below 185% of the poverty guidelines; and a sole income-producing asset whose loss would push such a family member below the poverty guidelines, or where that person agrees to pay SCDHHS all income above 185% of that line.12 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 as Healthy Connections, administered by SCDHHS. There are three ways to apply.1

Nursing-home and in-home care applicants use DHHS Form 3401. If income runs over the $2,982 cap, sign the Income Trust first: eligibility cannot start before the month it is signed.1

Where to get help

Learn More

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.