Applying for South Carolina Medicaid requires an income trust if income tops $2,982/month, and SC's spousal asset protection is capped at $66,480 -- far below what most states allow. This guide walks through how to apply for South Carolina Medicaid through South Carolina Healthy Connections, the documents you'll need, and what to do if Medicaid denies your application.

In This Guide

Before You Apply: The Income Trust Requirement

South Carolina is an income-cap state. That means if your gross monthly income, from all sources combined, exceeds $2,982 in 2026, you cannot qualify for long-term care Medicaid -- not even by spending down on medical bills. There is no medically needy pathway for SC long-term care Medicaid.

The workaround is a Qualified Income Trust (QIT), commonly called a Miller Trust. Here's how it works: each month, you deposit income above the $2,982 cap into the trust account. That deposited income is then excluded from the Medicaid income test. The trust funds typically go toward your cost of care (your patient pay amount), and whatever remains at your death goes to the state as partial repayment.

Setting up a Miller Trust is not a DIY project. The trust document must meet specific state requirements, and a single error can cost you eligibility. If your income is anywhere near $2,982 -- or over it -- talk to a South Carolina elder law attorney before applying. The cost of getting it right is far less than the cost of a delayed or denied application.

If your income is under the cap, you can skip the trust and apply directly.

The Spousal Asset Warning Every Married Applicant Needs

When one spouse applies for nursing home or waiver Medicaid, federal law protects some of the couple's joint assets for the spouse who stays at home (the "community spouse"). That protection is called the Community Spouse Resource Allowance (CSRA).

Most states allow the at-home spouse to keep up to $162,660 in countable assets (the 2026 federal maximum). South Carolina does not use that range. Under State Plan Amendment SC-25-0011, SC sets a single fixed CSRA standard of $66,480. The community spouse keeps that amount, and the rest must be spent down to qualify the applicant.

For a couple with $200,000 in savings, the difference is significant. In a state using the federal maximum, the at-home spouse keeps $162,660 and the couple spends down only $37,340. In South Carolina, the at-home spouse keeps $66,480 and the couple must spend down $131,520.

Married couples need to account for this before applying. Legal strategies -- annuities, spousal refusal, care agreements, asset conversion -- may be available depending on your situation. An elder law attorney who practices in South Carolina can map out what applies to your case.

The community spouse income allowance (MMMNA) is $4,066.50 per month. If the at-home spouse's own income falls short of that amount, SCDHHS can redirect some of the applicant's income to the community spouse to make up the gap.

How to Apply for South Carolina Medicaid

South Carolina Healthy Connections gives you three ways to apply.

Online at apply.scdhhs.gov

Go to apply.scdhhs.gov to complete the application online. You can create an account, save your progress, and upload supporting documents through the portal.

For long-term care applications -- nursing home coverage or a home and community-based waiver -- the online portal may prompt you for additional information beyond what a basic community Medicaid application requires. Have your income documents and financial account statements ready before you start.

By Phone at 1-888-549-0820

Call 1-888-549-0820 to apply over the phone or to ask questions about the application. A representative can walk you through the process and help you understand what documents you'll need. If you need help gathering records or setting up a Miller Trust, ask the representative to note that in your file and give you additional time.

By Paper Application

Paper applications are available at local SCDHHS county offices. You can also request one by calling 1-888-549-0820. Complete the application, gather your supporting documents, and return the package to your county SCDHHS office.

For nursing home applicants, the facility's social worker can often help with the paperwork. They handle Medicaid applications regularly and know which documents the county office needs.

Not sure if you qualify? Talk to Brevy's care navigator at brevy.com for a free eligibility check.

What Documents You'll Need

Gather these before you apply. Missing paperwork is the most common reason applications stall.

Identity and residency:

  • Photo ID (driver's license, state ID, or passport)
  • Social Security card or proof of Social Security number
  • Proof of South Carolina residency (utility bill, lease, or similar)
  • Birth certificate or other proof of U.S. citizenship or qualified immigration status

Income:

  • Social Security award letter or current SSA-1099
  • Pension or retirement income statements
  • Any other income sources (annuities, rental income, etc.)
  • If income is over $2,982/month: the Miller Trust document itself, plus proof the trust is funded

Assets and financial accounts:

  • Bank statements for all accounts -- checking, savings, CDs -- for the current month and at least three prior months
  • Retirement account statements (IRA, 401(k), etc.)
  • Life insurance policies showing face value and cash surrender value
  • Vehicle title or registration
  • Property deeds and recent tax bills
  • Prepaid burial contracts and cemetery deed

For nursing home applicants:

  • The facility's admission paperwork or notice of admission date
  • Five years (60 months) of bank statements for asset-transfer review

Medical:

  • Medicare card (if applicable)
  • Health insurance card(s)

What Happens After You Apply

SCDHHS will review your application and may contact you for additional documents or a phone interview. The processing timeline for long-term care Medicaid in South Carolina is typically 45 days, though complex cases -- particularly those involving asset transfers -- can take longer.

SCDHHS looks back 60 months from your application date for any asset transfers made below fair market value. A transfer during that window triggers a penalty period: a stretch of time during which Medicaid won't pay for nursing home care. The penalty is calculated by dividing the transferred amount by the state's average daily nursing home cost. If you or a family member gave away assets or sold property for less than full value in the past five years, flag this with an elder law attorney before applying -- not after.

If you're approved, you'll receive a Medicaid ID card and a notice explaining what's covered, your patient pay amount, and the program you're enrolled in. In nursing home cases, the patient pay amount is your monthly income minus your Personal Needs Allowance of $60 and any allowed deductions.

If You're Denied

A denial notice will explain the reason and give you instructions for requesting a fair hearing. You typically have 30 days from the date of the notice to request one, though confirm the deadline on your specific notice.

To request a fair hearing, call 1-888-549-0820 or send a written request to SCDHHS. You can request to have the case reconsidered and present new or corrected information. If your denial was due to a missing document, you can sometimes resolve it by providing the document quickly rather than waiting for the full hearing process.

Get help. Most South Carolinians who appeal a Medicaid denial benefit from having someone in their corner. Options include:

  • South Carolina Legal Services: Free legal aid for income-eligible residents; can assist with Medicaid applications and appeals at sclegal.org
  • SHIIP (SC's SHIP program): Free Medicare and Medicaid counseling through the South Carolina Department on Aging; call 1-800-868-9095
  • Elder law attorneys: Particularly useful when the denial involves an income trust, asset transfers, or spousal issues; the South Carolina Bar referral service can help locate one

Have a specific question? Brevy's care navigator can help you figure out next steps at brevy.com.

Frequently Asked Questions

No. South Carolina does not offer a medically needy spend-down option for long-term care Medicaid. If your gross income exceeds $2,982/month, the only path to eligibility is a Qualified Income Trust (Miller Trust). There is no mechanism to subtract medical bills from income to get under the cap.

A Miller Trust -- formally a Qualified Income Trust or QIT -- is an irrevocable trust that holds excess income each month so it falls outside the Medicaid income test. You need one if your gross monthly income from all sources combined exceeds $2,982 in 2026. The trust must be drafted and signed before your application is approved, and it must meet SCDHHS requirements. An elder law attorney should set it up.

South Carolina sets a fixed Community Spouse Resource Allowance of $66,480. This is the amount the at-home spouse may keep in countable assets when one spouse applies for long-term care Medicaid. It is significantly lower than the federal maximum ($162,660 in 2026) used by most other states. Assets above $66,480 must be spent down for the applicant to qualify.

Exempt assets in South Carolina include your primary home (if a spouse, minor child, or disabled child lives there, or if you intend to return), one vehicle, household goods and personal effects, and prepaid irrevocable burial arrangements. The home equity limit for exemption is $752,000 in 2026.

SCDHHS reviews financial records for the 60 months (five years) before your application date. Any transfers of assets for less than fair market value during that window can trigger a penalty period. The penalty is a number of months during which Medicaid won't pay for nursing home care, calculated by dividing the uncompensated transfer amount by the state's average daily nursing home cost. Transfers to a spouse, a disabled child, or into certain types of trusts may be exempt.

Yes. Many applications come in after a resident is already placed. The nursing home's social worker or admissions coordinator can usually help with the paperwork. Apply as soon as possible -- Medicaid coverage generally won't start earlier than the month of application, so delays cost real money.

Learn More

Find personalized help applying for South Carolina Medicaid 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.

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Brevy Care Team

Expert eldercare guidance from Brevy's team of healthcare professionals and researchers.