South Carolina Medicaid Nursing Home Coverage 2026

South Carolina Medicaid pays for nursing home care through Healthy Connections, the state's Medicaid program, once Medicare's short rehabilitation window runs out.

For a married couple, the number to watch is South Carolina's elected $66,480 spousal resource standard: the federal formula treats it as a floor on what the at-home spouse keeps, but SCDHHS's own notice form words it as a cap, so get the agency's calculation in writing.1

In This Guide

• Does South Carolina Medicaid Pay for Nursing Home Care?
• Medical Eligibility (Level of Care)
• Financial Eligibility: Assets and Income
• What You Pay: Patient Liability
• Protecting the At-Home Spouse
• Estate Recovery After Nursing Home Care
• How to Find a South Carolina Medicaid Nursing Home
• Frequently Asked Questions
• Learn More

Does South Carolina Medicaid Pay for Nursing Home Care?

It does. Medicaid is the only public program that pays for long-term custodial nursing home care in any meaningful way, and in South Carolina that program is Healthy Connections, run by the South Carolina Department of Health and Human Services (SCDHHS). Medicare Part A covers up to 100 days of skilled nursing care per benefit period, generally after a qualifying inpatient hospital stay of at least three consecutive days, and those days are not all free: days 1 through 20 cost $0 a day once the $1,736 Part A deductible is paid (most people have already paid it for the hospital stay in the same benefit period), days 21 through 100 carry a daily coinsurance of $217 in 2026, and after day 100 Medicare pays nothing.4 Custodial care, the day-to-day help with bathing, dressing, eating, and moving that most nursing home residents need long-term, is not something Medicare pays for. That's the gap Healthy Connections fills.

For a resident who qualifies, Healthy Connections pays the nursing facility directly for covered care.1 The resident contributes most of their own income, the patient liability explained below, and Medicaid covers the difference between that contribution and the facility's Medicaid rate. South Carolina applies one set of eligibility requirements to nursing facility care and to its home and community-based waiver services, so the financial test below is the same whichever setting you end up in.1 If you meet the clinical and financial criteria, the coverage is there.

What Healthy Connections pays for inside the facility:

• Room and board.
• Nursing care and help with daily activities.
• Prescription drugs.
• Physician services, therapies, and medical supplies covered under the daily rate.
• Medically necessary transportation.

To get there, an applicant has to clear two separate tests: a medical one and a financial one.

South Carolina Medicaid Nursing Home Medical Eligibility (Level of Care)

Before Healthy Connections pays for a nursing home, the resident has to need that level of care. South Carolina uses a level-of-care determination to confirm the person requires the kind of skilled or custodial care a nursing facility provides, rather than care that could safely be delivered at home or in assisted living.1

In practice, this means the resident needs ongoing nursing supervision or hands-on help with several activities of daily living, things like transferring in and out of bed, toileting, eating, and managing medications. A physician documents the need, and the facility's admission process and the resident's medical records support it. Most older adults entering a nursing home directly from a hospital stay, after a stroke, a serious fall, or advancing dementia, clear this bar without difficulty.

If the person's needs are real but could be met at home, the better fit may be one of South Carolina's home- and community-based waiver programs, such as the Community Choices waiver, rather than institutional Medicaid. Those programs apply the same spousal protections discussed below, which is worth knowing before you assume a nursing home is the only option.

Financial Eligibility: Assets and Income

This is where most families get stuck. There are two limits, and they work very differently.

The asset limit

A nursing-home or waiver applicant is limited to $2,000 in countable assets.2 Where one spouse stays at home, the couple's countable resources are totaled under the federal spousal-impoverishment formula, the at-home spouse's resource allowance is set aside, and SCDHHS's own notice says the spouse in the facility may keep up to $2,000 in countable resources.1,2 Under the federal formula, that allowance starts at South Carolina's $66,480 standard and rises to half the couple's countable resources wherever half is more, up to $162,660, but SCDHHS's notice form treats $66,480 as a cap (see Protecting the At-Home Spouse).1,5

Some assets don't count toward that limit:

• The home, up to an equity limit. Federal law bars long-term-care assistance when home equity is over a limit that starts at $752,000 in 2026 and that a state may raise to as much as $1,130,000, so ask SCDHHS which figure South Carolina applies. The limit does not apply at all when a spouse, a child under 21, or a blind or disabled child lawfully lives in the home, and an applicant over it can bring the equity down with a reverse mortgage or home equity loan.3
• Certain personal property, which South Carolina sets by its own policy rather than by the federal rules above. Ask your eligibility worker which exclusions apply to your case and what the current dollar limits are, because these are not safe to assume from a general chart.

Under 42 U.S.C. 1396p(c)(1)(B)(i), a 60-month look-back applies to assets disposed of on or after February 8, 2006, so gifts or below-market transfers made in the five years before applying can trigger a penalty period. That's worth planning around well before an application.1

The income cap and the income trust

South Carolina sets the institutional Medicaid income limit at 300% of the SSI Federal Benefit Rate, which is $2,982 per month in 2026.1

The income cap works differently from the asset limit, and it catches people off guard. South Carolina is a true income-cap state: if your gross monthly income is even a dollar over $2,982, you don't simply pay more, you're over the cap and ineligible until you fix it. The fix SCDHHS publishes is an Income Trust, which it describes as a special trust an applicant or beneficiary funds by depositing their income each month. Income that flows through the Income Trust does not count toward the Medicaid Cap, and South Carolina's approved State Plan recognizes the route, granting additional personal-needs deductions for individuals who were required to establish an income trust in order to become eligible for Medicaid.1 The money still goes toward your care; it just routes through the trust so you stay eligible.

Sign the trust early, because it is not retroactive. SCDHHS's Income Trust form states that eligibility cannot be established prior to the month the trust document is signed, so it is important to complete the document as soon as possible: every month of delay is a month of nursing-facility care the trust cannot cover. SCDHHS also requires the applicant or beneficiary to appoint a trustee, and states that they cannot serve as their own trustee, so an elder-law attorney typically sets one up.1

For a full walk-through of the income standards and exempt assets, see South Carolina Medicaid eligibility and income limits.

What You Pay: Patient Liability

Once a resident is approved, the question becomes how much of their income goes to the facility each month. South Carolina calls the resident's contribution patient liability (sometimes "applied income"), and the math runs in a fixed order.

Start with the resident's gross monthly income. Subtract, in order:

1. The personal needs allowance, $60 per month in South Carolina (raised from $30 effective October 2025), which the resident keeps for personal expenses like haircuts, clothing, and toiletries. A resident taking part in a work-therapy program as part of their plan of care is allowed $100 instead.1
2. Health-care expenses the resident incurs that no third party pays. South Carolina's approved State Plan states this deduction as "Medicaid, Medicare, and other health insurance premiums, deductibles, or coinsurance charges, or copayments," which on its face covers a Medigap premium and a Medicare Part B premium alike.1 Ask SCDHHS to confirm in writing which of your premiums it is deducting, because that figure moves your patient liability dollar for dollar.
3. A monthly maintenance allowance for an at-home spouse, if there is one (covered in the next section).

Whatever remains is the patient liability the resident owes the facility. Medicaid pays the rest of the facility's Medicaid rate. In practice, a resident whose only income is Social Security pays nearly all of it to the facility, keeps the $60 personal needs allowance, and never goes without that set-aside.1

Protecting the At-Home Spouse

When one spouse enters a nursing home and the other stays in the community, federal spousal-impoverishment rules keep the at-home spouse from being left destitute. South Carolina's approved State Plan attests that it follows those federal rules, but on the asset side SCDHHS's own notice form and the federal formula don't line up, which makes this the part of the application to get in writing.1

Two protections do the heavy lifting:

• The Community Spouse Resource Allowance (CSRA) lets the at-home spouse keep a share of the couple's countable assets. For 2026, federal law sets a minimum resource standard of $32,532 and a maximum of $162,660, and each state elects its standard inside that range.5 Rather than electing the maximum the law permits, South Carolina's approved State Plan elects a standard of $66,480 (SPA TN 25-0011, approved March 16, 2026, effective October 1, 2025).1 Under the federal statute, that standard is the State-plan amount at clause (i) of the greatest-of rule in 42 U.S.C. 1396r-5(f)(2)(A), and the allowance itself is the greatest of four amounts: the $66,480 standard; half the couple's countable resources up to the $162,660 federal maximum; an amount set at a fair hearing; or an amount transferred by court order. On the statute's terms, then, $66,480 is a floor rather than a cap.1,5
• The monthly maintenance needs allowance lets income shift from the nursing-home spouse to the at-home spouse. South Carolina sets its community-spouse maintenance standard at the maximum federal law permits, and that maximum is $4,066.50 per month in 2026. The standard allowance may not exceed it, but a fair hearing that finds exceptional circumstances causing significant financial duress, or a court order of support, can set it higher.1,5

That $66,480 figure is where South Carolina's own paperwork and the federal formula part ways. SCDHHS's Notice of Resource Assessments (DHHS Form 3227ME) says the at-home spouse may retain up to $66,480 of the couple's countable assets, and that everything above that limit will be presumed available to the spouse in the facility. We have not found an SCDHHS source showing the agency computing a half share above $66,480, so don't assume a larger half share will be protected in practice. If half of your countable resources comes to more than $66,480, ask SCDHHS to show you in writing how it computed the allowance. The statute's fair-hearing and court-order routes carry no dollar limit, though the fair-hearing route first counts the nursing-home spouse's available income as going to the at-home spouse before it allows more in assets.1,5 See South Carolina spousal impoverishment protections for the full framework.

Estate Recovery After Nursing Home Care

After certain Healthy Connections members die, South Carolina recovers what Medicaid paid for their care, for services received July 1, 1994, or later, from their estates. SCDHHS runs this through its estate recovery program.1

Recovery applies to two groups: a member who was 55 or older when they received nursing-facility care, home and community-based services, or related prescription and hospital services; and a member of any age who was living in a nursing facility or other long-term-care facility at death and was paying most of their monthly income toward the cost of care. It works through the deceased person's estate after death, never during the member's lifetime.1 Protections still apply:

• No recovery while a surviving spouse is alive.
• No recovery while a surviving child is under 21, or is blind or permanently and totally disabled, at any age.
• Recovery must be waived on proof of undue hardship.

Because estate recovery and the rules for protecting a home can get technical, this is a conversation worth having with an elder-law attorney before a parent enters a facility. For the full mechanics, see South Carolina Medicaid estate recovery.

How to Find a South Carolina Medicaid Nursing Home

Most nursing homes in South Carolina are certified to accept Healthy Connections, but quality varies widely, and that's the choice that matters most. Two free tools should drive it: Medicare Care Compare, which rates every certified facility, and South Carolina's long-term care ombudsman, which places advocates across the state who often know things a survey report doesn't show.

Questions worth asking any facility you're considering:

• How many Healthy Connections beds do you currently have open?
• What's your current five-star rating, and have you had deficiencies in the past year?
• What's your staffing ratio on day, evening, and overnight shifts?
• Will you accept a "Medicaid pending" admission, and how do you bill during the application period?

Learn More

Find personalized help mapping a South Carolina Medicaid nursing home application 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.