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.

This guide walks through how South Carolina Medicaid nursing home coverage works in 2026: who qualifies medically and financially, the income trust an over-cap applicant has to set up, what you keep versus what goes to the facility each month, and South Carolina's unusual single-standard spousal asset rule that protects the at-home spouse differently from almost every other state.

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 after a qualifying inpatient hospital stay of at least three consecutive days, and those days are not all free: days 1 through 20 are covered in full, days 21 through 100 carry a daily coinsurance of $217 in 2026, and after day 100 Medicare pays nothing.2 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, or $9,950 if that person can qualify under South Carolina's aged, blind, or disabled (ABD) criteria. Ask your eligibility worker which of the two limits SCDHHS is applying to your case before you spend down to the lower one. There is no separate couple limit: where one spouse stays at home, SCDHHS totals the couple's countable resources, subtracts the community spouse's share of up to $66,480, and the remainder has to meet the applicant's own $2,000 or $9,950 limit.1

Some assets don't count toward that limit:

• The primary residence. It is excluded regardless of equity value when a spouse, a child under 21, or a blind or disabled child lawfully lives in the home. Otherwise, an applicant with home equity over $752,000 in 2026 is not eligible for nursing-facility vendor payment or other long-term-care services.1
• One vehicle.
• Household goods and personal effects.
• Up to $1,500 each in designated burial funds, for the applicant and for the applicant's spouse.1

South Carolina applies a 60-month look-back to uncompensated transfers, 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. SCDHHS's eligibility manual instructs its long-term-care workers that when an applicant's income exceeds the Medicaid Cap, the only way to qualify for Medicaid is to set up an Income Trust, commonly called a Miller Trust or Qualified Income Trust. The applicant funds it by depositing their income into a dedicated trust account each month; income that flows through the trust does not count toward the Medicaid Cap, and there is no upward income limit for Income Trust cases. The money still goes toward your care; it just routes through the trust so you stay eligible. An elder-law attorney typically sets one up, and it has to be in place before coverage starts.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 insurance premiums the resident pays, such as a Medigap policy. Read this deduction narrowly: SCDHHS's manual states it does not include Medicare Part A and Part B premiums, so a dual-eligible resident should not expect a Part B premium to come off their patient liability.1
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 applies these protections, but it handles the asset side in a way that sets it apart from nearly every other state.3

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. Federal law sets a range for 2026, from $32,532 up to $162,660, and lets each state elect a standard inside it.3 Rather than electing the maximum the law permits, South Carolina's approved State Plan sets a single fixed standard of $66,480 (SPA TN 25-0011, approved March 16, 2026, effective October 1, 2025), and SCDHHS subtracts the community spouse's share of up to that amount from the couple's total countable resources.1
• 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 allowance may not exceed it.1,3

That fixed $66,480 figure is the single most important thing for a married couple to understand here. In a federal-range state, a community spouse with a sizable joint estate can sometimes protect well into six figures. In South Carolina, the at-home spouse's protected amount is capped at $66,480 no matter how much the couple has, so couples with more than that have more to plan around.1 See South Carolina spousal impoverishment protections for the full framework.

Estate Recovery After Nursing Home Care

After a Healthy Connections recipient who received long-term care dies, federal law requires South Carolina to try to recover what it spent from the person's estate. SCDHHS runs this through its estate recovery program.

Recovery applies only to recipients who were 55 or older when they received long-term-care services, and it works through the deceased person's estate after death, never during the resident's lifetime. The home is an exempt asset while the resident is alive; recovery is a post-death question.1 Federal 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 disabled, at any age.
• Recovery must be waived on proof of undue hardship, asserted by an heir or devisee of the property being claimed, for example a family member who depends on the home.

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.