South Carolina Medicaid Guide 2026: Healthy Connections LTC

South Carolina Healthy Connections Medicaid covers long-term care through an income-cap system with a 2026 limit of $2,982 per month and a required Miller Trust for anyone over that cap.

South Carolina Medicaid is administered by the South Carolina Department of Health and Human Services (SCDHHS) under the name Healthy Connections. For an older adult seeking nursing facility or home and community-based coverage, two rules most often decide whether a plan works: the hard income cap with its Miller Trust requirement, and South Carolina's distinctive fixed spousal resource allowance. This guide maps every key question to the dedicated article that answers it, and points you to the exact next step.1

What South Carolina Medicaid Covers

South Carolina Healthy Connections Medicaid covers the mandatory federal benefit categories plus a set of state-elected optional services:

• Hospital care: Inpatient and outpatient
• Physician, clinic, and specialist visits
• Prescription drugs through the SCDHHS pharmacy benefit
• Behavioral health: Mental health and substance use disorder services
• Home health: Skilled nursing and home health aide services
• Long-term care: Nursing facility care and Home and Community-Based Services (HCBS) waiver services for people who meet the clinical level-of-care standard
• Medicare Savings Programs (MSPs): Premium and cost-sharing assistance for dual-eligible beneficiaries
• Non-emergency medical transportation (NEMT)

For seniors, long-term care is the most financially significant benefit. In South Carolina, a semi-private nursing home room runs about $108,405 per year and a private room about $115,340, according to the CareScout 2025 Cost of Care Survey. Medicaid covers that cost in full once a resident meets both the financial and the clinical eligibility standards.2

Who Qualifies for South Carolina Medicaid

South Carolina Medicaid Eligibility Overview

For seniors and people with disabilities seeking long-term care coverage, South Carolina is an income-cap state. The key 2026 financial parameters:1

• Asset limit: $2,000 for a single applicant; $3,000 for a married couple when both spouses apply. Countable assets exclude the primary home (subject to the equity cap), one vehicle, household goods, and prepaid burial.
• Income cap: $2,982/month, equal to 300% of the 2026 SSI Federal Benefit Rate of $994. This is a hard cap: an applicant whose gross income exceeds $2,982/month cannot qualify without a Miller Trust.
• Home equity limit: South Carolina applies the 2026 federal minimum home-equity limit of $752,000.1 The primary residence is exempt while a spouse lives there.1
• Miller Trust required: South Carolina does not operate a medically needy spend-down for long-term care. An applicant whose income exceeds $2,982/month must establish a Qualified Income Trust (also called a Miller Trust) and deposit the excess into it each month before Medicaid will pay for nursing facility or HCBS waiver services.

For example, an applicant with $3,400/month in Social Security and pension income sits $418 above the $2,982 cap. Each month, that $418 excess is deposited into the Miller Trust and directed toward the cost of care, which lets the applicant meet the income test while the trust handles the overage. Without the trust in place, SCDHHS cannot approve coverage.1

For full income limits, asset rules, and how the Miller Trust works in South Carolina, see South Carolina Medicaid Eligibility & Income Limits.

South Carolina Medicaid Long-Term Care

Nursing Facility Coverage

South Carolina Healthy Connections covers nursing facility care for eligible older adults who meet the clinical level-of-care standard and fall within the income and asset limits. Once eligible, the resident contributes most monthly income toward the facility, keeping a Personal Needs Allowance of $60/month, which SCDHHS raised from $30 effective October 1, 2025, plus enough to cover any Medicare premium for a dual-eligible resident.1

HCBS Waivers: Home and Community-Based Services

SCDHHS administers HCBS waivers that fund personal care, attendant care, adult day services, and other supports for people who would otherwise require nursing facility care. Waiver eligibility uses the same income-cap and asset standard as nursing facility Medicaid.1

The 5-Year Lookback and Transfer Penalties

South Carolina applies a 60-month (five-year) lookback to asset transfers made for less than fair market value before a long-term care application, following the federal rule under 42 U.S.C. § 1396p(c). Uncompensated transfers within that window create a penalty period of Medicaid ineligibility for long-term care services. An undue-hardship waiver is available where the penalty would deprive the applicant of necessary care.1

Estate Recovery

After the death of a recipient age 55 or older who received long-term care services, South Carolina pursues federally mandated estate recovery. Recovery reaches the probate estate only. Because South Carolina has not adopted the optional expanded-estate definition, assets that pass outside probate (joint accounts with right of survivorship, payable-on-death accounts, and named-beneficiary life insurance) are not reachable. A surviving spouse, or a surviving child under 21 or a blind or disabled child of any age, defers recovery entirely, and an undue-hardship waiver is available.3

See South Carolina Medicaid Estate Recovery for the full rules, exemptions, and hardship process.

South Carolina Medicare Savings Programs

South Carolina Medicaid administers three Medicare Savings Programs (MSPs) for low-income Medicare beneficiaries, using the standard federal income tiers and resource limits:4

These are the federal standards, not absolute cutoffs: states can effectively raise both the income and the resource limits by disregarding certain income and resources, so someone somewhat over should apply rather than rule themselves out. The difference between QMB and SLMB is what each pays: QMB covers the Part B premium and all Medicare cost-sharing (deductibles, coinsurance, and copays), and federal law bars providers from billing a QMB enrollee for any of it. SLMB and QI cover the Part B premium only and provide no other Medicaid benefit; QI also has to be applied for again every year. QMB enrollees are also automatically deemed eligible for Part D Extra Help. Apply through SCDHHS or the Social Security Administration.4

See South Carolina Medicare Savings Programs for full details on income disregards, the QMB billing prohibition, and how to apply.

Spousal Impoverishment Protections

South Carolina applies a notably different spousal rule from most states. Rather than the federal sliding-scale Community Spouse Resource Allowance, South Carolina sets a single fixed standard.1

Key 2026 figures:

• Community Spouse Resource Allowance (CSRA): Fixed at $66,480 (effective October 1, 2025, under State Plan Amendment SC-25-0011). In most states the CSRA can range up to the federal maximum of $162,660; South Carolina caps it at $66,480.1
• Monthly Maintenance Needs Allowance: Up to $4,066.50/month in income the community spouse may keep (the federal maximum, effective January 1, 2026), with a federal floor of $2,705.00.5
• Home: Exempt from the eligibility calculation while either spouse lives there.

The fixed $66,480 CSRA is the single biggest planning difference for South Carolina couples, because it caps the community spouse's protected assets far below the level most states allow. See South Carolina Spousal Impoverishment Protections for how the snapshot process works.1

How to Apply for South Carolina Medicaid

Applying for South Carolina long-term care Medicaid follows a defined sequence. Gather your paperwork first, then submit through one of the agency pathways.

See How to Apply for South Carolina Medicaid for a full walkthrough and document checklist.

If South Carolina Medicaid Denies or Cuts Your Coverage

A denial is not the end of the road, and the deadline to challenge it is usually shorter than people expect.

Federal law guarantees every Medicaid applicant and beneficiary the right to a fair hearing before the state agency, whether the dispute is about eligibility or about a specific service being reduced or ended.6 South Carolina notices give 30 days to appeal, measured from either the date of the notice or the day you receive it, depending on the notice, so read yours to see which of the two triggers applies.7 South Carolina's deadline is 30 days, not 90: the 90 days in 42 CFR 431.221(d) is the ceiling on how long a state's window may run, not a floor you are owed, and the shorter state deadline is fully enforceable against you.7

A second and earlier deadline matters more if you are already enrolled. To keep existing benefits or services running while the appeal is decided, ask for continuation within 10 days of the date on the notice.7 Federal law ties that protection to requesting the hearing before the date the action takes effect, and if you lose, disputed benefits paid during the appeal may have to be repaid.8 Miss the 10-day window and you may still appeal, but coverage can stop in the meantime.

When an adverse notice arrives, find both dates on it, and request the hearing in writing before the earlier one. See South Carolina Medicaid Appeals and Fair Hearings for how to file, what the hearing itself involves, and what happens after a decision.

Keeping South Carolina Medicaid Once You Have It

Eligibility is re-checked on a recurring cycle, and missing that step is one of the most common ways people lose coverage they still qualify for.

Before it can ask you for anything, South Carolina Medicaid must first try to renew your coverage automatically from information it already holds, and may only request documents if it cannot.9 If it does need paperwork, it must send a renewal form and give you at least 30 days from the date of the form to return it. That duty, and the 90-day reconsideration window below, cover eligibility based on modified adjusted gross income (MAGI). If you qualify through age, disability, long-term care, a Medicare Savings Program, or the medically needy pathway, South Carolina may offer the same windows but is not required to, so ask SCDHHS what applies to you.9

If coverage does close because a form went unreturned, that is not the end of it. Federal rules require the agency to reconsider your eligibility without a new application if you return the renewal form within 90 days of the termination (required for MAGI-based coverage; a state option otherwise).9

Keep your address current, open anything from South Carolina Medicaid, and return a renewal form the week it arrives. See South Carolina Medicaid Recertification and Renewal for the full cycle and how to recover coverage that has already closed.

Where to Get Help

South Carolina Medicaid FAQ

Learn More

Find personalized help with South Carolina Medicaid and Healthy Connections 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.