Missing a renewal can end your South Carolina Medicaid coverage even if you still qualify. Federal law requires South Carolina Healthy Connections to try to renew you automatically from data it already holds before it asks you for a single document, but when a renewal packet does reach you, it has to come back on time. This guide explains how the South Carolina Medicaid recertification and renewal cycle works, what to do when your packet arrives, and the 90-day window to recover coverage if you miss the deadline.

Renew online at apply.scdhhs.gov · Appeal a closure through the SCDHHS Office of Appeals and Hearings

Eligibility is set once at your initial application to the Medicaid program, but under 42 CFR 435.916 it is redetermined every 12 months afterward. When coverage closes at renewal, the person very often still qualified and simply did not return the packet in time, which is exactly what the 90-day reconsideration window below is built to fix.

In This Guide

How the South Carolina Medicaid Renewal Cycle Works

Under 42 CFR 435.916, the South Carolina Department of Health and Human Services (SCDHHS), the single state agency that runs Healthy Connections, must redetermine eligibility at least every 12 months. That 12-month interval is also a ceiling for MAGI-based coverage, but for beneficiaries who qualify on the basis of age, blindness, disability, or long-term care it is only a floor: the state may redetermine more often. Your renewal month is fixed when you are first approved and recurs in that calendar month each year.

Renewals split into two procedural paths depending on your eligibility category:

  • MAGI populations (children in Partners for Healthy Children, pregnant women, and low-income parents or caretaker relatives): renewed using Modified Adjusted Gross Income methodology. In South Carolina, children qualify with family income at or below 213% of the federal poverty level, pregnant women at or below 199%, and parents or caretaker relatives at or below 67%. Income is verified through the federal data hub, which includes Social Security Administration records, Internal Revenue Service tax data, and available electronic wage data.
  • Non-MAGI populations (aged, blind, and disabled, long-term care, the Community Choices HCBS waiver, and Medicare Savings Programs): renewed under a framework that includes an asset test. The state still attempts an automatic renewal, but because federal law requires the state to verify assets at renewal through an electronic Asset Verification System (Section 1940 of the Social Security Act, 42 U.S.C. 1396w), expect a request for bank statements, retirement and life insurance records, and a signed financial-records authorization. Refusing or revoking that authorization is itself a ground to find you ineligible.

South Carolina has not adopted the Affordable Care Act Medicaid expansion, so there is no statewide MAGI pathway for non-disabled, childless adults. That is not the same as no coverage at all: medicaid.gov footnotes South Carolina's "No" to a section 1115 demonstration that reaches some additional low-income adults, subject to its own eligibility, benefit, geographic and enrollment-cap limits. Ask SCDHHS before concluding you have no route.

Ex Parte South Carolina Medicaid Renewal: The Federal Mandate

The single most important federal rule in modern Medicaid renewal is the ex parte default at 42 CFR 435.916(a)(2). Before it asks a beneficiary for any information, the agency must make a redetermination without requiring information from the individual whenever it can do so from reliable data already in the person's account or otherwise available, including electronic data sources. Only when it cannot renew on that basis may it request information from the enrollee.

In South Carolina, ex parte renewal pulls from Social Security earnings, retirement, SSDI, and SSI records; tax filings; available wage and unemployment data; Medicare entitlement data; and your own record from the prior cycle. If those sources confirm your income and household have not changed, the renewal processes automatically and a notice states that coverage continues for another 12 months and no action is required.

Ex parte does not clear everyone. The most common reasons it fails:

  • Asset verification gap: aged, blind, disabled, and long-term care renewals need asset documentation and a signed authorization that automated data cannot supply
  • Income that data cannot see: self-employment, gig work, cash income, and seasonal work do not appear in wage databases
  • Household changes or income near the cutoff: a new baby, a move, marriage, or divorce needs documentation, and income close to the limit triggers a manual review

When ex parte fails, the state must send a renewal form with the information the agency already has, and must give the beneficiary at least 30 days from the date of the renewal form to respond, provide missing information, and sign it. The clock runs from the form's date, not the day it arrives. 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 follow the same procedures but is not required to, so ask SCDHHS which deadlines apply. SCDHHS mails packets ahead of the renewal month so the clock closes before coverage would lapse.

How to Renew Your South Carolina Medicaid

Under 42 CFR 435.916, a renewal may be submitted through any channel the agency offers, and the agency may not require an in-person interview to renew. In South Carolina that means online, by phone, by mail, and in person.

Channel Where Notes
Online apply.scdhhs.gov Fastest; create an account, upload documents, check status; recommended
Phone Healthy Connections member line (number on your renewal notice) A representative can complete the renewal and request a replacement packet
Mail Return the signed packet to the address printed on it Allow several days for delivery and processing
In person Local SCDHHS county eligibility office Staff can provide and accept the renewal form

The portal at apply.scdhhs.gov is the same system you used to apply; create an account with your name, date of birth, and the Medicaid case number from any notice.

The 90-Day Reconsideration Window After a Missed Renewal

If your coverage closed because you missed the renewal paperwork, you usually do not have to start over.

Under 42 CFR 435.916, if a beneficiary loses Medicaid for failure to return the renewal form (a procedural termination, not an eligibility-based one), the agency must reconsider eligibility and treat the late-returned form as the renewal if it is submitted within 90 days of the termination, without requiring a new application (required for MAGI-based coverage; a state option otherwise). If you are found still eligible, your coverage is restored.

In practice: if your renewal closed on June 30, you have until roughly September 28 to submit the missing paperwork. The clock runs from the termination date, not the notice date, so read the closure notice carefully; whether the window is open to you turns on the termination type, compared below.

To use it, submit the renewal form through any channel above. If you no longer have the form, log into apply.scdhhs.gov or call the member line for a new packet, noting your closure date so SCDHHS routes the case correctly.

Children's 12-Month Continuous Eligibility

Section 5112 of the Consolidated Appropriations Act, 2023 amended the Social Security Act to require every state to give children under age 19 in Medicaid or CHIP 12 months of continuous eligibility from the date of enrollment, effective January 1, 2024. In South Carolina, children are covered through Partners for Healthy Children, the state's Medicaid-expansion CHIP, at family income up to 213% of the federal poverty level.

Once a child is enrolled, coverage is locked in for 12 months regardless of changes in family income. If a parent loses Medicaid mid-year because income rose above the 67%-of-poverty parent limit, the children stay covered until their next renewal (narrow exceptions: turning 19, moving out of state, voluntary disenrollment). Report a rising income anyway: accurate reporting protects you from later fraud allegations, and your children keep coverage either way.

Pregnant Women and 12-Month Postpartum Coverage

South Carolina covers pregnant women with income at or below 199% of the federal poverty level, and that coverage continues for a full 12 months after the end of pregnancy, regardless of income changes. The 12-month postpartum extension is a permanent state option created by the American Rescue Plan Act of 2021 and made permanent by the Consolidated Appropriations Act, 2023. The standard annual renewal cycle resumes after that period ends.

Long-Term Care and Waiver Renewals

If you receive Medicaid long-term care (a nursing facility stay or the Community Choices HCBS waiver), your renewal has two independent components, and both must stay current.

Financial redetermination

SCDHHS reviews your income and assets on the annual 12-month cycle, including the asset test federal law requires the state to run at renewal through the Asset Verification System. This review confirms:

  • Income against the cap: South Carolina is an income-cap state, with a long-term care income limit of $2,982 per month in 2026 (300% of the SSI Federal Benefit Rate). Income above the cap must flow through an Income Trust (Miller Trust) each month for eligibility to continue, and the trust is not retroactive: eligibility cannot be established before the month the trust document is signed, so a month's delay in signing is a month of nursing-facility care you pay for yourself.
  • Assets against the limit: verified through bank, retirement, and life insurance records plus a signed AVS authorization. SCDHHS publishes no countable-resource limit for the nursing-facility and waiver group on a citable page (the $9,950 it does publish is its Aged, Blind or Disabled limit, not this one), so confirm your limit with SCDHHS.
  • Community Spouse Resource Allowance: $66,480 is the resource standard South Carolina feeds into the federal spousal-impoverishment formula. It is a floor on what an at-home spouse may keep, not a ceiling.
  • Patient pay amount: your monthly income minus the $60 Personal Needs Allowance and any allowed deductions.

Level of care reassessment

Run by SCDHHS through its Community Long Term Care (CLTC) division, this review confirms you still meet the nursing facility level of care that the Community Choices Waiver and institutional Medicaid both require. It looks at your activities of daily living, cognitive function, and medical complexity.

The two reviews are independent: you can pass one and fail the other. If level of care is not approved, long-term care Medicaid ends, but you may continue on standard aged, blind, and disabled Medicaid if otherwise eligible.

Managed Care and Returned Mail

Most Healthy Connections members receive their benefits through a Medicaid Managed Care Organization (MCO). SCDHHS partners with five: Absolute Total Care, BlueChoice (Healthy Blue), Humana Healthy Horizons, Molina, and Select Health (First Choice).

The federal rule that required an agency to search for a new address before acting on returned mail, 42 CFR 435.919, was removed effective July 31, 2026. Federal law now says only that the agency may act without advance notice when your whereabouts are unknown (42 CFR 431.213(d)), and that coverage must be reinstated if your whereabouts become known while you are still eligible (42 CFR 431.231(d)). South Carolina may still have its own procedures, so if your packet was returned as undeliverable, call the Healthy Connections member line and ask where your case stands.

To avoid a returned-mail delay after you move, update your address at apply.scdhhs.gov (or by calling that same member line), update it with your MCO, and file a Postal Service change-of-address form.

Procedural vs Eligibility-Based Termination

This distinction decides whether you have a 90-day reconsideration window under 42 CFR 435.916 or must file a new application.

Termination type What it means Reconsideration available?
Procedural Failure to return the renewal form, missing signature, no documentation, or no response to a request for information Yes, within 90 days of the termination date
Eligibility-based SCDHHS determined you no longer meet income, residency, citizenship, or categorical rules No; file a new application (or appeal the finding)

Read the stated reason on your closure notice. "Failure to provide requested information" or "no response to renewal" means the 90-day window is open; an income calculation, an asset limit, or a categorical change means your remedy is a new application or an appeal.

Appeal Rights When Coverage Ends

If your renewal is denied or your coverage is terminated, you have a federal right to a fair hearing under Section 1902(a)(3) of the Social Security Act and 42 CFR 431.220. In South Carolina, these appeals are decided by the SCDHHS Office of Appeals and Hearings.

Two South Carolina specifics matter most:

  • The deadline is shorter than the federal ceiling. Federal law caps the request window at 90 days from the date the notice is mailed. That 90 days is the most a state may allow, not a minimum you are owed: a shorter state deadline is fully enforceable against you. South Carolina notices set the filing deadline at 30 days, so go by the date printed on your notice of action and do not wait. File eligibility appeals online at scdhhs.gov/appeals, by phone at 888-549-0820, by fax, mail, or email; the hearing itself is in person before a hearing officer, not by telephone.
  • Keep your coverage during the appeal by acting within 10 days. Federal law continues benefits during an appeal if the agency sent the required advance notice and you request the hearing before the action takes effect. If you are already past that date, ask anyway: a separate federal rule, 42 CFR 431.231, lets the agency reinstate services when you request a hearing no more than 10 days after the date of action. In South Carolina, request continued benefits within 10 days of the date on the notice; disputed benefits may have to be repaid if the hearing officer upholds the closure.

If the decision came from your MCO rather than SCDHHS eligibility, work through the health plan's internal appeal process before filing with the Office of Appeals and Hearings.

Special Populations and Renewal Nuances

Medicare Savings Program renewals. Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary, and Qualified Individual eligibility is redetermined on the same 12-month non-MAGI cycle, with ex parte attempted first. Keeping your MSP through renewal also keeps automatic "deemed" eligibility for the Medicare Part D Low-Income Subsidy (Extra Help); losing MSP ends deemed status and requires a separate Extra Help application.

Refugees and qualified immigrants. When the agency cannot promptly verify a declared citizenship or satisfactory immigration status at renewal, federal law (42 CFR 435.956) requires a reasonable opportunity period, generally ending the earlier of verification or 90 days, during which the agency may not delay, deny, reduce, or terminate benefits for someone it otherwise finds eligible.

What Changes After 2026: The Move to 6-Month Renewals

The COVID-19 continuous-enrollment requirement ended in 2023, and the unwinding redeterminations ran through 2024. What matters now is a newer federal change.

Section 71107 of the 2025 federal budget-reconciliation law (H.R.1, Public Law 119-21) requires states to redetermine eligibility once every 6 months, rather than every 12 months, for the ACA expansion-adult population, for renewals scheduled on or after January 1, 2027. Its only exemption covers an Indian or Urban Indian as defined in the Indian Health Care Improvement Act, a California Indian, and anyone otherwise determined eligible as an Indian for the Indian Health Service, on the state's own determination. Everyone else falls outside the provision rather than being excused from it, and stays on the 12-month cycle. Because South Carolina has not adopted ACA expansion, it has no expansion group for this to reach, but it signals a national move toward more frequent renewals.

The same law also shortens retroactive eligibility for applications filed on or after January 1, 2027, to two months before the application month for most enrollees and one month for the expansion group, down from the long-standing three-month default. Three months is the federal outer boundary, not a guarantee: the exact effective date inside it is a state-plan choice, and a demonstration waiver can shorten a state's window, so confirm South Carolina's with SCDHHS.

Common South Carolina Medicaid Renewal Mistakes

  1. Ignoring the renewal packet because it looks like junk mail. Pull anything from SCDHHS or Healthy Connections out of the mail pile and open it, and return a manual packet by the deadline printed on it.
  2. Updating your address with Social Security or your MCO but not with SCDHHS. Update it at apply.scdhhs.gov and with your MCO.
  3. Not knowing the 90-day reconsideration window exists. A procedural closure can be reconsidered within 90 days with no new application (required for MAGI-based coverage; a state option otherwise), and coverage restored if you are still eligible.
  4. Missing the AVS signature for ABD or long-term care. Without your signed asset-verification authorization, SCDHHS cannot run the bank-record check and the renewal stalls.
  5. Waiting too long to appeal. South Carolina notices set a 30-day filing deadline, and continued benefits require a request within 10 days of the notice date.

Frequently Asked Questions

How often do I have to renew South Carolina Medicaid?

Once every 12 months for most beneficiaries. Your renewal month is tied to your initial approval date and stays the same each year. Under 42 CFR 435.916 that is a minimum, not a cap, for aged, blind, disabled, and long-term-care beneficiaries. One change is coming: the ACA expansion-adult population moves to a 6-month cycle for renewals scheduled on or after January 1, 2027, a group South Carolina does not currently have.

What happens if I miss my South Carolina Medicaid renewal deadline?

Your coverage closes at the end of your renewal month. If the closure was procedural (you did not return paperwork or respond to a request for information), you have a 90-day reconsideration window to submit the renewal form and have your eligibility reconsidered without a new application (required for MAGI-based coverage; a state option otherwise); if you are found still eligible, your coverage is restored. If you miss the 90-day window, you file a new application.

My income went up mid-year. Does my child lose Medicaid?

No. Under federal continuous-eligibility rules effective January 1, 2024, children under 19 have 12 months of continuous eligibility from enrollment. Even if your income rises above the parent limit of 67% of poverty, your child keeps coverage through Partners for Healthy Children until the next annual renewal.

I am on ABD Medicaid. Why does my renewal need bank statements?

Aged, blind, disabled, and long-term care Medicaid have an asset limit, and federal law requires the state to verify your assets at renewal through an Asset Verification System. Ask SCDHHS for the limit that applies to your coverage group., SCDHHS reviews recent bank, retirement, and life insurance records, and the check requires your signed authorization.

Can I appeal if my South Carolina Medicaid renewal is denied?

Yes. Federal law lets a state allow up to 90 days from the mailing date to request a hearing, and no more; a state may allow less, and South Carolina notices set a 30-day deadline, which is the one that binds you, so act quickly. If you request the hearing within 10 days of the notice date, your coverage can continue pending the decision. Appeals are decided by the SCDHHS Office of Appeals and Hearings; if the decision came from your MCO, work through the plan's internal appeal first.

Contacts and Resources

These offices can help with an annual renewal, coverage lost in the past 90 days, or an appeal.

Healthy Connections Member Portal Renew online, upload documents, update your address, and check case status. apply.scdhhs.gov
SCDHHS (Healthy Connections) The single state Medicaid agency for South Carolina. scdhhs.gov
SCDHHS Office of Appeals and Hearings File an appeal of a denial or termination; eligibility appeals and fair hearings. Eligibility appeals: 888-549-0820 Office of Appeals and Hearings: 803-898-2600 or 800-763-9087 scdhhs.gov/appeals
Medicaid Managed Care Organizations Update your contact information with your health plan: Absolute Total Care, BlueChoice (Healthy Blue), Humana Healthy Horizons, Molina, or Select Health (First Choice).
South Carolina Legal Services Free legal aid for income-eligible residents, including Medicaid terminations and appeals. sclegal.org
South Carolina SHIP Free Medicare and Medicare Savings Program counseling. aging.sc.gov

If you are unsure whether your renewal has been processed, log into apply.scdhhs.gov and check your case status. The South Carolina Medicaid hub explains whether you remain eligible at renewal. For a state-by-state view, see the Medicaid by state directory.

Learn More

MedicaidHow to Apply for South Carolina MedicaidApply for South Carolina Medicaid (Healthy Connections) online, by phone, by mail, or in person, plus the income trust, spousal asset floor, and appeals. MedicaidSouth Carolina Medicaid Income and Asset LimitsSouth Carolina Medicaid income limits 2026: the $2,982 long-term-care cap and income trust rule, plus the MAGI limits for parents, children, and pregnancy. MedicaidSouth Carolina Medicaid Appeals and Fair HearingsHow to appeal a South Carolina Medicaid denial, keep benefits during the appeal, exhaust a managed care plan's appeal, and request a fair hearing in SC. MedicaidSouth Carolina Medicaid HCBS WaiversSouth Carolina's Community Choices Waiver is the state's main Medicaid HCBS program, paying for home and community care for adults who need nursing-home care. MedicaidSouth Carolina Medicaid and Nursing Home CareHow South Carolina Medicaid nursing home coverage works in 2026: Healthy Connections eligibility, asset and income limits, patient liability, spousal rules. MedicaidSouth Carolina Medicare Savings ProgramsSouth Carolina Medicare Savings Programs 2026: QMB, SLMB, and QI income limits, what each pays, Part D Extra Help, and how to apply through SCDHHS.

Find personalized help renewing your 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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