South Carolina Medicaid Spousal Impoverishment 2026: CSRA Guide

South Carolina Medicaid spousal impoverishment rules set a $66,480 community spouse resource standard for 2026, and that is a floor on what the at-home spouse keeps, not a ceiling. Federal law protects the greater of that standard or half the couple's countable assets, up to $162,660, so a Healthy Connections applicant with real savings should not assume $66,480 is the answer.1,2

How Do South Carolina Medicaid Spousal Impoverishment Rules Work?

When one spouse is expected to stay in a nursing facility for at least 30 consecutive days while the other lives at home, South Carolina Medicaid (Healthy Connections) applies the federal spousal impoverishment protections under 42 U.S.C. 1396r-5, which its State Plan says it follows. SCDHHS applies the same eligibility requirements to nursing-facility care and to home- and community-based services (HCBS) waivers. These rules divide into two parts: an asset protection for the at-home spouse and an income protection. The spouse entering long-term care is the institutionalized spouse; the spouse who remains at home is the community spouse.1

South Carolina is an income-cap state. The institutionalized spouse's income must be at or below $2,982/month (300% of the 2026 SSI Federal Benefit Rate), a limit SCDHHS calls the Medicaid Cap. An applicant over that limit can still qualify by depositing income each month into an Income Trust, also called a Qualified Income Trust or Miller Trust, because income that flows through the trust doesn't count toward the cap. Medicaid eligibility can't begin before the month the trust document is signed.1

The spousal protections apply regardless of whether a Miller Trust is needed. The community spouse's asset and income protections are calculated independently of the trust.

How Much Can Your Spouse Keep in Assets? (The CSRA)

Federal law at 42 U.S.C. 1396r-5(f)(2)(A) sets the Community Spouse Resource Allowance (CSRA) as the greatest of four alternatives: the resource standard a state elects in its Medicaid plan; the lesser of the spousal share (half the couple's countable assets at the start of institutionalization) or the indexed federal maximum of $162,660; an amount established at a fair hearing; or an amount transferred under a court order.2,4 Under State Plan Amendment SC-25-0011 (approved March 16, 2026, effective October 1, 2025), South Carolina elected a resource standard of $66,480, described on the plan page itself as an amount between the federal minimum and the federal maximum. That standard is the first alternative on the list, which makes it a floor. It does not switch off the half-of-assets alternative, and South Carolina has not said otherwise.1

The table below shows how the four alternatives play out for a South Carolina couple.

The greatest of those four is what the community spouse keeps. For a couple with $300,000 in countable assets, the spousal share is $150,000, which is larger than the $66,480 standard and below the $162,660 maximum, so $150,000 is protected. The $66,480 standard governs only where half the couple's assets comes to less than that.1,2

A worked example illustrating South Carolina's CSRA:

The figures below are hypothetical and shown only to illustrate how the calculation works. They are not a real case and not a prediction of your own result.

A couple in Columbia has $200,000 in combined countable assets at the snapshot date. The spousal share is half of that, $100,000, which sits below the $162,660 federal maximum. That is greater than South Carolina's $66,480 standard, so the community spouse's CSRA is $100,000, not $66,480. The remaining $100,000 is the institutionalized spouse's share, and it must be spent down to South Carolina's long-term-care resource limit before Medicaid will pay. SCDHHS publishes that limit in its Medicaid Policy and Procedures Manual rather than on its public eligibility page, so ask the agency to confirm the current figure in writing before you plan around it.1,2,4

What Counts as a Countable Asset?

At application, everything either spouse owns, alone or together, is pooled, whatever name is on the account and regardless of state marital-property law.4 Countable assets generally include:

• Checking and savings accounts
• CDs and money market funds
• Stocks, bonds, and mutual funds
• Retirement accounts such as IRAs and 401(k)s (ask SCDHHS how South Carolina treats them)
• Cash value of life insurance, when the face value of all policies on one person is over $1,500 under the federal SSI baseline5
• Non-home real estate

Some assets don't count at all; they're listed under "Which Assets Are Exempt?" below.

How Much Income Is the At-Home Spouse Guaranteed? (The MMMNA)

The Minimum Monthly Maintenance Needs Allowance (MMMNA) protects the at-home spouse's income. Federal law sets a floor of $2,705.00/month (effective 7/1/2026 through 6/30/2027) and a cap of $4,066.50/month (effective 1/1/2026).2

In South Carolina, the cap is the standard. The state sets its maintenance needs standard for every community spouse at the federal maximum of $4,066.50/month, which SCDHHS lists as the Spousal Allocation on its eligibility table for January 1, 2026.1

The Name-on-the-Check Rule

Under federal law (42 U.S.C. 1396r-5(b)), none of the community spouse's income is deemed available to the institutionalized spouse while he is in the facility. Income paid solely in her name counts as hers alone, and income paid in both names is split one-half to each unless the paperwork says otherwise.2

Income Diversion

When the community spouse's own income falls below $4,066.50/month, South Carolina deducts an income allowance from the institutionalized spouse's income to make up the difference, but only to the extent that income is actually made available to her. The allowance comes out after the Personal Needs Allowance, which is $60/month in South Carolina (raised from $30 effective October 1, 2025). The State Plan also deducts his health-insurance costs not covered by a third party, such as Medicare premiums.1,4

Worked example illustrating income diversion:

The figures below are hypothetical and shown only to illustrate how the calculation works. They are not a real case and not a prediction of your own result.

The community spouse receives $1,300/month from Social Security. South Carolina's standard is $4,066.50/month, so her shortfall is $2,766.50/month. After the $60 Personal Needs Allowance is set aside, up to $2,766.50 of the institutionalized spouse's remaining income can go to her, as far as his income reaches. The plan's other deductions, such as his Medicare premium, come out of what is left.1,4

Can She Get More Than $4,066.50?

In many states, high housing costs (an excess shelter allowance) raise the allowance toward the federal cap. South Carolina already starts every community spouse at that cap, so housing costs can't lift it further.1 Two routes go above it. At a fair hearing, either spouse can show she needs more income due to "exceptional circumstances resulting in significant financial duress," and an adequate amount is substituted. And if a court has ordered support, the allowance is at least the amount ordered. South Carolina's State Plan preserves both routes.2,4,1

Is the Home at Risk? Home Equity in South Carolina

Under the federal SSI resource rules that serve as Medicaid's baseline, the home you live in doesn't count as a resource.5 Federal law also sets a home-equity limit for long-term care, a minimum of $752,000 for 2026 that a state may raise as high as $1,130,000, but that limit does not apply at all while the community spouse lives in the home. Equity of any amount does not by itself disqualify the applicant then.3 South Carolina's own home-equity figure appears in its Medicaid policy manual rather than on a public eligibility page.1

Federal law sets a 60-month (five-year) look-back on asset transfers. Consult an elder law attorney before transferring any assets within five years before application.1

Which Assets Are Exempt?

The federal SSI resource rules exclude these categories. They are the baseline for Medicaid, not automatically South Carolina's rule:5

• The home you live in and the land it's on (the equity limit doesn't apply while the community spouse lives there)3
• One vehicle, regardless of value, if it's used for transportation
• Household goods and personal effects
• Burial spaces for the applicant and immediate family
• Burial funds up to $1,500 each for the applicant and spouse, kept separate and clearly set aside for burial5

South Carolina's own exempt-asset list sits in its Medicaid policy manual, not on a public eligibility page, so confirm each item with SCDHHS before you rely on it.1

When Is a Miller Trust Required?

Because South Carolina is an income-cap state, an institutionalized spouse with monthly income above $2,982 can qualify through an Income Trust (a Qualified Income Trust, often called a Miller Trust). Income is deposited into the trust each month, and income that flows through it doesn't count toward the Medicaid Cap. SCDHHS requires the applicant to appoint a trustee and doesn't allow the applicant to serve as their own. The trust isn't retroactive: eligibility can't begin before the month the trust document is signed, so every month of delay is a month of care it can't cover.1 Under federal law, the state receives whatever remains in the trust when the applicant dies, up to the total Medicaid paid on his behalf.1 For more on income eligibility, see South Carolina Medicaid eligibility and income limits.

How Do You Apply for South Carolina Medicaid Spousal Impoverishment Protection?

South Carolina Medicaid for long-term care is administered by the South Carolina Department of Health and Human Services (SCDHHS).1 Either spouse can ask for a resource assessment at the start of the first continuous stay in a facility, with or without a Medicaid application. The state must total the couple's resources as of that date and give each spouse a copy with notice of the right to a fair hearing, and it may charge a reasonable fee if the request isn't part of an application.4

For a full walkthrough, see the South Carolina Medicaid how-to-apply guide.

Medicaid Planning Strategies to Consider

Because the CSRA is the greater of the $66,480 standard and the spousal share, the state standard only binds couples whose countable assets are modest to begin with.1 Options to consider:

• Converting countable assets to excluded ones: for example, repairs to the home you live in or a vehicle used for transportation, after confirming with SCDHHS that South Carolina excludes the item.5
• Community-spouse annuities: converting excess countable assets into an income stream for the community spouse. Since the Deficit Reduction Act of 2005, the annuity must be irrevocable and nonassignable, actuarially sound, and pay in equal amounts, and it must name the state as remainder beneficiary (first, or second after the community spouse or a minor or disabled child) to avoid a transfer penalty.1
• Fair hearing: if the CSRA does not generate enough income to meet the MMMNA, a fair hearing can substitute a larger resource allowance, after the state first counts all of the institutionalized spouse's income that could go to her.4

For broader options, see Medicaid planning strategies. Couples with moderate savings should consult a South Carolina-licensed elder law attorney before applying.

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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.