South Carolina Medicaid Spousal Impoverishment 2026: CSRA Guide

South Carolina Medicaid spousal impoverishment rules set a fixed community spouse asset allowance of $66,480 for 2026, which is far below the $162,660 federal maximum most states use. This guide explains exactly how the at-home spouse's assets and income are protected under South Carolina Healthy Connections.1

How Do South Carolina Medicaid Spousal Impoverishment Rules Work?

When one spouse enters a nursing facility or qualifies for a home- and community-based services (HCBS) waiver, South Carolina Medicaid (Healthy Connections) applies the federal spousal impoverishment protections under 42 U.S.C. 1396r-5. 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 must have gross income at or below $2,982/month (300% of the 2026 SSI Federal Benefit Rate) to qualify, and an applicant over that limit must establish a Qualified Income Trust, also called a Miller Trust, before Medicaid will pay for long-term care.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)

Most states set the Community Spouse Resource Allowance (CSRA) using a half-of-assets formula, letting the at-home spouse keep up to the federal maximum of $162,660. South Carolina takes a different approach. Under State Plan Amendment SC-25-0011 (effective October 1, 2025), South Carolina sets a single fixed CSRA standard of $66,480. There is no half-of-assets calculation: the community spouse keeps $66,480 in countable assets, regardless of what the couple had before.1

The table below shows how South Carolina's fixed standard differs from the federal half-of-assets approach used by most states.

The difference matters most for couples who entered the application with substantial savings. Under the federal formula a couple with $300,000 in countable assets could protect up to $162,660 for the at-home spouse; under South Carolina's rule that spouse keeps $66,480.1,2

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. Under a federal half-of-assets formula the community spouse would keep $100,000; under South Carolina's fixed $66,480 standard the community spouse keeps $66,480. The institutionalized spouse's countable assets are $200,000 minus $66,480, minus the $2,000 applicant asset limit, so roughly $131,520 must be spent down before Medicaid eligibility is established.1

What Counts as a Countable Asset?

Both spouses' assets are pooled regardless of whose name is on the account. Countable assets generally include:

• Checking and savings accounts
• CDs and money market funds
• Stocks, bonds, and mutual funds
• Both spouses' IRAs and 401(k)s
• Cash value of life insurance above the small-policy exclusion
• Non-home real estate

Assets that are exempt include the primary home, one vehicle, household goods and personal effects, and prepaid irrevocable burial contracts.1

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. While South Carolina's CSRA is below the federal maximum, the state applies the federal maximum MMMNA of $4,066.50/month, with a floor of $2,705.00/month.2

For 2026, South Carolina applies a floor of $2,705.00/month (effective 7/1/2026 through 6/30/2027) and a ceiling of $4,066.50/month (effective 1/1/2026).2

The Name-on-the-Check Rule

Under federal law (42 U.S.C. 1396r-5(b)(2)), the community spouse keeps all of her own income regardless of amount. Income in the community spouse's name is hers alone and does not factor into the applicant's Medicaid eligibility. Only the institutionalized spouse's income flows toward the nursing facility cost.2

Income Diversion

When the community spouse's own income falls below the MMMNA floor, South Carolina allows an income diversion from the institutionalized spouse to bring the at-home spouse up to the floor. The institutionalized spouse's income is first reduced by the Personal Needs Allowance ($60/month in South Carolina, raised from $30 effective October 1, 2025), any Medicare premium, and other allowed deductions; from the remainder, enough is diverted to reach the MMMNA floor.1

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. The MMMNA floor is $2,705.00/month, so her shortfall is $1,405.00/month. After the institutionalized spouse's income is reduced by the $60 Personal Needs Allowance and his Medicare premium, enough of the remainder is diverted to the community spouse to cover the $1,405.00 shortfall. Whatever is left after that diversion goes to the nursing facility as patient liability, and South Carolina Medicaid covers the rest.1,2

Reaching the MMMNA Ceiling

The community spouse can reach the $4,066.50 ceiling if she has excess shelter costs above a federal shelter standard. Actual rent or mortgage, property taxes, homeowners insurance, and utilities that exceed that standard raise the allowable income toward the ceiling. Because the shelter standard is a federal figure that resets periodically, confirm the current amount with SCDHHS before relying on a specific number.2

Is the Home at Risk? Home Equity in South Carolina

The primary residence is exempt from Medicaid eligibility calculations as long as the community spouse lives there; the home's equity does not count as a resource. For 2026, the South Carolina home equity limit is $752,000, the federal minimum. If the community spouse lives in the home, the equity cap rarely comes into play as a disqualifier.3

South Carolina applies a 60-month look-back on asset transfers. Consult an elder law attorney before transferring any assets within five years before application.1

Which Assets Are Exempt?

Beyond the home, other asset categories are excluded from the Medicaid eligibility calculation:

• Primary residence (equity up to $752,000 while the community spouse lives there)3
• One vehicle of any value
• Household goods and personal effects
• Prepaid irrevocable burial contracts
• Burial plots for the applicant and immediate family

These same exemptions apply whether or not a Miller Trust is required.1

When Is a Miller Trust Required?

Because South Carolina is an income-cap state, an institutionalized spouse with gross monthly income above $2,982 must establish a Qualified Income Trust (Miller Trust) before South Carolina Medicaid will pay for long-term care. The excess income is deposited into the trust each month; from it, the trustee pays the Personal Needs Allowance, the community spouse income diversion, any Medicare premium, and the patient liability. The trust must be established by an attorney and name SCDHHS as the remainder beneficiary. For more on income eligibility, see South Carolina Medicaid eligibility and income limits.1

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), which applies the $66,480 CSRA and the MMMNA as part of the nursing home Medicaid application. A couple can request a resource assessment without filing a full Medicaid application; requesting it at the time of nursing facility admission preserves the asset snapshot while documentation is freshest.1

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

Medicaid Planning Strategies to Consider

South Carolina's $66,480 CSRA means many couples will face a larger spend-down than in most other states.1 Options to consider:

• Converting countable assets to exempt ones: home improvements, prepaying an irrevocable burial contract, or purchasing a vehicle.
• Community-spouse annuities: converting excess countable assets into an income stream for the community spouse using an irrevocable annuity that meets Deficit Reduction Act 2005 requirements.
• Fair hearing: if the CSRA does not generate enough income to meet the MMMNA, a fair hearing may increase the resource allowance based on the income shortfall.

For broader options, see Medicaid planning strategies. Given South Carolina's below-market CSRA, 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.