South Carolina Medicaid Spousal Impoverishment 2026: CSRA Guide

South Carolina Medicaid spousal impoverishment rules set a fixed community spouse asset allowance of $66,480, which is lower than the federal maximum most states use.

How South Carolina Medicaid Spousal Impoverishment Works

When one spouse enters a nursing facility or qualifies for a home- and community-based services (HCBS) waiver, South Carolina Medicaid (Healthy Connections) applies federal spousal impoverishment protections under 42 USC § 1396r-5. These rules divide into two parts: an asset protection for the at-home spouse and an income protection.

South Carolina is an income-cap state. That means the institutionalized spouse must have income at or below $2,982/month (300% of the 2026 SSI Federal Benefit Rate) to qualify, and applicants over that limit must establish a Qualified Income Trust (also called a Miller Trust) before Medicaid will pay for long-term care.

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

The spouse entering long-term care is called the institutionalized spouse. The spouse who remains at home is the community spouse.

South Carolina's Fixed CSRA: A Key Difference

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, South Carolina sets a single fixed CSRA standard of $66,480 (effective October 1, 2025). There is no half-of-assets calculation. The community spouse keeps $66,480 in countable assets, period, regardless of what the couple had before.

This matters enormously for couples who came into the nursing facility application with more than $133,000 in combined countable assets. Under federal rules, those couples would have the community spouse keep up to $162,660. Under South Carolina's rules, the community spouse keeps $66,480.

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

This is why South Carolina's CSRA is a critical planning variable that families should understand before applying.

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 $1,500 face value
• Non-home real estate

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

How the South Carolina Medicaid Spousal Impoverishment MMMNA Works

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.

For 2026, South Carolina applies:

• Floor (minimum MMMNA): $2,643.75/month (effective 7/1/2025 through 6/30/2026)
• Ceiling (maximum MMMNA in South Carolina): $4,066.50/month (effective 1/1/2026 through 12/31/2026)

The Name-on-the-Check Rule

Under federal law (42 USC § 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.

Income Diversion

When the community spouse's own income falls below the MMMNA floor, South Carolina allows an income diversion from the institutionalized spouse's income to bring the community spouse up to the floor.

The institutionalized spouse's income is reduced by the Personal Needs Allowance ($60/month in South Carolina, raised from $30 effective October 1, 2025), Medicare Part B premiums, and other deductions. From the remainder, enough is diverted to the community spouse to reach the MMMNA floor.

Worked example #1 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 $2,643.75/month. Her shortfall is $1,343.75/month. The institutionalized spouse receives $2,500/month from Social Security and pension. After the $60 PNA and a $185 Medicare Part B premium, $2,255 is available. Of that, $1,343.75 is diverted to the community spouse. The remaining $911.25 goes to the nursing facility as patient liability. South Carolina Medicaid covers the rest.

Reaching the MMMNA Ceiling

The community spouse can reach the $4,066.50 ceiling if she has excess shelter costs above the federal shelter standard ($793.13/month for 2026). Actual rent, mortgage, property taxes, homeowners insurance, and utilities exceeding $793.13/month raise the allowable income toward the ceiling.

The Home and 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 cap is $752,000. If the community spouse lives in the home, the equity cap rarely comes into play as a disqualifier.

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

Assets That 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)
• One vehicle of any value
• Household goods and personal effects
• Prepaid irrevocable burial contracts
• Burial plots for the applicant and immediate family

The Miller Trust and Income Eligibility

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, Medicare premiums, 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.

South Carolina Medicaid Spousal Impoverishment and the Application Process

Who Administers This

South Carolina Medicaid for long-term care is administered by the South Carolina Department of Health and Human Services (SCDHHS). The CSRA of $66,480 and the MMMNA are applied as part of the nursing home Medicaid application.

How to Request a Resource Assessment

A couple can request a resource assessment without filing a full Medicaid application. Requesting it at the time of nursing facility admission preserves the snapshot when documentation is freshest. Apply online at apply.scdhhs.gov, by phone at 1-888-549-0820, or by paper application.

The Application Process

South Carolina Medicaid long-term care applications generally follow these steps. For a full walkthrough, see the South Carolina Medicaid how-to-apply guide.

1. Gather documentation: bank and brokerage statements, property records, insurance policies, income statements.
2. Determine whether a Miller Trust is needed (income over $2,982/month).
3. Apply online, by phone at 1-888-549-0820, or by paper application.
4. SCDHHS calculates the CSRA ($66,480) and MMMNA and notifies both spouses.
5. Both spouses have the right to appeal any determination.

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. Options to consider:

• Converting countable assets to exempt ones: home improvements, prepaying burial contracts, 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.

Learn More

• South Carolina Medicaid Eligibility and Income Limits
• How to Apply for South Carolina Medicaid
• Medicaid Planning Strategies

Find personalized help understanding South Carolina Medicaid spousal impoverishment rules 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.