South Carolina Medicaid Planning: What Families Need to Know

In South Carolina, Healthy Connections Medicaid, run by the South Carolina Department of Health and Human Services (SCDHHS), can pay for nursing-home care and in-home waiver services. In the agency's table effective March 1, 2026, a single applicant generally needs countable resources of $2,000 or less and monthly income of $2,982 or less. Gifts and transfers in the prior five years are reviewed.

Most people facing a parent's or spouse's move into a nursing home in South Carolina arrive at this question in the middle of something hard: a hospital discharge, a fall, a diagnosis that changes what home can safely be. The money questions follow quickly. Will the savings be gone in months? What does the husband or wife who stays home keep? Is the house at risk? What about the money given to a grandchild a few years ago? This page sets out how South Carolina's own program answers those questions, and where the answer depends on rules that change.

What South Carolina Medicaid Long-Term Care Covers — and What It Does Not

Healthy Connections pays for long-term care for people living in licensed and certified nursing facilities, according to SCDHHS. The program also pays for special services for people in Home and Community-Based Services (HCBS) waivers and in the Program for All-Inclusive Care of the Elderly (PACE). SCDHHS says the same eligibility requirements apply to both. The difference is that a person who needs nursing-home care but chooses to stay at home can receive waiver services that help them remain there.

SCDHHS's eligibility table effective March 1, 2026 lists these categories, among others:

• MAO-Institutional: for people who are aged, blind or disabled, need nursing-home care medically, and live in an approved medical facility for at least 30 days. Medicaid pays the nursing home, and the resident pays part of the cost of care.
• Home and Community-Based Services (Waivers): for people who need nursing-home-level care but choose to remain at home. They must require or receive at least one waiver service for at least 30 consecutive days.
• Optional State Supplementation: for residents of approved, licensed residential care homes who meet SSI rules except for income.

Federal law sets the framework every state follows, but South Carolina runs its own program. A family in Charleston, Greenville or Myrtle Beach is judged under the same statewide SCDHHS rules. This page covers Medicaid for long-term care only. It does not cover Medicare, private long-term-care insurance or veterans' benefits.

South Carolina Medicaid Eligibility: Assets, Income, and the Countable-Asset Limit

SCDHHS says an applicant generally must be age 65 or older, or blind or disabled. Disability is decided under the Supplemental Security Income (SSI) guidelines. Beyond that, the agency applies two money tests.

The resource test. A countable asset is anything SCDHHS counts toward the limit when it decides eligibility. The March 1, 2026 table sets the resource limit for the MAO-Institutional and waiver categories per individual, as noted at the top of this page. An exempt asset is one the rules do not count. Which assets are exempt, and on what conditions, depends on South Carolina's current rules. Federal spousal rules borrow the SSI exclusions when they define "resources" (42 U.S.C. § 1396r-5). Separately, federal law bars long-term-care coverage when the applicant's home equity is above a set limit. That bar does not apply when a spouse, a child under 21, or a blind or disabled child lives in the home. The dollar figure South Carolina applies depends on its current rules.

The income test. For both the nursing-home and waiver categories, the income limit is 300% of the SSI federal benefit rate, which works out to the monthly per-individual figure in the March 1, 2026 table. SCDHHS's program page dates the figure to January 1, 2026, and the CMS 2026 standards chart lists the same amount as the "Income Cap Limit (300%)" effective January 1, 2026. In plain terms, South Carolina's long-term-care categories use a fixed income cap rather than an open-ended income test.

A Miller Trust, also called a qualified income trust, is a trust some states use so that an applicant whose income is above the cap can still qualify. Whether South Carolina offers one, and on what terms, depends on its current rules. The Kentucky Medicaid planning page shows how another state with a similar income standard approaches the question.

A community spouse is the husband or wife who stays at home while the other spouse receives institutional care. The federal spousal-impoverishment rules in 42 U.S.C. § 1396r-5 protect the community spouse in several ways:

• At the start of the first continuous stay in an institution, the state adds up both spouses' resources and computes a spousal share equal to half the total.
• At application, the institutionalized spouse is treated as having only the resources above the community spouse resource allowance.
• After eligibility, none of the community spouse's resources are deemed available to the institutionalized spouse.
• During months in the institution, none of the community spouse's income is generally deemed available to the institutionalized spouse.

South Carolina's application asks whether a married applicant entering a nursing home wants to allocate part or all of their income to the spouse remaining at home. The allowance amounts South Carolina applies depend on current SCDHHS figures.

The Look-Back Period and Transfer Penalties in South Carolina

Many families in Columbia, Spartanburg and elsewhere reasonably worry about money they gave away years before anyone imagined a nursing home. The look-back period is the window before a Medicaid application in which gifts and below-value sales are reviewed.

Medicaid.gov describes the federal rule this way: people who need long-term services and supports will be denied that coverage if they, or their spouses, transferred, sold or gifted assets for less than fair market value during the five years before applying. Federal law sets that window at 60 months for transfers made on or after February 8, 2006. South Carolina's application asks whether the applicant or spouse has sold or given away cash, property, a vehicle, a boat or any other resource.

A penalty period is a stretch of time during which Medicaid will not pay for long-term care because of a transfer for less than fair market value. How SCDHHS calculates its length depends on South Carolina's current rules. Under federal law, the penalty starts on the later of two dates: the month of the transfer, or the date the person is otherwise eligible and would be receiving institutional-level care. Because of this, a gift inside the look-back is penalized the same way whether it was made four months or four years before the application.

Federal law also lists exceptions to the penalty. One is a transfer to the applicant's own spouse, which carries no transfer penalty. The full list of exceptions, and how SCDHHS applies them, depends on the governing rules and the family's facts.

Protecting the Family Home in South Carolina

The house in Charleston or the farm outside Florence is often the asset families care about most. Two different rules apply to it: one while the parent is alive, and one after death.

During life, whether the home counts as a resource depends on South Carolina's current rules. The federal home-equity bar described above still applies, unless a spouse, a child under 21, or a blind or disabled child lives in the home.

After death, estate recovery is the process by which SCDHHS seeks repayment from a Medicaid member's estate for benefits it paid. SCDHHS's July 18, 2025 public notice sets out the scope of the program:

• It recovers for claims related to hospice, community long-term care and nursing-home care.
• The estate must be valued at more than $25,000, and the Medicaid claims paid must exceed $500, before SCDHHS can recoup funds.

South Carolina's estate-recovery statute applies to assistance paid after June 30, 1994. It allows recovery only after the death of a surviving spouse, and only when there is no surviving child under 21 and no child who is blind or permanently and totally disabled. That tracks the federal deferral in 42 U.S.C. § 1396p(b)(2). Deferral delays the claim but does not cancel it.

Federal law also requires states to have procedures to waive recovery when it would cause undue hardship (42 U.S.C. § 1396p(b)(3)). South Carolina's statute says recovery must be waived on proof of undue hardship asserted by an heir or devisee. The statute defines "immediate family member" as a child, grandchild, parent, brother or sister of the deceased. SCDHHS's notice says that, effective on or after August 1, 2025, the hardship waiver for immediate family members expands to include grandchildren. Written comments on that action may be reviewed at the SCDHHS Office of Third Party Liability, 1801 Main St., Columbia. No planning step guarantees that recovery will be avoided.

What a South Carolina Medicaid Planning Attorney Does

An elder-law or Medicaid planning attorney compares a family's assets, income, transfers and dates against South Carolina's rules. That work includes explaining which assets SCDHHS counts and which it does not, how the five-year review applies to past gifts, and what a spouse at home may keep. This holds whether the family lives in Greenville, Rock Hill or Aiken.

The tools an attorney may discuss include irrevocable trusts, annuities, spend-down choices, income trusts and caregiver agreements. Each carries conditions. Medicaid.gov notes that a trust funded with at least some of the applicant's money, by the applicant, the spouse or someone acting for them, can be treated as available when Medicaid decides eligibility. No tool always protects assets.

Timing affects which options exist, because transfers inside the look-back are reviewed. The North Carolina Medicaid planning and Texas Medicaid planning pages show how neighboring and larger states handle these same questions under their own rules.

This page does not cover Medicare, veterans' benefits or tax planning. Medicaid Asset Protection Group is an information and inquiry website, not a law firm. It does not give legal advice and does not represent anyone.

Applying for South Carolina Medicaid: The Process and What to Expect

Applications go to SCDHHS on its Application for Nursing Home, Residential or In-Home Care, DHHS Form 3401 (May 2025). The same form is used for nursing-home care, waiver services and Optional State Supplementation. The same statewide process applies in Columbia, Charleston, Greenville, Myrtle Beach and Spartanburg. SCDHHS lists 1-888-549-0820 (TTY 1-888-842-3620) for help completing the form.

The form asks about citizenship or immigration status and a Social Security Number. Non-citizens applying for full benefits must provide immigration documents, such as an I-551 or I-94. It also asks about gifts and sales of resources, and about income allocated to a spouse. Families commonly gather bank statements, deeds and titles, and income records. South Carolina's current requirements decide what must actually be supplied.

Once SCDHHS has everything it needs, it decides eligibility. The form says a letter should arrive within 45 days of the date the agency receives the application, or up to 90 days if a disability determination is needed. Changes in income or other information are to be reported immediately.

Appeals. A person who disagrees with an SCDHHS decision can ask for a fair hearing. The notice states the deadline. Some notices allow 30 days from the date of the notice, and others allow 30 days from the day it is received. To keep existing benefits in place during the appeal, continued benefits must be requested within 10 days of the notice date. Disputed benefits received during the appeal may have to be repaid if the hearing officer rules for the agency. SCDHHS says hearings are not held by telephone. An attorney can assist with an appeal.

Discussing Medicaid Planning in South Carolina

The rules on this page connect to one another. The spousal rules shape what a husband or wife at home keeps while the other spouse receives care. Those same family circumstances later decide when estate recovery can begin: a surviving spouse, a child under 21, or a blind or disabled child delays a claim, and the 2025 hardship-waiver change brings grandchildren within the immediate-family definition. Past gifts sit alongside both, because the five-year review can affect when coverage starts. How these pieces fit together turns on details: the dates and amounts of past gifts, whose name is on the deed and accounts, which care setting is involved, and who lives in the home. Those are the facts a conversation with an attorney would cover. This page does not address other states' rules, Medicare or tax questions.

To talk these facts through with an attorney, you can request a consultation about South Carolina's long-term-care rules, the spousal protections and estate recovery as they apply to your family, through Medicaid Asset Protection Group.