South Carolina Medicaid Eligibility: Income Limits, Asset Rules & How to Apply

South Carolina’s Medicaid program is called Healthy Connections — and it operates under one of the most significant coverage restrictions of any state in the Southeast.

South Carolina has not expanded Medicaid under the Affordable Care Act.

That means an estimated 200,000+ low-income South Carolinians who would qualify for Medicaid in 39 other states and D.C. are left without coverage here — earning too little for Marketplace subsidies but too much for South Carolina’s narrow eligibility categories.

The people most affected: adults aged 19–64 without disabilities who don’t have dependent children.

If you’re a parent, senior, disabled, or a child, Healthy Connections may still cover you. This guide explains every program, who qualifies, the 2026 income limits, the unique Working Disabled buy-in, the Community Choices Waiver, and exactly how to apply.

For income limits across all 50 states, see Medicaid income limits by state.

Understanding South Carolina’s Non-Expansion Status

Before diving into programs, it’s important to understand what the coverage gap means in practice.

In expansion states, adults earning up to 138% FPL (~$1,799/month for a single person) qualify for Medicaid regardless of whether they have children or a disability.

In South Carolina, that pathway does not exist.

A single adult earning $800/month with no children and no documented disability has no Medicaid pathway in South Carolina — even though they fall well below the federal poverty line. They also earn too little to receive Marketplace subsidies, which start at 100% FPL.

This is the coverage gap: income too low for Marketplace plans, category ineligible for Medicaid.

If you believe you fall into this gap, see the “Options for Uninsured Adults” section at the bottom of this guide.

Healthy Connections Programs

South Carolina runs several distinct Medicaid programs across different populations.

Healthy Connections Kids (CHIP) covers children up to age 19 in households with incomes up to 213% FPL through South Carolina’s Children’s Health Insurance Program.

No asset test applies. This is one of the most accessible pathways in the state.

Medicaid for Pregnant Women covers pregnant women up to 213% FPL (~$2,787/month for a single person).

Coverage extends 12 months postpartum regardless of income changes after delivery. No asset test applies.

Medicaid for Parents and Caretaker Relatives covers parents or adult caretakers of dependent children under 19.

The income limit is 45% FPL ($587/month for a single parent) — one of the lowest parent income thresholds in the United States. South Carolina’s threshold is significantly lower than most neighboring states.

Regular Medicaid (Aged, Blind, and Disabled — ABD) covers low-income elderly, blind, or disabled residents who do not need nursing home care.

The income limit is $967/month (single). Importantly, the asset limit for ABD Medicaid in South Carolina is $9,950 for a single applicant — significantly higher than the $2,000 limit for nursing home/waiver programs, and higher than most states’ ABD limits. This allows seniors and disabled individuals to hold more modest savings while receiving basic medical coverage.

Nursing Home / Institutional Medicaid covers long-term care in Medicaid-certified nursing facilities and ICF/IID facilities.

This is an entitlement — eligible applicants cannot be turned away due to program capacity. Income limit: $2,901/month (single), asset limit: $2,000 (single).

Community Choices Waiver (HCBS) provides home and community-based care for seniors 65+ and physically disabled adults 18–64 who need nursing home-level care but want to remain at home.

This is not an entitlement — limited slots exist and waiting lists may apply. Contact CLTC Centralized Intake at 1-888-971-1637 to begin the process.

Working Disabled Program — South Carolina’s Medicaid buy-in for adults with disabilities who are employed.

Working disabled adults can earn up to 250% FPL and hold up to $9,950 in assets while receiving full Healthy Connections benefits. South Carolina adopted this program in 1998 as one of the earlier state adopters. Applicants must meet SSI’s definition of total and permanent disability and have income primarily from employment.

Breast and Cervical Cancer Program — Full Healthy Connections benefits for uninsured women found to need treatment for breast or cervical cancer or pre-cancerous lesions (CIN 2/3 or atypical hyperplasia).

The woman must be screened through the Best Chance Network (BCN) or a physician, have income at or below 200% FPL, and have no other insurance covering cancer treatment. This is one of the few pathways for non-disabled adult women in South Carolina who don’t otherwise qualify for Medicaid.

Healthy Connections Prime — South Carolina’s dual demonstration project (Section 1115 Waiver) for seniors who are enrolled in both Medicare and Healthy Connections (dual eligibles) and living in the community.

Prime integrates Medicare and Medicaid care coordination for community-dwelling dual-eligible seniors aged 65+. Participants cannot be in a nursing home or ICF/IID at enrollment, and cannot be receiving hospice or End Stage Renal Disease treatment.

BabyNet — South Carolina’s Individuals with Disabilities Education Act (IDEA) Part C program for infants and toddlers with disabilities or developmental delays, from birth through age 3.

Administered by SCDHHS, BabyNet connects families to early intervention services. Contact SCDHHS for BabyNet referrals.

Income Limits — 2026

All amounts are monthly gross income. The Federal Benefit Rate (FBR) is $967/month for 2026.

Key Notes on South Carolina’s Income Rules

The coverage gap in numbers: A single non-disabled adult in South Carolina earning between $0 and $1,303/month has no Medicaid pathway and no Marketplace subsidy eligibility. This affects hundreds of thousands of South Carolinians in industries like tourism, agriculture, retail, and food service — sectors with high concentrations of workers earning below poverty-level wages.

Nursing Home/HCBS income: Income above $2,901/month goes toward care costs after protecting a Personal Needs Allowance of $65/month for nursing home residents (higher for HCBS), Medicare premiums, and any applicable spousal allowance.

If income exceeds $2,901, a Qualified Income Trust (QIT) can redirect the excess to restore eligibility.

Community Spouse Allowance: When one spouse applies for nursing home or waiver care, the healthy spouse may keep income up to $3,948/month as a Minimum Monthly Maintenance Needs Allowance (MMMNA) — if their housing and utility costs exceed $793.13/month (effective July 1, 2025 – June 30, 2026).

Working Disabled income note: The 250% FPL threshold involves a two-step income test: net family income must first fall under 250% FPL, then the applicant’s unearned income must be at or below 100% FPL separately. Contact SCDHHS for the current calculation methodology.

Federal Poverty Level Reference — 2026

Use the FPL Calculator to find the exact threshold for your household size.

Asset Rules for South Carolina Medicaid

No asset test applies to children, pregnant women, parents, or the Working Disabled program. Asset limits apply to nursing home/HCBS and ABD programs.

South Carolina’s ABD asset limit of $9,950 is significantly more generous than the LTC limit.

This is an important planning consideration: a senior with $8,000 in a savings account can still qualify for ABD Medicaid (basic medical coverage) even though they would exceed the $2,000 limit for nursing home Medicaid.

Home equity limit: The primary home is exempt while the applicant or their spouse resides there or intends to return. Home equity cap: $730,000.

For ABD Medicaid applicants specifically, the home is exempt regardless of equity value — there is no equity cap for ABD Medicaid in South Carolina.

Exempt (Non-Countable) Assets

• Primary home (no equity cap for ABD; $730,000 cap for LTC programs)
• One vehicle
• Household goods and personal effects
• Irrevocable Funeral Trusts (IFTs) — up to $15,000 (higher than the $1,500 standard in most states)
• Medicaid Compliant Annuities
• Life insurance with face value $1,500 or less

South Carolina’s IFT exemption of $15,000 is notable — most states cap IFTs at $1,500 or accept the face value of the life insurance policy. The higher cap gives SC applicants more room to set aside burial funds while reducing countable assets.

South Carolina’s HCBS Waivers — Multiple Pathways

South Carolina operates multiple specialized HCBS waivers beyond the main Community Choices program.

Community Choices Waiver serves elderly adults 65+ and physically disabled adults 18–64 at risk of nursing home placement. This is the primary HCBS pathway for seniors.

Apply through CLTC Centralized Intake at 1-888-971-1637 or submit a referral online at phoenix.scdhhs.gov/cltc_referrals/new.

HIV/AIDS Waiver serves Healthy Connections members of any age living with HIV or AIDS who need community-based support services.

Mechanical Ventilator Dependent Waiver serves members of any age with severe respiratory conditions requiring mechanical ventilation who meet nursing facility level of care.

Innovations Waiver (administered by BHDD-OIDD) serves Healthy Connections members of any age with intellectual or related disabilities who meet ICF/IID level of care.

Call the Department of Behavioral Health and Developmental Disabilities Office at 1-800-289-7012 to apply.

Brain and Spinal Cord Injuries Waiver serves members with traumatic brain injury, spinal cord injury, or similar disabilities who meet nursing facility level of care. Call BHDD-OIDD at 1-800-289-7012.

Medically Complex Children’s Waiver serves Healthy Connections children up to age 21 with chronic physical or health conditions expected to last at least one year, who meet hospital level of care.

All HCBS waivers are non-entitlements — enrollment is limited, and waiting lists apply when slots are filled.

The 60-Month Look-Back Period

South Carolina enforces a 60-month (5-year) look-back for Nursing Home Medicaid and all HCBS Waivers.

When you apply for long-term care Medicaid, SCDHHS reviews all financial transfers from the 5 years before your application date. Transfers below fair market value — gifts, below-market sales, or certain trust transfers — trigger a penalty period of ineligibility calculated from when you otherwise meet all eligibility criteria.

Even ABD applicants should be cautious: Although the look-back does not apply to ABD Medicaid itself, if an ABD recipient later needs nursing home care or waiver services, any past disqualifying transfers will surface at that point.

It’s better to address potential look-back issues before they become a crisis.

Exempt transfers:

• Transfers to a spouse
• Transfers to a blind or disabled child
• Home transfer to a caregiver child who lived there for at least 2 years before institutionalization and whose care delayed nursing home placement
• Transfer to a sibling with an equity interest who lived in the home for at least 1 year before institutionalization

No look-back for ABD Regular Medicaid, children, pregnant women, or parents programs.

Medical and Functional Requirements

To qualify for Nursing Home Medicaid or any HCBS Waiver, applicants must demonstrate a Nursing Facility Level of Care (NFLOC) through documented limitations in:

ADLs: Mobility, bathing, dressing, eating, and toileting.

IADLs: Cooking, shopping, managing finances, medication management.

Cognitive or behavioral issues: Alzheimer’s, dementia, or other conditions — diagnosis alone does not guarantee NFLOC; functional limitations must be formally assessed by SCDHHS.

For ABD Regular Medicaid, proof of disability or blindness per SSA standards is required — NFLOC is not.

Medicaid Estate Recovery

South Carolina’s Estate Recovery Program may seek reimbursement for long-term care costs paid by Healthy Connections after a beneficiary’s death.

Recovery targets the primary home most commonly, if not protected through a surviving spouse, qualifying disabled child, or caregiver child exemption.

Early planning is far more effective than post-crisis responses. A Certified Medicaid Planner can identify available protections within South Carolina’s specific rules.

Options If You Exceed the Limits

Qualified Income Trusts (QITs): If income exceeds $2,901/month, a QIT redirects excess into an irrevocable trust, restoring nursing home or waiver eligibility.

South Carolina Medicaid must be named as the trust beneficiary upon death.

Irrevocable Funeral Trusts (IFTs): SC allows up to $15,000 in pre-paid funeral costs in an irrevocable trust — exempt from asset limits.

This is one of the highest IFT exemptions in the country and is particularly useful for applicants with modest excess assets.

Spend Down: Convert countable assets into exempt ones — home improvements, paying off debt, vehicle purchase, medically necessary equipment.

Not all spend-down purchases avoid look-back scrutiny. Consult a planner before acting.

Medicaid Compliant Annuities: Convert lump-sum assets into an income stream, reducing countable assets while directing income toward care costs.

Options for Uninsured Adults in the Coverage Gap

If you are an adult without dependents, not disabled, and not otherwise qualifying for Healthy Connections, your options in South Carolina include:

Federally Qualified Health Centers (FQHCs): Community health centers throughout South Carolina provide primary care on a sliding fee scale based on income.

Many charge $20–$40 per visit or less for uninsured adults. Find locations at findahealthcenter.hrsa.gov.

HealthCare.gov Marketplace: If your income is at or above 100% FPL, you may qualify for subsidized Marketplace coverage during Open Enrollment (November–January) or a Special Enrollment Period.

Catastrophic plans: Available to adults under 30 or those qualifying for a hardship exemption, with lower premiums.

Hospital charity care: South Carolina hospitals are required to provide charity care or financial assistance programs. Contact the financial services office at any hospital for current programs.

Federal Policy Changes Affecting South Carolina

Work Requirements (January 2027): Federal work requirements under the One Big Beautiful Bill target ACA expansion adults.

Since South Carolina has not expanded Medicaid, most of the expansion-adult work requirement framework does not apply here. Parents enrolled in Medicaid may face state-specific work rules — contact SCDHHS for current requirements. See SNAP work requirements for parallel context.

Reduced Retroactive Coverage (January 2027): Medicaid will cover only 2 months prior to application, down from 90 days.

Apply as soon as you think you qualify — delayed applications mean uncovered medical bills for the gap period.

More Frequent Renewals (December 2026): Renewals shift from annual to every 6 months for most enrollees.

Use the SCDHHS online portal to renew promptly and avoid coverage gaps.

New Cost-Sharing (October 2028): Non-exempt enrollees may face up to $35 per specialist visit. Primary care and preventive services remain free.

Children, pregnant women, nursing facility residents, and seniors are exempt.

South Carolina Medicaid and SNAP: Two Separate Agencies

An important practical note: Healthy Connections Medicaid is administered by SCDHHS, while SNAP is administered by DSS (Department of Social Services) — two completely separate state agencies.

This is unlike states such as Pennsylvania where both run through the same portal. In South Carolina, you apply for Medicaid through apply.scdhhs.gov, and for SNAP separately through dss.sc.gov.

Many South Carolina families with children or seniors qualify for both simultaneously. South Carolina SNAP uses the federal 130% FPL gross income limit — one of the more restrictive SNAP structures in the Southeast.

Useful links:

• South Carolina SNAP benefits and eligibility
• How to apply for SNAP in South Carolina
• South Carolina WIC income guidelines
• Can seniors on Social Security get food stamps?
• Big Beautiful Bill SNAP and benefit changes

How to Apply for Healthy Connections Medicaid

Online: Apply at apply.scdhhs.gov — the SCDHHS online portal for Healthy Connections.

Note: The portal may be offline Sunday, Tuesday, and Thursday evenings after 8 PM for maintenance.

By Phone: Call Healthy Connections Customer Service at 1-888-549-0820.

By Mail or Fax: Download the application at scdhhs.gov, complete it, and submit by mail to:

SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101

Or fax to: 1-888-820-1204

In Person: Visit your nearest SCDHHS county office. South Carolina has 46 counties, each served by at least one local office.

Long-Term Care / Community Choices: Contact CLTC Centralized Intake at 1-888-971-1637 or submit a referral at phoenix.scdhhs.gov/cltc_referrals/new. A NFLOC assessment must be completed before waiver eligibility is determined.

Intellectual/Developmental Disabilities Waivers: Contact BHDD-OIDD at 1-800-289-7012.

For the step-by-step application walkthrough: how to apply for Medicaid in South Carolina.

Documents You’ll Need

• South Carolina residency proof (utility bill, lease, or official mail)
• U.S. citizenship or qualifying immigration status documentation
• Income proof: pay stubs, SSA award letters, pension statements
• SSNs for all household members
• For LTC/ABD: bank statements, property records, 60 months of financial history
• For disability: SSA disability documentation or physician letter
• For the Working Disabled program: proof of employment plus disability documentation
• For Breast and Cervical Cancer program: BCN or physician documentation of cancer diagnosis/treatment need

Processing Times

• Standard applications: Up to 45 days
• Disability-based applications: Up to 90 days
• Expedited: Pregnant women and urgent cases may qualify for faster processing

Frequently Asked Questions

Why doesn’t South Carolina cover most working-age adults through Medicaid?

South Carolina has not expanded Medicaid under the ACA.

This means non-disabled adults without dependent children — regardless of income — are not eligible for Healthy Connections. Estimates suggest over 200,000 South Carolinians fall into the coverage gap: earning too little for Marketplace subsidies (which start at 100% FPL) but not qualifying for any Medicaid category.

What is the Working Disabled program in South Carolina?

It’s a Medicaid buy-in for adults who are totally and permanently disabled according to SSI standards but are still employed.

Working disabled South Carolinians can earn up to 250% FPL (~$3,260/month single) and hold up to $9,950 in assets and receive full Healthy Connections benefits. South Carolina adopted this program in 1998. Apply through SCDHHS at 1-888-549-0820.

What is the Breast and Cervical Cancer program?

Women who are uninsured, have no other coverage for cancer treatment, and are diagnosed with breast cancer, cervical cancer, or specific pre-cancerous conditions can qualify for full Healthy Connections coverage — even if they don’t qualify under any other Medicaid category.

They must be screened through the Best Chance Network (BCN) or a physician, and have income at or below 200% FPL. This is one of the only Medicaid pathways for non-disabled adult women in South Carolina.

What is the ABD Medicaid asset limit in South Carolina?

$9,950 for a single applicant — significantly higher than the $2,000 limit for nursing home and waiver programs.

This allows seniors and disabled individuals with modest savings to still qualify for basic Healthy Connections medical coverage (doctor visits, prescriptions, emergency care) even while exceeding the LTC limit.

Why does South Carolina’s IFT exemption go up to $15,000?

South Carolina allows up to $15,000 in pre-paid funeral costs in an irrevocable trust, exempt from asset limits.

Most states cap this at $1,500 (the face value of exempt life insurance). South Carolina’s higher cap gives long-term care applicants more room to reduce countable assets through pre-planning — it’s one of the more favorable IFT policies in the Southeast.

Do I apply for Medicaid and SNAP through the same place in South Carolina?

No — unlike Pennsylvania (COMPASS) or Oregon (ONE portal), South Carolina uses two completely separate agencies and portals.

Medicaid (Healthy Connections) → apply.scdhhs.gov or call 1-888-549-0820.

SNAP (Food Assistance) → dss.sc.gov or call 1-800-616-1309.

If you need both, you’ll need to apply separately. See South Carolina SNAP eligibility for details.

What is the Community Choices Waiver and who qualifies?

The Community Choices Waiver is South Carolina’s primary HCBS program — funding in-home care, adult day services, and personal assistance for seniors 65+ and physically disabled adults 18–64 who require nursing home-level care but want to remain at home.

It is not an entitlement — slots are limited and waiting lists exist. Contact CLTC Centralized Intake at 1-888-971-1637 to begin the process early. Income limit: $2,901/month. Asset limit: $2,000 (single).

What community health options exist for adults in the coverage gap?

Federally Qualified Health Centers (FQHCs) across all 46 South Carolina counties provide primary care on a sliding fee scale — often $20–$40 or less per visit for uninsured adults.

Find the nearest FQHC at findahealthcenter.hrsa.gov. Hospital charity care programs and free clinics also operate throughout the state. If your income is at or above 100% FPL, explore HealthCare.gov Marketplace plans during Open Enrollment.

Last updated: 2026 | Sources: South Carolina Department of Health and Human Services (SCDHHS), USDA FPL guidelines, CMS.gov. Verify current figures at scdhhs.gov or by calling Healthy Connections at 1-888-549-0820. This guide is for informational purposes only — eligibility is determined by SCDHHS.