South Carolina Medicaid Eligibility 2025: Income Limits, Asset Rules & How to Apply

South Carolina Medicaid, known as Healthy Connections, is a health insurance program funded by federal and state dollars, providing medical and health-related services to low-income individuals, including children, pregnant women, parents, seniors, and disabled individuals. T

his guide outlines the 2025 eligibility criteria, income limits, asset rules, and application process for Healthy Connections, based on federal and South Carolina Department of Health and Human Services (SCDHHS) guidelines, with a focus on long-term care for seniors (aged 65+), as well as other eligibility groups.

South Carolina Medicaid Programs

South Carolina Medicaid offers coverage for various groups, with specific eligibility requirements based on income, assets, age, and medical needs. The main programs include:

• Institutional / Nursing Home Medicaid: An entitlement program covering nursing home care, hospitals, and Intermediate Care Facilities for Individuals with Intellectual Disabilities (ICF/IID). Requires a Nursing Facility Level of Care (NFLOC).
• Home and Community Based Services (HCBS) Waivers: Non-entitlement programs with limited slots, offering services like in-home care, adult day care, and delivered meals to help seniors and disabled individuals avoid institutionalization. Programs like the Community Long Term Care (CLTC) Waiver may have waiting lists.
• Regular Medicaid (Aged, Blind, and Disabled): Covers low-income elderly, blind, or disabled individuals, with less stringent medical requirements than long-term care programs.
• Medicaid for Children and Pregnant Women: Covers children up to age 19 and pregnant women with higher income limits through Healthy Connections Kids.
• Medicaid for Parents and Caretaker Relatives: Covers low-income parents or caretakers of dependent children.

South Carolina has not expanded Medicaid under the Affordable Care Act (ACA), resulting in stricter eligibility rules, leaving many low-income adults without children in a coverage gap.

Eligibility for South Carolina Medicaid

Eligibility varies by program and population. General requirements include:

• Residency: Must be a resident of South Carolina.
• Citizenship: Must be a U.S. citizen, national, permanent resident, or legal alien with qualifying immigration status (e.g., refugees, asylees, or lawful permanent residents with 5+ years in the U.S.).
• Income: Varies by program, often based on a percentage of the Federal Poverty Level (FPL) or Federal Benefit Rate (FBR).
• Assets: Limits apply for long-term care and aged/blind/disabled programs.
• Medical/Functional Need: Long-term care programs require a Nursing Facility Level of Care (NFLOC), assessed through limitations in Activities of Daily Living (ADLs) or Instrumental Activities of Daily Living (IADLs).

Categorical Eligibility

Individuals receiving Supplemental Security Income (SSI) or certain means-tested benefits are often categorically eligible for Regular Medicaid, bypassing some income and asset tests.

Income Limits for South Carolina Medicaid

Income limits vary by program and household status. Below are the 2025 income limits for South Carolina, based on federal guidelines and state policies, expressed as monthly amounts unless noted.

Additional Notes on Income Limits

• Seniors/Disabled (Nursing Home/HCBS): Income above $2,901/month must go toward care costs, except for a Personal Needs Allowance ($65/month for nursing home, higher for HCBS), Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse. A Qualified Income Trust (QIT) can redirect excess income to meet eligibility.
• Married, One Spouse Applying: Applicant’s income limit is $2,901/month; non-applicant spouse’s income is not counted. The non-applicant may receive a Minimum Monthly Maintenance Needs Allowance (MMMNA) of up to $3,948/month if their housing and utility costs exceed $793.13/month (effective 7/1/25–6/30/26).
• Children/CHIP: Limits may extend to 213% FPL ($2,787/month for one) for Healthy Connections Kids.
• Pregnant Women: Coverage extends 12 months postpartum.
• Non-Expansion State: South Carolina’s lack of ACA expansion means no coverage for adults aged 19–64 without dependents unless they meet other category requirements.

2025 Federal Poverty Level (FPL) Guidelines for Reference (48 States & D.C.)

Note: Use the FPL Calculator to estimate your household’s FPL percentage.

Asset Rules for South Carolina Medicaid

Asset limits apply primarily to long-term care and aged/blind/disabled programs.

Long-Term Care Medicaid (Nursing Home and HCBS Waivers)

• Single Applicant: $2,000 in countable assets (e.g., bank accounts, stocks, bonds, secondary properties).
• Married, Both Applying: $3,000 total.
• Married, One Applying: $2,000 for the applicant; $157,920 for the non-applicant spouse (Community Spouse Resource Allowance, or CSRA).
• Home Equity Limit: $730,000 for the primary residence (if applicant/spouse resides there or intends to return).

Non-Countable Assets

• Primary home (if applicant/spouse resides there or intends to return)
• One vehicle
• Household goods and personal effects
• Irrevocable Funeral Trusts (up to $15,000)
• Medicaid Compliant Annuities
• Life insurance with a face value of $1,500 or less

Medicaid’s Look-Back Rule

South Carolina enforces a 60-month look-back period for Nursing Home Medicaid and HCBS Waivers, reviewing asset transfers within 5 years of application. Transfers below fair market value (e.g., gifting) may result in a penalty period of ineligibility. No look-back period applies for Regular Medicaid.

Estate Recovery

South Carolina’s Medicaid Estate Recovery Program seeks reimbursement for long-term care costs after a beneficiary’s death, often targeting the home if not protected. Consult a Certified Medicaid Planner to safeguard assets.

Regular Medicaid (Aged, Blind, and Disabled)

• Asset Limit: $2,000 for an individual; $3,000 for a couple.
• No home equity limit or look-back period.

Medicaid for Children, Pregnant Women, and Parents

• No Asset Test: These programs focus solely on income.

Medical/Functional Requirements

For Nursing Home Medicaid and HCBS Waivers, applicants must demonstrate a Nursing Facility Level of Care (NFLOC), assessed through:

• Limitations in Activities of Daily Living (ADLs): Mobility, bathing, dressing, eating, toileting.
• Limitations in Instrumental Activities of Daily Living (IADLs): Cooking, shopping, managing finances.
• Cognitive or Behavioral Issues: E.g., Alzheimer’s or dementia, though diagnosis alone does not guarantee eligibility.

Regular Medicaid for the aged, blind, or disabled requires proof of disability or blindness per Social Security Administration criteria but not necessarily NFLOC.

Changes Due to Federal Policy

As of 2025, federal policy changes may affect Medicaid, with South Carolina’s non-expansion status amplifying some impacts:

• Work Requirements (Starting January 2027): Not applicable to South Carolina, as it has not expanded Medicaid for adults aged 19–64. Other groups (e.g., parents) may face state-specific work rules.
• Reduced Retroactive Coverage (Starting January 2027): Medicaid will cover only 2 months prior to application (down from 90 days), increasing potential medical debt for late applicants.
• More Frequent Eligibility Checks (Starting December 2026): Beneficiaries must renew eligibility every 6 months, requiring regular documentation to avoid coverage gaps.
• New Out-of-Pocket Costs (Starting October 2028): Non-exempt beneficiaries may face up to $35 per visit for specialist services or procedures, but primary care and preventive services remain free.

Options if Over the Income or Asset Limit

If your income or assets exceed the limit, consider:

• Qualified Income Trusts (QITs): Redirect excess income to meet limits for Nursing Home or HCBS Waivers. The trust is irrevocable, and South Carolina Medicaid must be designated as the beneficiary upon the recipient’s death.
• Irrevocable Funeral Trusts (IFTs): Pre-paid funeral and burial expenses (up to $15,000) are exempt from asset limits.
• Spend Down: Convert countable assets into exempt ones (e.g., home repairs, purchasing a vehicle, or paying off debt).
• Certified Medicaid Planners: Professionals can help with financial strategies to achieve eligibility, such as Medicaid Compliant Annuities or asset restructuring.

Application Process

To apply for South Carolina Medicaid:

• Online: Use the Healthy Connections portal at apply.scdhhs.gov. Check eligibility with the Medicaid Eligibility Calculator.
• Phone: Call the Healthy Connections Customer Service at 1-888-549-0820 for assistance.
• In-Person or Mail: Complete and submit an application to a local SCDHHS Office. Download the application from scdhhs.gov.
• Assistance: Contact the South Carolina Department of Health and Human Services or a local Area Agency on Aging for program-related questions. Call 1-855-472-3432 for long-term care support.

Required documents include proof of income, assets, residency, citizenship, and medical records (for long-term care or disability programs). An interview may be required.

Processing Time

• Standard applications: Up to 45 days (90 days for disability-based applications).
• Expedited processing: May apply for urgent cases (e.g., pregnant women via presumptive eligibility for outpatient care).

Frequently Asked Questions

How do I apply for Medicaid in South Carolina?

Apply online at apply.scdhhs.gov, by phone at 1-888-549-0820, in person at an SCDHHS Office, or by mail with a downloaded application from scdhhs.gov.

What are the 2025 Medicaid income limits for South Carolina?

For seniors/disabled (Nursing Home/HCBS), the limit is $2,901/month (single) or $5,802/month (couple). Regular Medicaid (aged, blind, disabled) is $967/month (single) or $1,450/month (couple). Children and pregnant women qualify up to 213% FPL ($2,787/month for one). Parents qualify up to 45% FPL ($587/month for one).

Are there asset limits for South Carolina Medicaid?

Yes, for long-term care and aged/blind/disabled programs: $2,000 (single), $3,000 (couple, both applying), or $157,920 for a non-applicant spouse. No asset tests for children, pregnant women, or parents.

What is the Medicaid look-back period in South Carolina?

A 60-month look-back period applies to Nursing Home Medicaid and HCBS Waivers, penalizing asset transfers below fair market value. No look-back for Regular Medicaid.

Can I qualify for Medicaid if my income or assets are too high?

Yes, through Qualified Income Trusts (QITs), Irrevocable Funeral Trusts (IFTs), or spending down assets on exempt items. Consult a Certified Medicaid Planner for assistance.

Why doesn’t South Carolina cover low-income adults without children?

South Carolina has not expanded Medicaid under the ACA, so adults aged 19–64 without dependents are ineligible unless they meet other category requirements (e.g., disability).

This guide is based on 2025 federal and South Carolina Department of Health and Human Services guidelines. Verify details with the Healthy Connections program for accuracy.