Long-Term Care Costs in South Carolina

South Carolina's long-term care costs are below national averages across all categories — nursing home care (semi-private) averages $9,034 per month, approximately 6% below the national average of $9,581, while assisted living averages $5,350 per month, approximately 14% below the national average of $6,200. Home care averages $5,982 per month, approximately 10% below the national rate of $6,673. South Carolina's Medicaid program is called Healthy Connections, administered by the South Carolina Department of Health and Human Services (SCDHHS). The income limit for Nursing Home Medicaid is $2,982/month, with a $60/month Personal Needs Allowance. The asset limit is $2,000 for individuals. South Carolina uses Miller Trusts (Qualified Income Trusts) for applicants over the income cap. A critical planning factor: South Carolina's Community Spouse Resource Allowance (CSRA) is only $66,480 — significantly lower than the $162,660 federal maximum. South Carolina did not expand Medicaid under the ACA. This guide covers what care costs in South Carolina, how to qualify for Medicaid, and what options exist for veterans and family caregivers in Charleston, Columbia, Greenville, Myrtle Beach, and across the Palmetto State.

South Carolina's Aging Population: The Numbers Behind the Need

South Carolina is home to more than 1.1 million residents aged 60 or older — a rapidly growing portion of the state's roughly 5.4 million total population. The senior population is concentrated in Charleston (Charleston County), Columbia (Richland County — the state capital), Greenville (Greenville County), Myrtle Beach (Horry County — a major retirement destination), Spartanburg (Spartanburg County), Rock Hill (York County), Florence (Florence County), and Hilton Head (Beaufort County).

South Carolina's geography — from the densely populated Charleston and Greenville metros to rural areas in the Midlands and Pee Dee region — creates significant long-term care access challenges. The Charleston, Columbia, and Greenville metros have the most provider options, while rural counties in the Pee Dee, Lowcountry, and Upstate face provider shortages and limited home care availability.

Unpaid Caregivers in South Carolina: Scale and Impact

An estimated 650,000 unpaid family caregivers in South Carolina provide care to aging relatives and adults with disabilities. According to AARP research, family caregivers nationwide spend an average of $7,242 per year in out-of-pocket costs related to caregiving.

South Carolina provides caregiver support through the Community Choices Waiver, which offers respite care and adult day health services to give family caregivers needed breaks. The Healthy Connections Prime (HCP) managed care program provides coordinated services for dual-eligible individuals. The SC Lt. Governor's Office on Aging operates family caregiver support programs through the state's 10 Area Agencies on Aging.

What Long-Term Care Costs in South Carolina

South Carolina's care costs are consistently below national averages:

• Assisted Living: $5,350 per month — approximately 14% below the national average of $6,200
• Nursing Home (semi-private room): $9,034 per month — approximately 6% below the national average of $9,581
• Nursing Home (private room): $9,612 per month
• Home Care (home health aide): $5,982 per month — approximately 10% below the national average of $6,673
• Adult Day Care: $1,560 per month — approximately 24% below the national average of $2,058
• Memory Care: $6,700 per month — approximately 14% below the national estimate of $7,750

At these rates, a three-year nursing home stay in South Carolina costs approximately $325,000 — while home care totals roughly $215,000 over the same period. Adult day care, at $1,560/month, is one of the most affordable options and costs approximately $56,000 over three years. Combining home care with adult day services can reduce monthly costs compared to nursing home care. For a detailed breakdown of care costs by type and how South Carolina compares to other states, visit our South Carolina Care Costs page.

How to Qualify for South Carolina Medicaid (Healthy Connections): Eligibility Rules for 2026

South Carolina's Medicaid program is called Healthy Connections, administered by the South Carolina Department of Health and Human Services (SCDHHS). In addition to nursing home care and community residential care facilities (assisted living), SC Medicaid pays for many home-based services that help frail seniors remain at home. Consulting with a South Carolina elder law attorney or Certified Medicaid Planner early can help families avoid costly mistakes. Eligibility rules vary by program type:

• Nursing Home Medicaid (Institutional): Income limit of $2,982/month (a Miller Trust can be used for excess income). Asset limit of $2,000 (single) or $4,000 (married couple both applying). All monthly income except a $60/month Personal Needs Allowance, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must be paid to the nursing home (Patient Liability). When only one spouse applies, the non-applicant spouse may retain up to $66,480 in assets (2026 CSRA). This is an entitlement.
• Medicaid Waivers / HCBS (Community Choices Waiver): Income limit of $2,982/month. Asset limit of $2,000 (single) or $4,000 (couple, both applying). Miller Trust available for excess income. This is not an entitlement — limited slots and waiting lists may exist.
• Regular Medicaid / ABD (Aged, Blind, or Disabled): Income limit of $1,330/month (single) or $1,803.33/month (couple). Asset limit of $9,950 (single) or $14,910 (couple). No Look-Back Period applies. This is an entitlement.

South Carolina applies a 60-month (5-year) look-back period for Nursing Home Medicaid and HCBS Waiver applications. Asset transfers during this period — including gifts to family members — can trigger a penalty period of Medicaid ineligibility. The federal $19,000 Gift Tax Exemption (2026) does NOT apply to Medicaid's look-back rules. The Look-Back Period does not apply to Regular Medicaid (ABD). For the full South Carolina Medicaid eligibility breakdown, see our South Carolina Medicaid Guide.

Spousal Protections and Community Spouse Resource Allowance

When one spouse applies for Nursing Home Medicaid or an HCBS Waiver in South Carolina, only the applicant spouse's income is counted. South Carolina's CSRA of $66,480 is significantly lower than the federal maximum of $162,660 — this is one of the most critical planning factors for married couples in the state.

South Carolina uses the maximum Monthly Maintenance Needs Allowance (MMMNA) of $4,066.50 as the standard — there is no minimum floor or shelter allowance calculation. If the non-applicant spouse already has $4,066.50 or more in monthly income, no additional allowance is provided. For Regular Medicaid (ABD), both spouses' income is counted and there is no MMMNA or CSRA.

South Carolina Medicaid Programs: Community Choices & Managed Care Options

South Carolina provides long-term care through several Medicaid programs:

• Community Choices Waiver: South Carolina's primary HCBS waiver for elderly and disabled individuals who require nursing home level of care but wish to live at home, in adult foster care, or in community residential care facilities. Benefits include home modifications, adult day health care, specialized medical equipment, and assistance with ADLs (bathing, mobility, eating). Waiting lists may exist.
• Healthy Connections Prime (HCP): A managed care program providing long-term care at home, in the community, and in nursing homes for "dual eligible" individuals enrolled in both Medicaid and Medicare. Combines benefits under one coordinated care plan.
• Program of All-Inclusive Care for the Elderly (PACE): Combines Medicaid and Medicare benefits into a single program for participants aged 55+. Additional benefits such as dental and eye care may be available.
• Money Follows the Person (Home Again): A federal program helping institutionalized Medicaid-eligible individuals transition back home or into the community. Provides transition coordination, housing assistance, and community support services.

Qualifying When Over the Limits: Miller Trusts (Qualified Income Trusts)

South Carolina uses Miller Trusts (Qualified Income Trusts / QITs) for applicants whose income exceeds the $2,982/month cap. South Carolina does not have a Medically Needy / Spend-Down program for Nursing Home or HCBS Medicaid:

• Miller Trust (QIT): Excess income above $2,982/month is deposited into an irrevocable trust. The trust must name a trustee, funds may only be used for approved purposes (care costs, medical expenses, Personal Needs Allowance), and SCDHHS must be named as the remainder beneficiary.
• Asset Spend-Down: Spend excess assets on non-countable items — home modifications (wheelchair ramps, roll-in showers, stair lifts), vehicle modifications (wheelchair lifts, adaptive controls), prepaying funeral/burial expenses, and paying off debt. Keep documentation as proof Medicaid's look-back rule was not violated.
• Medicaid Planning: Work with a Medicaid Planning Professional to employ legal strategies for eligibility and protect your home from Medicaid's Estate Recovery Program.

Asset Rules: What Counts and What Doesn't

Countable assets in South Carolina include cash, stocks, bonds, investments, cryptocurrency, bank accounts, and non-residential real estate. In South Carolina, IRAs / 401Ks in payout status (Required Minimum Distributions being withdrawn) are exempt from the asset count. IRAs/401Ks of non-applicant spouses are automatically exempt. Exempt (non-countable) assets include personal belongings (clothing, jewelry), household furnishings, one vehicle, and generally one's primary home.

South Carolina's asset limit is $2,000 for an individual and $4,000 for a married couple (both applying) for Nursing Home and HCBS Medicaid. For Regular Medicaid (ABD), the limit is $9,950 (single) and $14,910 (couple). All assets of a married couple are considered jointly owned regardless of the Medicaid program. Burial funds up to $1,500 per spouse are exempt. Life insurance cash surrender value is exempt up to $10,000 combined face value. In South Carolina, VA Aid & Attendance and Housebound Allowances (above Basic VA Pension) do not count as income. Nationally, Holocaust restitution payments are not counted as income.

Veterans and Long-Term Care in South Carolina

South Carolina has a large veteran population, with facilities including the Ralph H. Johnson VA Medical Center in Charleston, the Wm. Jennings Bryan Dorn VA Medical Center in Columbia, and community-based outpatient clinics across the state. South Carolina also operates four state veterans' nursing homes — in Anderson, Columbia, Florence, and Walterboro.

South Carolina does not count VA Aid & Attendance and Housebound Allowances (above Basic VA Pension) as income for Medicaid eligibility purposes. Veterans should factor this advantage into their long-term care planning strategy. For a comprehensive overview of veteran long-term care benefits, see our Veterans Long-Term Care Guide.

Planning Ahead: How to Pay for Nursing Home Care in South Carolina

Understanding how to pay for nursing home care in South Carolina — or any long-term care setting — requires evaluating multiple funding sources. With nursing home costs at $9,034/month, a 60-month look-back period, a $2,000 asset limit, and a CSRA of only $66,480, advance planning is critical. Key steps include:

• Understanding your current financial position relative to South Carolina's Medicaid eligibility thresholds
• Recognizing that South Carolina's CSRA of $66,480 is significantly lower than the $162,660 federal maximum — protecting the non-applicant spouse's assets requires careful planning
• Using a Miller Trust (QIT) to qualify when income exceeds $2,982/month
• Leveraging the maximum MMMNA of $4,066.50 to protect the non-applicant spouse's income
• Recognizing that IRAs/401Ks in payout status are exempt from the asset count
• Recognizing that VA Aid & Attendance does not count as income
• Exploring the Community Choices Waiver for home and community-based alternatives to nursing homes
• Exploring PACE programs for comprehensive combined Medicaid/Medicare benefits
• Consulting with a South Carolina elder law attorney or Certified Medicaid Planner to protect assets and avoid look-back penalties

Estate Recovery: Protecting Your Home in South Carolina

South Carolina operates a Medicaid Estate Recovery Program, which allows the state to seek reimbursement from a deceased Medicaid beneficiary's estate for long-term care costs paid by Medicaid. This can include the family home if proper protections are not in place. The primary home is automatically exempt if the applicant's spouse, child under 21, or permanently blind or disabled child (of any age) lives in it.

If no qualifying family member lives in the home, there is a home equity interest limit of $730,000 (in 2026). If the applicant does not have qualifying family in the home, they must demonstrate Intent to Return. There is no home equity interest limit for Regular Medicaid (ABD). The home is NOT exempt from estate recovery — families should consult a South Carolina elder law attorney to explore legal protections.

Regional Cost Variations Across South Carolina

Long-term care costs in South Carolina vary by region. The Charleston metro (Charleston, Berkeley, and Dorchester Counties) typically sees the highest costs due to higher demand and cost of living. Greenville-Spartanburg (Upstate) represents mid-range costs with strong provider availability. Columbia (Richland and Lexington Counties) has moderate costs. The Myrtle Beach/Horry County area has seen growing demand due to retirement migration. Rural Pee Dee and Lowcountry counties generally have lower costs but significantly fewer providers and limited home care availability.

Application Timeline and Process

South Carolina Medicaid (Healthy Connections) applications can be submitted through several channels:

• Apply online at the Healthy Connections website
• Submit required forms to your local Healthy Connections county office
• ABD Medicaid forms are under the "Aged, Blind or Disabled (ABD)" section
• Nursing Home/HCBS Waiver forms are under the "Individuals in Nursing Facilities and/or Receiving HCBS Waiver Services" section
• Call the Healthy Connections Members Help Center at 1-888-549-0820

Applicants must be certain all eligibility criteria are met prior to submitting a Medicaid application. Persons with excess income and/or assets should strongly consider Medicaid Planning. Processing times vary but typically take 45–90 days.

Federal Policy Update: One Big Beautiful Bill Act (OBBBA)

The One Big Beautiful Bill Act (OBBBA) includes approximately $1 trillion in Medicaid cuts over 10 years. While Nursing Home Medicaid is largely protected from future funding reductions, Home and Community Based Services (HCBS) — including South Carolina's Community Choices Waiver, Healthy Connections Prime, and PACE — are likely targets for cuts. This law is still facing legal challenges. Families relying on or planning to use HCBS should monitor developments and consider applying early.

Last updated: September 2026. Data sources: South Carolina Department of Health and Human Services, CareScout 2025 care cost survey (updated March 2026). All Medicaid figures reflect 2026 eligibility thresholds. This guide is for informational purposes only and does not constitute legal or financial advice.