Medicaid Long-Term Care Guide in South Carolina
Long-term care eligibility, benefits, and how to apply through the South Carolina Department of Health and Human Services (SCDHHS).
What makes South Carolina Medicaid different
South Carolina Medicaid (Healthy Connections) provides long-term care coverage through nursing homes, community residential care facilities (assisted living), and home-based services. The state uses a Miller Trust system for applicants over the income cap and has notably lower spousal asset protection ($66,480 CSRA) compared to most states. South Carolina did not expand Medicaid under the Affordable Care Act.
Administered by the South Carolina Department of Health and Human Services (SCDHHS).
Program Types
Institutional / Nursing Home Medicaid
An entitlement program providing care in Medicaid-certified nursing home facilities
Level of care: Nursing Home Level of Care (NFLOC)
Medicaid Waivers / HCBS
Home and Community Based Services with limited slots and potential waiting lists
Level of care: Nursing Home Level of Care (NFLOC)
Regular Medicaid / ABD
Aged Blind or Disabled Medicaid with some long-term care benefits like personal care assistance
Level of care: Help with ADLs (not NFLOC)
2026 South Carolina Medicaid Long-Term Care Eligibility for Seniors
Institutional / Nursing Home Medicaid
Medicaid Waivers / HCBS
Regular Medicaid / ABD‡
*All of a beneficiary's income, with the exception of a Personal Needs Allowance of $60/month, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must be paid to the nursing home (Patient Liability).
†Based on one's living setting, a program beneficiary may not be able to keep monthly income up to this level.
‡Effective 3/1/26-2/28/27. Alternative pathway: persons eligible for SSI are automatically approved for Regular Medicaid, including long-term services if functional criteria are met.
Explore South Carolina Medicaid Programs
Compare programs, see caregiver pay rates, get step-by-step application guidance, and check your eligibility — all specific to South Carolina.
Long-term care Medicaid guide
Eligibility · Caregiver pay · How to apply · 2026 data
Important: Rates vary — contact your state Medicaid office for current figures. This tool provides general guidance, not legal or financial advice.
Compare Medicaid Programs — South Carolina
How the main LTC programs available in South Carolina compare side by side.
| Program | Pay | Pay type | Tax-free? | Spouse OK? | Waitlist? |
|---|---|---|---|---|---|
| Consumer-directed HCBS | $13–16/hr | Hourly wage | No | Usually no | Often |
| Structured Family Caregiving (SFC) | Not in South Carolina | Daily stipend | Yes | Usually no | Often |
| Personal Care Agreement | Market rate (from assets) | Private pay | No | Yes | No |
| VA Aid & Attendance | Up to $2,874/mo | Monthly pension | Yes | Yes | No |
South Carolina Medicaid programs
HCBS Waiver
Community Choices Waiver
Sources: KFF (Jan 2026), medicaidplanningassistance.org (Feb 2026). Programs and rates change — verify with your state Medicaid office.
How Family Caregivers Get Paid Through Medicaid in South Carolina
If you're a family member providing care, you may be able to get paid through Medicaid — often at rates comparable to a home care agency.
Consumer-directed care — hourly pay
Available in South CarolinaHow it works: The person receiving care becomes the "employer" — they hire you and a fiscal intermediary handles payroll, taxes, and paperwork on their behalf. You receive a paycheck just like a regular job.
How to apply: DHHS · scdhhs.gov
Personal Care Agreement — private pay from assets
Available to any familySources: KFF Medicaid Home Care Survey 2025 (Jan 2026), Careforth FAQ (Jan 2026), IRS Notice 2014-7.
How to Apply for Medicaid Long-Term Care in South Carolina
What to expect when applying for LTC Medicaid and getting family caregiver pay set up in South Carolina. The process typically takes 45–90 days from application to first paycheck.
Apply in South Carolina: DHHS · scdhhs.gov
Medicaid Eligibility Screener — South Carolina
Answer 7 quick questions — we'll check the financial and care requirements for South Carolina and explain what each one means.
What is the marital status of the person who needs care?
Medicaid looks at only the applicant's income and assets — but being married triggers special protections that let the healthy spouse keep significantly more money.
Sources
- CMS Medicaid — eligibility, HCBS waivers, and long-term services medicaid.gov/medicaid/eligibility
- CMS Medicaid — Home & Community-Based Services (HCBS) medicaid.gov/medicaid/home-community-based-services
- Social Security Administration — SSI Federal Benefit Rate (2026 figures) ssa.gov/oact/cola/SSI.html
- CMS — Spousal Impoverishment standards (CSRA & MMMNA) medicaid.gov/medicaid/eligibility/spousal-impoverishment
- CMS — Estate Recovery and the 5-year lookback period medicaid.gov/medicaid/eligibility/estate-recovery
- IRS Notice 2014-7 — Tax treatment of Medicaid caregiver payments irs.gov/individuals/certain-medicaid-waiver-payments-may-be-excludable-from-income
Educational guidance only — not legal or financial advice. Your state Medicaid office determines actual eligibility.
Key Rules at a Glance
- Nearly all income counts: employment wages, alimony, pensions, Social Security (including SSDI), IRA withdrawals, and stock dividends
- Nationally, Holocaust restitution payments are NOT counted
- South Carolina: VA Aid & Attendance and Housebound Allowances (above Basic VA Pension) do NOT count as income
- Married couples (Nursing Home/Waiver): Only applicant's income is counted; non-applicant spouse income is disregarded
- Married couples (Regular Medicaid/ABD): Both spouses' income is counted toward eligibility limit
- Countable assets: cash, stocks, bonds, investments, cryptocurrency, bank accounts, and non-residential real estate
- Exempt assets: personal belongings (clothing, jewelry), household furnishings, one vehicle, primary home (with conditions)
- Burial funds: Up to $1,500 per spouse is exempt
- Life insurance: Cash surrender value exempt up to $10,000 combined face value
- IRAs/401Ks of applicants: Exempt if in 'payout status' (Required Minimum Distribution being withdrawn)
- IRAs/401Ks of non-applicant spouses: Automatically exempt
- Married couples: All assets considered jointly owned regardless of which spouse applies
- Home automatically exempt if applicant's spouse, child under 21, or blind/disabled child (any age) lives in it
- Home equity interest limit: $730,000 (2026)
- If above family members don't live in home, applicant must have 'Intent to Return'
- Regular Medicaid (ABD): No home equity interest limit applies
- Home equity = home value minus outstanding debt; equity interest = portion of equity owned by applicant
- Estate Recovery: Home is NOT exempt from Medicaid's Estate Recovery Program—state may seek reimbursement from deceased's estate
- South Carolina has a 60-month (5-year) Look-Back Period for Nursing Home Medicaid and Medicaid Waivers
- Medicaid reviews all asset transfers during the 60 months immediately before application date
- Gifting assets or selling for under fair market value triggers a Penalty Period of ineligibility
- Transfers by non-applicant spouses are also reviewed and can trigger penalties
- Federal Gift Tax Rule (up to $19,000/recipient in 2026) does NOT protect transfers from Medicaid's Look-Back
- Regular Medicaid (ABD): No Look-Back Period applies
- Keep documentation of all asset transfers and expenditures to prove compliance
- MMMNA: $4,066.50/mo · CSRA: $66,480 · CSRA Min: N/A
- Monthly Maintenance Needs Allowance (MMNA): Non-applicant spouse can receive income from applicant spouse up to $4,066.50/month (2026)
- South Carolina uses the maximum MMNA as the standard (no minimum floor or shelter allowance calculation)
- If non-applicant spouse already has $4,066.50+/month income, no additional allowance is provided
- Community Spouse Resource Allowance (CSRA): Non-applicant spouse can retain up to $66,480 of couple's assets (2026)
- IMPORTANT: South Carolina's CSRA ($66,480) is significantly LOWER than the federal maximum ($162,660)
- Spousal protections apply only to Nursing Home Medicaid and Medicaid Waivers, NOT Regular Medicaid (ABD)
- Qualified Income Trusts (QITs) / Miller Trusts: For applicants over the $2,982/month income cap—excess income is deposited into an irrevocable trust that doesn't count toward income limit
- Miller Trust requirements: Must name a trustee, funds only for approved purposes (care costs, medical expenses), SC DHHS must be remainder beneficiary, trust is irrevocable
- Asset Spend-Down: Reduce countable assets by spending on exempt items—home modifications (ramps, roll-in showers, stair lifts), home improvements (electrical, plumbing, water heater), vehicle modifications (wheelchair lifts, adaptive controls)
- Prepay funeral/burial expenses, pay off mortgage or other debts
- CRITICAL: Never gift assets or sell below fair market value within 5-year Look-Back Period—always keep receipts
- Medicaid Planning: Work with a Certified Medicaid Planner to employ legal strategies for eligibility and home protection from Estate Recovery
South Carolina Medicaid Programs
South Carolina Community Choices Waiver
Provides assistance for elderly and disabled individuals who require nursing home level of care but wish to live at home, in adult foster care homes, or community residential care facilities. Benefits include home modifications, adult day health care, specialized medical equipment, and help with ADLs (bathing, mobility, eating).
Healthy Connections Prime (HCP)
A managed care program providing long-term care services at home, in the community, and in nursing homes for 'dual eligible' individuals (enrolled in both Medicaid and Medicare).
Program of All-Inclusive Care for the Elderly (PACE)
Combines Medicaid long-term care services and Medicare benefits into one program, with additional benefits like dental and eye care.
Money Follows the Person (Home Again)
Federal program helping institutionalized Medicaid-eligible individuals transition back home or into the community.
How to Apply
- Online at Healthy Connections website
- Submit required forms to local Healthy Connections county office
- Forms for ABD Medicaid: Available under 'Aged, Blind or Disabled (ABD)' section
- Forms for Nursing Home/HCBS Waivers: Available under 'Individuals in Nursing Facilities and/or Receiving HCBS Waiver Services' section
Application process varies by program. Contact Healthy Connections Members Help Center for assistance. Ensure all eligibility requirements are met before applying—consider Medicaid Planning if over income/asset limits.
More South Carolina Long-Term Care Resources
South Carolina Long-Term Care Costs
Compare assisted living, home care, and nursing home costs.
South Carolina Senior Services Directory
Find local aging agencies, support programs, and community resources.
Veterans Long-Term Care Benefits
Aid & Attendance, caregiver programs, and VA nursing home coverage.
Take the Next Step for South Carolina Medicaid
Find out if you qualify or see how Medicaid fits into your overall long-term care plan.
Sources & references
Verified May 2026- Centers for Medicare & Medicaid Services — Long-Term Services & Supports
- Administration for Community Living — State Medicaid Agencies
- Centers for Medicare & Medicaid Services — Medicaid Eligibility
- American Council on Aging — About Medicaid Planning Assistance
- South Carolina Department of Health and Human Services (SCDHHS) — South Carolina Medicaid — Official site