South Carolina Medicaid
Eligibility Calculator

South Carolina did not expand Medicaid under the ACA, so standard Medicaid for adults remains limited to very low-income individuals meeting categorical eligibility requirements. Long-term care Medicaid — the program that pays for nursing homes and home-based care for elderly and disabled individuals — operates under separate, stricter rules regardless of expansion status.

There are two primary Medicaid programs in South Carolina that most families encounter: (1) standard Medicaid for low-income individuals and families, and (2) long-term care Medicaid (also called institutional Medicaid or nursing home Medicaid) for seniors needing sustained care. The eligibility rules, income limits, and asset tests differ dramatically between these two programs.

This page focuses on long-term care Medicaid, which is the more complex and higher-stakes determination for most families.

South Carolina Medicaid is administered by the South Carolina Department of Health and/or Human Services and is governed by federal Medicaid law as well as state-specific regulations. Key reference: S.C.

Code Ann. § 44-6-5 et seq..

• South Carolina Medicaid (South Carolina Healthy Connections) is administered by the South Carolina Department of Health and Human Services (SCDHHS). South Carolina uses managed care through Managed Care Organizations (Absolute Total Care, Molina, Wellcare) for standard Medicaid. Long-term care Medicaid uses FFS delivery for nursing facilities
• CommChoice waiver provides HCBS. Functional eligibility is assessed using South Carolina's Level of Care tool. South Carolina has not expanded Medicaid under the ACA. South Carolina's personal needs allowance for nursing facility residents is $30/month. South Carolina uses an income cap (300% SSI)
• Miller Trust required above the limit. South Carolina's MERP has limited scope, recovering primarily from the probate estate.

South Carolina is an "income cap" state, meaning nursing home Medicaid recipients must have monthly income at or below $2,901/month — 300% of the Supplemental Security Income (SSI) Federal Benefit Rate. In 2024, this cap is $2,829/month.

Individuals whose income exceeds this cap cannot qualify for long-term care Medicaid in South Carolina without using a Qualified Income Trust (QIT), also called a "Miller Trust." The Miller Trust funnels excess income into a trust account that is paid directly to the nursing home, effectively reducing countable income to below the cap.

All nursing home income in South Carolina — Social Security, pension payments, required minimum distributions, annuity income — counts toward the income calculation. Certain deductions may apply, including a personal needs allowance (typically $30–$60/month retained by the nursing home resident), health insurance premiums, and if a community spouse is present, a monthly maintenance needs allowance.

The community spouse's own income does not count toward the nursing home spouse's eligibility.

For married couples where one spouse needs nursing home care (the "institutionalized spouse") and the other remains at home (the "community spouse"), South Carolina applies spousal impoverishment protections. The community spouse is entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) — a monthly income floor set at $3,853.50 (2024 federal standard).

If the community spouse's own income falls below this threshold, the institutionalized spouse's income can be diverted to make up the difference, reducing what goes to the nursing home.

The individual countable asset limit for long-term care Medicaid in South Carolina is $2,000. This means a nursing home applicant must have $2,000 or less in countable assets to qualify.

Not all assets count — exemptions are critical to understanding the real planning picture.

Exempt (non-countable) assets in South Carolina include: the primary residence (subject to the home equity limit — see below), one automobile of any value, personal property and household furnishings, irrevocable prepaid burial plans and burial funds up to state limits, term life insurance (no cash value), and whole life insurance with face value under $1,500. Business property essential to self-support may also be exempt.

IRAs and retirement accounts in payout status may or may not be exempt depending on South Carolina rules.

For married couples, the Community Spouse Resource Allowance (CSRA) is the portion of the couple's combined assets the community spouse is allowed to keep. In South Carolina, the CSRA is between $29,724 and $148,620 — the federal floor and ceiling for 2024.

South Carolina uses the federal minimum as its CSRA, setting the community spouse's protection at $29,724. Combined countable assets above the CSRA plus the institutionalized spouse's $2,000 limit must be spent down before Medicaid eligibility is established.

The primary residence is exempt from Medicaid's asset test as long as the applicant or the applicant's spouse, minor child, or disabled child lives in the home, or the applicant intends to return home. However, South Carolina imposes a home equity limit of $713,000.

If the applicant's home equity — the home's fair market value minus any mortgage balance — exceeds this limit, the home loses its exempt status and must be counted as a resource.

South Carolina uses the federal standard home equity limit of $713,000. Many families in high-cost areas must be aware of this cap when planning.

Even when the home is exempt during the Medicaid recipient's lifetime, it may be subject to Medicaid Estate Recovery after death. In South Carolina, the estate recovery program has a relatively limited scope.

South Carolina limits estate recovery primarily to assets in the deceased recipient's probate estate, which means properly structured non-probate transfers — such as a life estate deed or an irrevocable trust — may avoid recovery in many cases.

Long-term care Medicaid in South Carolina covers two main settings: (1) nursing facility care (institutional Medicaid), which is an entitlement — meaning anyone who meets the financial and functional eligibility criteria must be enrolled — and (2) home and community-based services (HCBS) through waiver programs, which typically have waiting lists.

South Carolina's primary HCBS waiver for elderly individuals is the South Carolina HIV/AIDS Waiver & Mechanical Ventilation Waiver. Waiver programs allow Medicaid to pay for services that help people remain in their homes and communities rather than moving to nursing facilities.

Services may include personal care, adult day programs, home-delivered meals, transportation, and caregiver supports. Demand often far exceeds available waiver slots, resulting in wait times ranging from months to several years in South Carolina.

Functional eligibility for long-term care Medicaid requires a clinical determination that the individual needs a nursing-facility level of care — typically defined as needing substantial assistance with at least two or three Activities of Daily Living (ADLs) such as bathing, dressing, eating, toileting, and mobility. The South Carolina Medicaid agency conducts a Level of Care (LOC) evaluation, usually through a standardized assessment instrument, as part of the application process.

Medicaid planning — taking legal steps to restructure assets and income to qualify for Medicaid while preserving wealth for a spouse or heirs — is a specialized field of elder law. Common strategies used in South Carolina include Medicaid Asset Protection Trusts (MAPTs), which are irrevocable trusts that remove assets from countable resources after the 60-month look-back period; promissory notes; annuities; and the "spend-down" of excess assets on home improvements, debt payoff, or pre-paying funeral expenses.

Because South Carolina is an income cap state, a Qualified Income Trust (Miller Trust) is often required for applicants whose monthly income exceeds $2,901/month. The Miller Trust is drafted by an attorney, funded with the applicant's excess income each month, and helps ensure that income is properly directed to the nursing home while maintaining Medicaid eligibility.

Timing matters enormously in Medicaid planning. The 60-month (5-year) look-back period means that asset transfers made within 60 months of a Medicaid application are scrutinized and can result in penalty periods of Medicaid ineligibility.

Early planning — ideally 5+ years before care is needed — provides the most flexibility. An elder law attorney in South Carolina can help navigate the complex interplay between federal requirements and South Carolina-specific rules.

Medicaid eligibility is part of a broader long-term care planning picture. The South Carolina Medicaid Look-Back Period Calculator calculates potential penalty periods from prior asset transfers.

The South Carolina Long-Term Care Cost Calculator provides nursing home, assisted living, and home health cost benchmarks so you can understand the financial exposure before planning. Since many long-term care plans tie to estate strategy, the South Carolina Probate Cost Calculator helps estimate the cost of settling the estate afterward.

Connect with a South Carolina Medicaid planning attorney to review your specific situation.