Long-Term Care Medicaid in South Carolina: 2026 Guide

In South Carolina, Medicaid is called Healthy Connections Medicaid. It is run by the South Carolina Department of Health and Human Services (SCDHHS), which also decides eligibility. Long-Term Care Medicaid can pay for nursing home care and for care at home through Community Long Term Care (CLTC) and the Community Choices Waiver. This guide explains the 2026 rules in plain language.

At a glance: South Carolina 2026 figures

Figures last updated for 2026. Sources are listed at the end of this page.

Figures change periodically. Double-check current amounts with SCDHHS before relying on them.

What Long-Term Care Medicaid covers in South Carolina

Nursing home care. Medicaid pays for care in a certified nursing facility. You pay most of your income toward the cost each month, and Medicaid pays the rest.

Community Choices Waiver. This is South Carolina’s main home and community-based program. It serves people 65 and older, and adults 18 to 64 with physical disabilities, who meet a nursing facility level of care. Services include case management, personal care, attendant care, companion care, home-delivered meals, adult day health care, respite, personal emergency response systems, home changes, medical equipment and residential personal care. SCDHHS’s Community Long Term Care (CLTC) division runs the assessment and case management.

Waiting list. When the waiver is full, eligible people may wait. SCDHHS says that when openings outside reserved slots are available, people are admitted first-come, first-served by date of application.

PACE (Program of All-Inclusive Care for the Elderly). Available in some areas for people 55 and older.

Assisted living. Medicaid does not pay room and board in community residential care facilities. The waiver’s residential personal care service may help with care.

How Medicare fits in. Medicare Part A covers skilled nursing facility care only for a limited time. You generally need a medically necessary inpatient hospital stay of at least 3 days in a row first (time under observation or in the emergency room does not count), and you must need daily skilled nursing or therapy. In 2026, Medicare charges nothing for days 1 to 20 after the Part A deductible ($1,736) is met, $217 a day for days 21 to 100, and nothing after day 100, when you pay all costs. Medicare limits this coverage to 100 days in each benefit period. Medicaid can be a way to pay for long-term nursing home care after Medicare coverage ends.

Who qualifies

A person generally must:

• be 65 or older, or disabled (18 to 64 with a physical disability for the Community Choices Waiver);
• live in South Carolina and be a U.S. citizen or qualified non-citizen;
• meet a nursing facility level of care. For home care, SCDHHS does the first assessment through CLTC;
• meet the income and asset rules below, as decided by SCDHHS.

Income rules

In 2026, the income limit for long-term care is $2,982 a month.

Once you are on Medicaid in a nursing home, most of your income goes to the facility. You keep a personal needs allowance of $60 a month, and money can be set aside for a spouse at home and for health insurance premiums.

Asset rules

In 2026, a single applicant can have up to $2,000 in countable assets. For a couple who both need care, the limit is $3,000.

Countable assets include cash, bank accounts, CDs, stocks, bonds, mutual funds, retirement accounts that can be cashed in, life insurance cash value above set amounts and real estate other than the home.

Usually exempt:

• Your home, if you live there or plan to return, or a spouse or dependent relative lives there
• One vehicle
• Household goods and personal belongings
• Burial plots and limited burial funds, within SCDHHS rules

Spousal protections

• Assets: The spouse at home can keep a share of the couple’s countable assets, plus the home, one car and belongings. South Carolina sets its own spousal share.
• Income: The spouse at home keeps their own income, and part of the applicant’s income may be set aside for them.

Look-back and penalties

When you apply, South Carolina looks back at the 60 months (5 years) before the application date. This is called the look-back period. The state checks whether you, or your spouse, gave away money or property, or sold something for less than it was worth, during that time.

Common examples of transfers that can cause a problem:

• Cash gifts to children or grandchildren, even small yearly gifts. (A gift that is fine for federal gift-tax purposes can still count for Medicaid.)
• Adding a child’s name to a house deed or bank account in a way that gives them part ownership.
• Selling a house or car to a relative for much less than it is worth.
• Paying a family member for care without a written agreement made at the time.

Some transfers are allowed, such as transfers between spouses, or transferring a home to a child who is blind or disabled.

How the penalty works. If the state finds a transfer that is not allowed, it does not deny Medicaid forever. Instead, it sets a penalty period: a stretch of time when Medicaid will not pay for long-term care. The state divides the amount given away by the penalty divisor ($9,758.58 a month ($320.83 a day)).

Example: Suppose you gave your daughter $50,000 three years before applying. $50,000 divided by $9,758.58 is about 5.1 months without Medicaid payment for long-term care.

The penalty period starts only once you have applied, are otherwise eligible, and are in (or need) long-term care. This is why gifts made while someone is healthy can still matter years later. If a gift is returned in full, the penalty can be removed.

Estate recovery in South Carolina

South Carolina’s estate recovery program is run by SCDHHS.

• What is recovered: Medicaid paid for services received at age 55 or older, and for some people of any age in a nursing facility.
• When it is put off: federal rules prevent recovery while a spouse is alive, or if there is a child under 21 or a child who is blind or disabled.
• Hardship waivers: SCDHHS can waive or put off recovery in some situations. Ask SCDHHS for the current rules.
• Family members and personal representatives can contact SCDHHS with questions.

How to apply

• Online: at apply.scdhhs.gov, SCDHHS’s online application
• On paper: SCDHHS Form 3401, Application for Nursing Home, Residential or In-Home Care
• In person or by mail: at your county SCDHHS office
• For the Community Choices Waiver: make a referral to CLTC through SCDHHS’s online CLTC referral form. SCDHHS suggests contacting CLTC about a care assessment before you complete the Medicaid application if care will be at home.

Applying for a spouse or parent. If you are applying for someone else, you may need legal authority to act for them, or you can be named as an authorized representative on the application. Gather statements for every account, not just the main one, and write down when the person’s care needs began. If the person is already in a nursing home, ask the facility’s business office or social worker which Medicaid forms they need from you and when, and tell the agency if any requested document is hard to get, since agencies can often give extra time when you ask before the deadline.

After you apply. SCDHHS will send you a written notice saying whether you qualify, from what date, and how much of your income goes toward your care each month. If you disagree with a decision, you have the right to ask for a fair hearing (appeal). The notice explains how to ask and the deadline for asking. Keep copies of everything you send and receive, and report changes in income, assets or address when they happen.

Gather what you can before you apply. The caseworker may ask for:

• Photo ID, Social Security card and Medicare card
• Proof of age and of U.S. citizenship or immigration status
• Proof that you live in the state (for example, a utility bill or lease)
• Proof of all income: Social Security award letter, pension statements, annuity statements
• Bank, credit union and investment statements (often for the full 60-month look-back period)
• Deeds, property tax bills and the value of any real estate
• Life insurance policies (showing cash value) and prepaid funeral or burial contracts
• Vehicle titles
• Health insurance cards and long-term care insurance policies
• Power of attorney or guardianship papers, if someone is applying for you
• For a spouse at home: their income and assets too, since both spouses’ assets are counted at the start

If you cannot find a document, apply anyway and tell the caseworker. They can explain what else is accepted.

Free public help in South Carolina

• SCDHHS and your county office: Medicaid applications and eligibility.
• Community Long Term Care (CLTC): assessments and case management for home care.
• Area Agencies on Aging / Aging and Disability Resource Centers: local information on long-term care options.
• SHIP (State Health Insurance Assistance Program): South Carolina’s free Medicare counseling program, through the Department on Aging.
• South Carolina Long-Term Care Ombudsman Program: free advocates for residents of nursing homes and residential care facilities.

Recent and upcoming changes

A 2025 federal law (Public Law 119-21) makes two changes that affect Long-Term Care Medicaid in every state, including South Carolina:

• Retroactive coverage gets shorter on January 1, 2027. Today, Medicaid can pay bills from up to 3 months before the month you apply, if you would have qualified then. For applications from January 1, 2027, this window shrinks to 2 months for older adults and people with disabilities. In plain terms: from 2027, it matters more to apply soon after care starts, so that earlier bills are not left unpaid.
• Home equity cap on January 1, 2028. States will no longer be able to set a home equity limit above $1,000,000 (except for some farm property). South Carolina’s 2026 home equity limit, $752,000, is already below the new cap, so this change is not expected to affect South Carolina’s limit.

The federal amounts that change each year (for example, the allowances for a spouse at home) will be updated on this page for 2027 once they are published.

State programs

Each program below has its own page with who qualifies, services, how to apply and waiting lists:

• South Carolina Community Choices Waiver
• South Carolina Healthy Connections Prime and Dual Plans

Frequently asked questions

What is the Community Choices Waiver? It is South Carolina’s Medicaid program for care at home for people 65 and older and adults with physical disabilities who need a nursing home level of care.

Is there a waiting list? There can be. When openings are available outside reserved slots, SCDHHS admits people in order of their application date.

What is the income limit? $2,982 a month in 2026. Ask SCDHHS whether a trust or another route is available if your income is higher.

How much can my spouse keep? South Carolina sets its own spousal share, plus the home, a car and belongings.

How long is the penalty for a gift? Divide the gift by $9,758.58 to get the number of months. A $20,000 gift would mean about 2 months without Medicaid payment for long-term care.

Will the state take my home after I die? SCDHHS can seek repayment for Medicaid paid after age 55, which can include the home. Recovery is put off while a spouse or a young or disabled child survives, and hardship waivers exist.

Figures change periodically. Double-check current amounts with SCDHHS before relying on them.

Sources

• SCDHHS, Program eligibility and income limits
• SCDHHS, Medicaid eligibility groups (2026)
• SCDHHS, Medicaid Bulletin, personal needs allowance (Oct. 1, 2025)
• SCDHHS, Medicaid Policy and Procedures Manual, Section 300
• SCDHHS, Community Choices Waiver
• SCDHHS, HCBS Waiver Summary Chart (January 2026).pdf
• Medicare.gov, Skilled nursing facility care
• CMS, 2026 SSI and spousal impoverishment standards
• Public Law 119-21 (2025)

Last updated for 2026. General information only, not legal or financial advice. Medicaid Answers is a free educational resource published by Medicaid Answers Foundation.