South Carolina Healthy Connections Prime and Dual Plans: South Carolina 2026 Guide

Healthy Connections Prime was South Carolina’s demonstration program for people 65 and older with both Medicare and Medicaid. It combined both benefits in one plan. CMS extended the demonstration through December 31, 2025. It ended on January 1, 2026, when members moved to Medicare Advantage dual eligible special needs plans (D-SNPs), including highly integrated plans (HIDE-SNPs) paired with an aligned Medicaid managed care plan.

This page explains, in plain language, who can get Healthy Connections Prime in 2026, what it pays for, how to apply, what to expect if there is a waiting list, and how it fits with nursing home Medicaid. For the full statewide rules on income, assets, spouses and the look-back, see our South Carolina Medicaid guide.

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

What Healthy Connections Prime is

Families still searching for Healthy Connections Prime are usually looking for a single plan that coordinates Medicare and Medicaid. Today that role is filled by D-SNPs offered in South Carolina, which coordinate Medicare benefits with the member’s Medicaid coverage. Long-Term Care Medicaid at home, such as the Community Choices Waiver, is still arranged through SCDHHS and CLTC, not through the Medicare plan.

For people with both Medicare and Medicaid, integration means one plan coordinating medical and long-term care. Federal policy now favors dual eligible special needs plans (D-SNPs) aligned with Medicaid plans. See Dual eligible special needs plans.

Who qualifies in 2026

To get Healthy Connections Prime, a person generally has to pass two separate tests, one about care need and one about money, and then receive an opening. In general, an applicant must:

have Medicare Parts A and B;
be eligible for South Carolina Medicaid;
live in a D-SNP’s service area; and
for waiver services, meet the separate Community Choices Waiver rules.

Income and assets. The financial side of Healthy Connections Prime follows South Carolina’s long-term care Medicaid rules. Savings, investments and real estate other than the home count; the home, a car, belongings and some burial funds usually do not. The five-year look-back on gifts and below-value transfers applies here too, so large gifts in the past five years can delay services.

For long-term care, South Carolina’s 2026 income limit is $2,982 a month and the single-person asset limit is $2,000. D-SNP enrollment itself depends on Medicaid eligibility, not on long-term care rules.

For reference, these are South Carolina’s key 2026 long-term care Medicaid figures:

Item	2026 figure
Income limit (applicant)	$2,982 a month
Asset limit (single applicant)	$2,000
Asset limit (couple, both applying)	$3,000
Home equity limit	$752,000
Spouse at home: resource allowance	$66,480 (South Carolina spousal share)
Spouse at home: monthly income allowance	Up to $4,066.50
Personal needs allowance (nursing home)	$60 a month (from October 1, 2025)
Look-back period	60 months (5 years)

If you are married. The spouse who stays home is protected: federal spousal impoverishment rules let them keep a share of the couple’s assets and, if their own income is low, part of the applicant’s income. The spousal allowance pages explain how these amounts are figured.

Services Healthy Connections Prime can cover

The plan covers long-term care services listed in the member’s plan of care, along with Medicaid medical benefits. Depending on assessed need, Healthy Connections Prime can include:

Medicare hospital, doctor and drug coverage through the D-SNP
care coordination between Medicare and Medicaid
extra benefits some plans offer, such as dental, vision or over-the-counter allowances
Long-Term Care Medicaid through SCDHHS, including the Community Choices Waiver and nursing facility care

Room and board is not included. Medicaid rules bar Healthy Connections Prime from paying rent and food, so anyone using it in a residential setting pays those costs from income. Family help is usually factored into the plan, and medical coverage runs alongside the waiver as before.

How to apply for Healthy Connections Prime

The usual sequence for Healthy Connections Prime is below. Running the financial application and the care assessment in parallel can shorten the wait.

Make sure the person is on South Carolina Medicaid.
Compare D-SNPs available in your county during an enrollment period. Dual eligibles have special enrollment opportunities.
Enroll in a plan through Medicare’s plan finder or the plan itself.
For home care, submit a Community Choices referral to SCDHHS.
Ask the plan’s care coordinator to work with the CLTC case manager.

Practical tips. Keep copies of everything you send and note the name of each person you speak with. Assessors only see one visit, so describe what a difficult day looks like and have a regular helper in the room. Cognitive problems and fall risk count toward need. If services are denied, the notice lists the deadline to appeal.

Waiting lists and timing

There is no waiting list for D-SNPs, but the Community Choices Waiver has one.

Starting the process early keeps options open if a wait develops. While waiting, other options can help: state plan personal care, adult day programs, PACE where offered, Older Americans Act services through the Area Agency on Aging, and family caregiver support. The waiver waiting lists page explains common rules.

How it relates to nursing home Medicaid

South Carolina Medicaid still pays for nursing facility care for people who qualify, separately from the Medicare plan, and Medicare covers short skilled nursing stays after a qualifying hospital stay.

Healthy Connections Prime usually covers both nursing facility care and care at home through the same plan, so moving between settings does not mean starting over. The same financial rules apply in both settings, but in a nursing facility most of the member’s income is paid toward care.

Tips for families

Network matters: check whether each plan includes the providers you already rely on. Keep the care plan on file, and treat any reduction notice as time-sensitive, since appeal windows are short. Five years of financial records are usually needed, and the look-back applies as with any long-term care Medicaid.

Working with a Certified Medicaid Planner is often the fastest way through Healthy Connections Prime. A planner who handles South Carolina cases regularly can spot eligibility problems before SCDHHS does, organize the records and help plan around any wait. Typical fees vary widely: help with an application alone often runs about $500 to $6,000, full planning about $2,500 to $15,000 or more, and hourly advice about $150 to $600.

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