South Carolina Medicaid for seniors and long-term care

Last verified: June 2026

Long-term care eligibility for seniors in South Carolina

Seniors age 65 and older who require nursing facility-level care may qualify for Healthy Connections long-term care Medicaid. Eligibility requires meeting both a medical standard (needing nursing facility level of care) and a financial standard (income and assets below the limits).

The income limit for long-term care Healthy Connections is 300% of the Social Security Federal Benefit Rate — $2,982 per month for an individual as of January 1, 2026, per SCDHHS. There is a separate resource (asset) limit, generally $2,000 for a single individual. A community spouse — the husband or wife who remains at home — may retain a protected resource amount under federal spousal impoverishment rules.

• Must be a South Carolina resident
• Must be a U.S. citizen or qualified noncitizen
• Must require nursing facility level of care (determined by SCDHHS clinical assessment)
• Income at or below $2,982/month (individual, effective January 2026)
• Countable resources generally at or below $2,000 for a single individual
• Community spouse may retain protected resources — see federal spousal impoverishment rules

Community Long Term Care (CLTC): staying home instead of a nursing facility

South Carolina's Community Long Term Care (CLTC) program provides home and community-based services to eligible people who need nursing facility-level care but choose to remain at home or in community settings. CLTC is SCDHHS's primary HCBS waiver program for elderly and disabled adults.

Before you can apply for HCBS waiver services, SCDHHS requires a CLTC determination — a clinical assessment confirming that you meet the nursing facility level of care standard. This must be done before completing the financial application. Contact your local SCDHHS office or call CLTC at 1-888-549-0820 to request the assessment.

• Personal care assistance and attendant care
• Home health aide and skilled nursing visits
• Adult day care
• Respite care for family caregivers
• Medical supplies and equipment
• Home modifications (wheelchair ramps, grab bars)
• Homemaker services
• Care coordination and case management

Healthy Connections Prime for dual eligibles

South Carolinians who qualify for both Medicare and Healthy Connections Medicaid — called "dual eligibles" — may enroll in Healthy Connections Prime. This program integrates Medicare and Medicaid benefits under a single managed care organization, reducing the coordination complexity that typically burdens dual eligible members.

Healthy Connections Prime covers all Medicaid services, Medicare cost-sharing, long-term services and supports, and behavioral health services for enrolled members. Contact SCDHHS for information about available Prime plans in your county.

Estate recovery in South Carolina

SCDHHS operates an estate recovery program. The state may seek reimbursement from the estate of a Healthy Connections member who received long-term care services — nursing facility or HCBS waiver — after age 55. Recovery applies to the cost of those services paid by Medicaid, not to other Medicaid-covered health care. Consult an elder law attorney before transferring assets if a family member may need long-term care Medicaid in the near future.

Medicaid as the primary payer for long-term care

Medicare does not cover custodial nursing home care beyond 100 days following a qualifying hospital stay. Private long-term care insurance covers only those who purchased it. For the majority of Americans who need extended nursing home care, Medicaid ends up as the payer — after they have spent down their own assets to the program's limit.

Nationally, Medicaid pays for roughly two-thirds of all nursing home residents, per CMS data. South Carolina's share of that population is administered through South Carolina Medicaid (Healthy Connections). The rules that determine eligibility — income, assets, lookback periods, and exempt property — differ from the MAGI-based rules used for standard Medicaid.

Long-term care Medicaid also includes home and community-based services (HCBS), which allow people to receive care at home or in assisted living rather than a nursing facility. These programs operate through Section 1915(c) waivers and have waiting lists in most states.

Nursing facility coverage

South Carolina Medicaid (Healthy Connections) covers skilled nursing facility care for seniors who meet clinical and financial criteria. Clinical eligibility requires a documented need for skilled nursing care — typically assessed through a standardized instrument. Financial eligibility means income and countable assets fall within the program's limits.

Once approved, Medicaid pays the nursing home directly. The resident contributes most of their monthly income toward the cost of care — typically all income minus a personal needs allowance (which varies by state but is often $30–$50 per month). Medicaid covers the gap.

If income exceeds the institutional Medicaid limit, South Carolina may use a "Miller Trust" (qualified income trust) arrangement to route excess income through a trust account, making the person financially eligible. Not all states allow this; verify whether South Carolina uses this approach with South Carolina Medicaid (Healthy Connections).

Home and community-based services (HCBS)

HCBS waivers let states cover long-term care services outside nursing facilities — in a person's home, adult day program, or assisted living. Section 1915(c) of the Social Security Act authorizes these waivers. Each state designs its own waiver programs, so what's available through South Carolina Medicaid (Healthy Connections) differs from what's available in neighboring states.

Common HCBS services include personal care assistance, home health aide visits, adult day health care, respite care for family caregivers, and modifications to make a home accessible. Some states cap the number of waiver slots, creating waiting lists that can run for months or years.

Contact South Carolina Medicaid (Healthy Connections) to ask which HCBS waiver programs are currently open for enrollment and whether there is a waiting list.

Asset limits for long-term care Medicaid

Unlike MAGI-based Medicaid, long-term care Medicaid has an asset test. Countable assets — bank accounts, investments, second vehicles, vacation property — must fall below the state's limit. The specific threshold varies by state and is updated periodically; it is not a figure this page can reliably publish.

Exempt assets are not counted. The primary home is exempt while the applicant lives there or intends to return, as well as when a spouse, minor child, or disabled adult child lives there. One vehicle is typically exempt. Personal belongings and a prepaid funeral arrangement are also generally exempt.

Medicaid has a 60-month (5-year) lookback period for asset transfers. Transfers of assets for less than fair market value within those 60 months can result in a penalty period during which Medicaid will not pay for care. Consult South Carolina Medicaid (Healthy Connections) or a Medicaid planning attorney before transferring assets.

Spousal protections

When one spouse needs nursing home care, federal law protects the other spouse from complete impoverishment. The community spouse (the one still at home) is entitled to keep a minimum amount of assets — called the Community Spouse Resource Allowance (CSRA) — and a minimum monthly income.

The CSRA allows the community spouse to keep between a federal minimum and maximum, with the exact amount varying by state and updated annually. South Carolina's current CSRA is set by South Carolina Medicaid (Healthy Connections) and published on their website.

The community spouse's own income is not counted toward the institutionalized spouse's Medicaid eligibility. If the community spouse has insufficient income, a portion of the institutionalized spouse's income may be allocated to them — the minimum monthly maintenance needs allowance (MMMNA).

What long-term care Medicaid typically covers

• Skilled nursing facility care — room, board, nursing services, and most medical care in the facility
• Physical, occupational, and speech therapy provided in a nursing home
• Personal care assistance with daily activities (bathing, dressing, eating) through HCBS waivers
• Home health aide visits for those receiving care at home
• Adult day health care programs
• Respite care to give family caregivers temporary relief
• Durable medical equipment prescribed by a physician
• Transportation to and from medical appointments