South Carolina Medicaid (Healthy Connections) Long Term Care Programs, Benefits & Eligibility

Summary
Medicaid’s rules, benefits and name can all vary by state. In South Carolina, Medicaid is called Healthy Connections. This article focuses on South Carolina Medicaid Long Term Care for seniors, which will pay for care in a nursing home, a beneficiary’s home and other settings through one of three programs – Nursing Home Medicaid, HCBS Waivers or ABD Medicaid. This is different than regular Medicaid, which is for financially limited people of all ages.

Last Updated: Mar 11, 2024

South Carolina Medicaid Long Term Care Programs Nursing Home Care Care at Home via HCBS Waivers Care at Home via ABD Medicaid Eligibility Criteria Nursing Homes HCBS Waivers ABD Medicaid How Medicaid Treats the Home Applying Choosing a Nursing Home

South Carolina Medicaid Long Term Care Programs

Nursing Home / Institutional Medicaid

South Carolina Medicaid, which is called Healthy Connections, will cover the cost of long-term care in a nursing home for financially limited South Carolina seniors who require a Nursing Facility Level of Care. Coverage includes payment for room and board, as well as all necessary medical and non-medical goods and services, such as:

Personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting)
Skilled nursing care
Physician’s visits
Prescription medication
Medication management
Mental health counseling
Social activities

Items not covered include a private room, specialized food, comfort items not considered routine (tobacco, sweets and cosmetics, for example) and any care services not considered medically necessary.

South Carolina Nursing Home Medicaid beneficiaries are required to give most of their income to the state to help cover care expenses. They are only allowed to keep a “personal needs allowance” (PNA) of $30/month, which can be spent on personal items such as clothes, snacks, books, haircuts, flowers, etc. They can also keep enough of their income to make Medicare premium payments if they are dual eligible, and enough to make any Medicaid-approved spousal income allowance payments to financially needy spouses who are not Medicaid applicants or recipients.

South Carolina Nursing Home Medicaid is an entitlement. This means all qualified applicants are guaranteed by law, aka “entitled,” to receive benefits without wait. However, not all nursing homes accept Medicaid, and those that do may not have any available spaces when you or your loved one needs care. So, eligible applicants are guaranteed nursing home coverage without wait, but they are not guaranteed coverage in any facility they choose.

A Nursing Home Alternative – South Carolina Nursing Home Medicaid beneficiaries who want to leave their nursing home and return to living “in the community” can receive financial and functional help with that transition through South Carolina’s Money Follows the Person program (MFP). This help can include paying for moving expenses, as well as long-term care services and supports in the new residence. MFP beneficiaries must be moving from a Medicaid-approved facility and into their own home, the home of a relative or a small group home with a maximum of four unrelated residents. In South Carolina, MFP is called Home Again.

Home and Community Based Services (HCBS) Waivers

Home and Community Based Services (HCBS) Waivers will pay for long-term care services and supports that help financially limited South Carolina seniors who require a Nursing Facility Level of Care remain living in the community instead of moving to a nursing home. The word “waiver” means something like voucher in this instance. Think of it as a voucher that will pay for long-term care services for South Carolina residents who live in their own home, the home of a loved one, an adult foster care home or an assisted living residence. While South Carolina HCBS Waivers may cover some long-term care services and supports in those settings, they will not cover room and board costs.

The HCBS Waiver relevant to South Carolina seniors is the South Carolina Community Choices Waiver.

South Carolina Community Choices Waiver
The South Carolina Community Choices Waiver, which is also referred to as Community Choices, covers long-term care services and supports for qualified South Carolina seniors who require a Nursing Facility Level of Care but live in their own home, the home of a loved one, an adult foster care home or an assisted living residence (also called a community residential care facility).

Community Choices Waiver benefits include adult day care, home modifications, specialized medical equipment, meal delivery, Personal Emergency Response Systems and personal care assistance with the Activities of Daily Living (mobility, bathing, dressing, eating, toileting). These benefits will be made available depending on the needs and circumstances of each individual.

Unlike Nursing Home Medicaid, most HCBS Waivers are not an entitlement. Instead, they have a limited number of enrollment spots and once those spots are full additional applicants are placed on a waitlist. The Community Choices Waiver had 26,651 enrollment spots as of 2023.

Aged, Blind, and Disabled (ABD) Medicaid

South Carolina’s Aged, Blind, and Disabled (ABD) Medicaid provides healthcare coverage and long-term care services and supports to financially limited South Carolina residents who are aged (65 and over), blind or disabled and live in the community. ABD Medicaid can sometimes be referred to as regular Medicaid for seniors, but it should not be confused with the regular Medicaid that is available for financially limited people of all ages. ABD Medicaid is an entitlement, which means that anyone who meets the requirements is guaranteed by law to receive healthcare coverage without wait. Access to long-term care benefits via ABD Medicaid depends on the availability of funds, programs and caregivers in the area where the beneficiary lives.

1. ABD Long Term Care Benefits
South Carolina seniors who show a medical need for long-term care services and supports can receive those services and supports through ABD Medicaid. These benefits can include in-home personal care, adult day care, meal delivery, home modifications and Personal Emergency Response Systems (PERS). ABD Medicaid beneficiaries qualify for these benefits one at a time. This is different from Nursing Home Medicaid, which makes all of its services immediately available for anyone who qualifies. Instead, South Carolina seniors will be evaluated by the state to determine what kind of long-term care benefits they need and will receive.

2. Program of All-Inclusive Care for the Elderly (PACE)
South Carolina residents who are age 55 or older and have ABD Medicaid can cover their medical, social service and non-medical personal needs with one comprehensive plan and delivery system using the Program of All-Inclusive Care for the Elderly (PACE). PACE program participants are required to need a Nursing Facility Level of Care, but they must live in the community. South Carolina’s PACE programs can be used by people who are “dual eligible” for Medicaid and Medicare, and it will coordinate the care and benefits from those two programs into one plan. PACE also administers vision and dental care, and PACE day centers provide meals, social activities, exercise programs and regular health checkups and services to program participants. South Carolina’s PACE programs are located in Orangeburg (Orangeburg Senior Helping Center), Columbia (Prisma Health SeniorCare PACE – Midlands) and Greenville (Prisma Health SeniorCare PACE – Upstate). To learn more about PACE, click here.

Eligibility Criteria For South Carolina Medicaid Long Term Care Programs

To be eligible for Healthy Connections (South Carolina Medicaid), a person has to meet certain financial and functional (medical) requirements. The financial requirements vary by the applicant’s marital status, if their spouse is also applying for Medicaid and what program they are applying for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

Just For You: The easiest way to find the most current Healthy Connections (South Carolina Medicaid) eligibility criteria for your specific situation is to use our Medicaid Eligibility Requirements Finder tool.

South Carolina Nursing Home Medicaid Eligibility Criteria

Financial Requirements
South Carolina residents have to meet an asset limit and an income limit in order to be financially eligible for nursing home coverage through Healthy Connections (South Carolina Medicaid). For a single applicant in 2024, the asset limit is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Treats the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for South Carolina Nursing Home Medicaid for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income. However, South Carolina Nursing Home Medicaid recipients are required to give most of their income to the state to help cover the cost of care. They are only allowed to keep $30/month of their income as a “personal needs allowance,” plus enough to make Medicare premium payments if they are “dual eligible,” and they can make any allowable spousal income allowance payments to financially needy, non-applicant spouses.

For married applicants with both spouses applying, the 2024 asset limit for nursing home coverage through Healthy Connections is a combined $4,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $66,480 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for South Carolina Nursing Home Medicaid applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, South Carolina has a Look-Back Period of five years. This means the state will look back into the previous five years of the Nursing Home Medicaid applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for nursing home coverage through Healthy Connections (South Carolina Medicaid) is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that can only be provided in a nursing home. To determine if the Nursing Facility Level of Care requirement is for Medicaid purposes, South Carolina assesses an applicants ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

South Carolina Medicaid Home and Community Based Services (HCBS) Waivers Eligibility Criteria

Financial Requirements
South Carolina residents have to meet an an asset limit and an income limit in order to be financially eligible for Home and Community Based Services (HCBS) Waivers. For a single applicant in 2024, the asset limit for HCBS Waivers in South Carolina is $2,000, which means they must have $2,000 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The 2024 income limit for HCBS Waivers in South Carolina for a single applicant is $2,829/month. Almost all income is counted – IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc. COVID-19 stimulus checks and Holocaust restitution payments are not considered income.

For married applicants with both spouses applying, the 2024 asset limit for HCBS Waivers in South Carolina is a combined $4,000, and the income limit is a combined $5,658/month. For a married applicant with just one spouse applying, the 2024 asset limit is $2,000 for the applicant spouse and $66,480 for the non-applicant spouse, thanks to the Community Spouse Resource Allowance. The 2024 income limit is $2,829/month for the applicant, and the income of the non-applicant spouse is not counted.

Plan Ahead: There are alternative pathways to eligibility for South Carolina HCBS Waiver applicants who don’t meet their financial limits, such as Medicaid Planning. However, applicants are not allowed to simply give away their assets in order to get under the asset limit. To make sure they don’t, South Carolina has a Look-Back Period of five years. This means the state will look back into the previous five years of the HCBS Waiver applicant’s financial records to make sure they have not given away assets.

Functional Requirements
The functional, or medical, criteria for Home and Community Based Service (HCBS) Waivers in South Carolina is needing a Nursing Facility Level of Care (NFLOC), which means the applicant requires the kind of full-time care that is normally associated with a nursing home. To determine if the Nursing Facility Level of Care requirement is for Medicaid purposes, South Carolina assesses an applicants ability to complete the Activities of Daily Living (mobility, bathing, dressing, eating, toileting).

South Carolina Aged, Blind, and Disabled Medicaid Eligibility Criteria

Financial Requirements
South Carolina residents have to meet an asset limit and an income limit in order to be financially eligible for Aged, Blind, and Disabled (ABD) Medicaid through Healthy Connections (South Carolina Medicaid). For a single applicant, the 2024 asset limit is $9,430, which means they must have $9,430 or less in countable assets. Countable assets include bank accounts, retirement accounts, stocks, bonds, certificates of deposit, cash and any other assets that can be easily converted to cash. An applicant’s home does not always count as an asset (see the How Medicaid Counts the Home section below for more details), and there are other non-countable assets, like Irrevocable Funeral Trusts and Medicaid Compliant Annuities.

The income limit for South Carolina ABD Medicaid for a single applicant from March 2024 to Feb. 2025 is $1,255/month. Almost all income is counted (IRA payments, pension payments, Social Security benefits, property income, alimony, wages, salary, stock dividends, etc.) other than COVID-19 stimulus checks and Holocaust restitution payments.

For married applicants, the 2024 asset limit for South Carolina ABD Medicaid is a combined $14,130, and the income limit is a combined $1,703/month from March 2024 to Feb. 2025. These limits apply to married couples with both spouses applying and married couples with just one spouse applying.

Plan Ahead: There are alternative pathways to eligibility for South Carolina ABD Medicaid applicants who are over the asset limit and/or the income limit, such as Medicaid Planning. While South Carolina has a Look-Back Period of five years for Nursing Home Medicaid and Home and Community Based Services Waivers applicants to make sure they don’t give away their assets to get under the limit, there is no Look-Back Period period for ABD Medicaid applicants. However, ABD applicants should be cautious about giving away their assets. They might eventually need Nursing Home Medicaid, or an HCBS Waiver, and those programs will deny or penalize the applicant for giving away assets.

Functional Requirements
The only functional requirement to receive basic healthcare coverage through South Carolina ABD Medicaid is being aged (65 and over), blind or disabled. For ABD Medicaid applicants and beneficiaries who require long-term care services and supports, the state will administer an assessment of their ability to perform Activities of Daily Living (mobility, bathing, dressing, eating, toileting) and Instrumental Activities of Daily Living (which include shopping, cooking, housekeeping and medication management) to determine the kind of long-term care benefits the state will cover.

How South Carolina Medicaid Treats the Home for Eligibility Purposes

One’s home is often their most valuable asset, and if counted toward Medicaid’s asset limit, it would likely cause them to be over the limit. However, in many situations the home is not counted against the asset limit:

If the applicant lives in their home and the home equity interest (the portion of the home’s equity value that the applicant owns minus any outstanding mortgage/debt) is less than $713,000 (as of 2024) then the home is exempt.
If the applicant’s spouse, minor child, or blind or disabled child of any age lives there, the home is exempt regardless of the applicant’s home equity interest, and regardless of where the applicant lives.
If none of the above-mentioned people live in the home, the home can be exempt if the applicant/beneficiary files an “intent to return” home and the home equity interest is at or below $713,000.

These rules apply to all three types of Medicaid, with one important exception – ABD Medicaid applicants can disregard the home equity limit. Value does not matter regarding their home’s exempt status. To learn more about the impact of home ownership on Medicaid eligibility, click here.

South Carolina Medicaid Long Term Care applicants and recipients may also want to consider protecting their home (and other assets) from estate recovery. States are required by law to try and collect reimbursement for long-term care after the death of Medicaid recipients. They do this through their Medicaid Estate Recovery Programs (MERPs). The rules and regulations regarding estate recovery can vary greatly by state, but all states have a MERP. To learn more about the MERP in South Carolina and how you can protect your home from it, click here.

Applying For South Carolina Medicaid Long Term Care Programs

The first step in applying for Healthy Connections (South Carolina Medicaid) Long Term Care coverage is deciding which of the three Medicaid programs discussed above you or your loved one wants to apply for – Nursing Home Medicaid, Home and Community Based Services (HCBS) Waivers or Aged, Blind, and Disabled (ABD) Medicaid.

The second step is determining if the applicant meets the financial and functional criteria, also discussed above, for that Long Term Care program. Applying for Healthy Connections when not financially eligible will result in the application, and benefits, being denied.

During the process of determining financial eligibility, it’s important to start gathering documentation that clearly details the financial situation for the Healthy Connections applicant. These documents will be needed for the official Medicaid application. Necessary documents may include tax forms, Social Security benefits letters, deeds to the home, proof of life insurance and quarterly statements for all bank accounts, retirement accounts and investments. For a complete list of documents you might need to submit with your Medicaid Long Term Care application, go to our Medicaid Application Documents Checklist.

After financial eligibility requirements are checked and double checked, documentation is gathered, and functional eligibility is clarified, South Carolina residents can apply for Healthy Connections online. They can also download and complete forms for nursing home coverage or the Community Choices Waiver on this webpage and submit them to their local Healthy Connections county office.

For step-by-step guides to applying for each of the three types of Medicaid Long Term Care, just click on the name: 1) Nursing Home Medicaid 2) HCBS Waivers 3) ABD Medicaid.

Professional Help: Many seniors need support when it comes to Medicaid Long Term Care’s rules, benefits and application process. These are all complicated, constantly changing and vary by state. The best place to get help with Medicaid Long Term Care is through a professional like a Certified Medicaid Planner or an Elder Law Attorney.

Choosing a South Carolina Medicaid Nursing Home

After being approved for nursing home coverage through Healthy Connections (South Carolina Medicaid), you or your loved one has to choose which Medicaid-accepting nursing home best meets your needs. Even though Nursing Home Medicaid is an entitlement, not all nursing homes accept Medicaid, and those that do may not have available spaces. Finding the right residence can be a chore, especially if you’re looking in a specific location.

South Carolina has about 150 nursing homes that accept Medicaid, and they are spread throughout the state. The Upstate region has roughly 40 facilities with clusters around Greenville, Spartanburg and Rock Hill. There are about 20 nursing homes within 25 miles of Columbia. But there are only a dozen or so nursing homes that take Medicaid within 25 miles of Charleston, which is the state’s most densely populated area. There are almost as many facilities around Myrtle Beach, which has eight facilities within 25 miles.

Residents in some South Carolina communities regularly cross state lines for personal and business reasons, including healthcare. But Medicaid coverage does not cross state lines. So, someone with Healthy Connections would not be covered for nursing homes in Charlotte, North Carolina, or Savanna, Georgia, even if the facilities in those places were convenient or well-suited for the South Carolina resident.

TOOLS: South Carolina residents can find and compare nursing homes using this search tool from the South Carolina Department on Aging. They can also use Nursing Home Compare, which is a search tool administered by the Centers for Medicare & Medicaid Services (CMS) that has information on more than 15,000 nursing homes across the country.

After you’ve found nursing homes that meet your needs and accept Medicaid, you can start comparing them, if you have multiple options. The search on Nursing Home Compare can be filtered by staffing, health inspections, quality measures and overall rating, which can be a good place to start. The healthcare professionals who work with you are another great source of information. And you can contact your local Area Agency on Aging to find more information on nursing homes in the state.

After doing some research, you or someone you trust should visit any nursing homes you’re considering before making a final decision. Call first to make an appointment for the visit, and arrive with a list of questions, like: How does the facility handle dental and vision care? Does it offer social activities? What is the food like? Who are the staff doctors? CMS has a comprehensive “Nursing home checklist” you can use to evaluate a nursing home while visiting.

CMS data collected from 2019-2022 shows that nursing homes in South Carolina fare well in terms of health conditions, fire safety and resident well-being. South Carolina nursing homes averaged 1.8 fire safety violations per facility from 2019-2022, which is significantly better than the national average of 13.5. During that same time frame, nursing homes in South Carolina averaged 15.9 health deficiencies, while the national average was 25.7. And only 3% of residents in South Carolina nursing homes had depressive symptoms, and the national average was 8.1%.