For seniors and their loved ones in South Carolina, Medicaid can be an amazing option to help pay for senior and long-term care, including care at home or in a senior community setting. South Carolina’s state Medicaid program is called Healthy Connections, and is administered by the South Carolina Department of Health and Human Services (SCDHHS), which provides coverage for eligible South Carolina seniors using a combination of state and federal funds. A variety of older individuals are eligible for coverage under Healthy Connections, including those with very low or no income, individuals suffering from blindness or other qualified disabilities, individuals who need nursing home care, and South Carolinians over the age of 65. To learn more about what seniors are eligible for Medicaid under Healthy Connections, as well as what services are covered and how to apply for them, read our guide below or reach out to the Sunbound team for more information.

Who is eligible for South Carolina Medicaid

South Carolina Medicaid provides coverage to a wide range of individuals, including South Carolina seniors aged 65 and above and those in need of nursing home care. While South Carolina offers a variety of Medicaid programs, the focus of this article is on South Carolina Medicaid Eligibility requirements for seniors looking for long-term care whether offered at home or in a facility such as a senior living community such as an assisted living community or residential care facility. Like with other states we’ve covered on the blog, Medicaid eligibility in South Carolina focuses on two main components: financial eligibility and medical eligibility.  

Financial Eligibility Requirements

In order to be eligible for Medicaid in South Carolina a senior must demonstrate limited financial resources, which is determined by looking at both their monthly income and their total assets. These two requirements, assets and income, will be different depending on whether an individual is single or married, and if married, whether both spouses are applying or just one. In 2023 the Medicaid income eligibility limit for a single individual applying is $2,742 per month whether they are single or are married and their spouse is not applying, and for a married individual where both spouses are applying the income limit is $5,484.

Just like with monthly income, South Carolina also imposes an asset cap for Medicaid eligibility. In 2023 for single applicants and married applicants where only one spouse is applying, the asset limit is $2,000 and for married applicants where both spouses are applying the limit is $4,000. While this limit may seem low, only certain assets count towards this limit. Generally, the assets that count towards this limit are cash and other bank accounts, investment accounts such as stocks and bonds, and real estate that is not the individual’s (or the couple’s) primary residence. Assets that are exempted from the South Carolina Medicaid asset limit include the first $688,000 in home equity of the applicant’s primary residence, personal belongings like clothing and jewelry, and the applicant’s car. Other excluded assets include up to $1,500 per spouse in burial funds and the value of life insurance policies up to $10,000.

One very important thing to remember for married couples where only one spouse is applying is that there are rules that allow the applicant spouse to transfer a portion of their income and assets to the non-applicant spouse. These rules, known as the Monthly Maintenance Needs Allowance (or MMNA) for income and the Community Spouse Resource Allowance (CSRA) for income, serve two related purposes. First, they allow the applicant spouse to reduce their income or assets to a level where they can be deemed eligible for Medicaid coverage. Relatedly, the second benefit of these exceptions is that they ensure that the non-applicant spouse will not need to impoverish themself just so that their spouse can be eligible for Medicaid coverage.

Medical Eligibility Requirements

In addition to the above financial eligibility requirements, South Carolina seniors must also demonstrate that they require a Nursing Facility Level of Care in order to qualify for Medicaid. This determination will be made as part of a pre-admission screening in which it will be determined whether the senior applicant has trouble accomplishing their Activities of Daily Living, which are: bathing and showering; continence and bladder control; dressing; mobility in and out of furniture; feeding and preparing food; and toileting independently. 

Types of South Carolina Medicaid programs

South Carolina Medicaid offers three main types of coverage options: Managed Care, Waiver Services, and Support Services. Each service provides different services to different individuals based on their eligibility qualifications and required care. 

Managed Care 

Many seniors who are enrolled in Healthy Connections in South Carolina will be enrolled in a Managed Care Organization which will provide most of their Medicaid-funded healthcare services. The exact benefits that a senior receives will be determined by their specific MCO plan. Managed Care options also include the ability to enroll in Medicare-Medicaid Plans (MMPs) through a program called Health Connections Prime. This program is open to South Carolina seniors aged 65 or older who are not currently residing in a nursing facility. 

Managed Care options also include South Carolina’s Program for All-Inclusive Care for the Elderly, known by its popular acronym PACE. This program is open to individuals aged 55 and above who require nursing home level of care, and is designed to allow them to live in their communities and therefore avoid the move to a nursing home facility.

Waiver Services

Waiver services programs in South Carolina are designed to help individuals with disabilities or chronic health conditions and allow healthcare professionals to provide care to seniors in their homes instead of requiring them to move to a long-term care facility. These Community Long Term Care programs are open to individuals who need care, live at home, and are eligible for Medicaid. The waiver service most likely to help South Carolina seniors is the Home and Community-Based Service waiver (known by the popular acronym HCBS) which are open to South Carolina seniors who are elderly, disabled, and require a nursing facility level of care.

Support Services

The South Carolina Medicaid support service most likely to assist seniors is the Home Again program, which is designed to allow South Carolina seniors who are living in a skilled nursing facility or hospital to move back to their homes. This program is open to seniors who currently reside in a nursing facility or hospital, meet either Intermediate or Skilled Level of Care, have been on Medicaid payment for at least one day, and who have been in the nursing facility or hospital for at least 60 consecutive days.

How to apply for South Carolina Medicaid 

If you or your senior loved one is eligible for South Carolina Medicaid, you can start your application online or apply in person at your local county office. If you have any questions, you can always reach out to Sunbound or call the Healthy Connections main customer service line at (888) 549-0820. Before applying, make sure that you know the following information in order to complete your application.

‍Date of birth

Social Security Number

Income from jobs or training

Benefits received now or in the past such as Social Security, Supplemental Security Income (SSI), veteran’s benefits, or child support

Amount of money in your bank accounts and the value of other assets you own

Monthly rent, mortgage, and utility bills

Payments for adult or child care health coverage and/or medical benefits

To learn more about how Sunbound can help make senior living more affordable for you or your loved one, send us an email at info@sunboundhomes.com or request more information on Sunbound. Sunbound is the best way to pay for senior living and is on a mission to make senior living affordable for everyone.