South Carolina Nursing Home Medicaid pays for a nursing home once Medicare’s short rehabilitation benefit runs out — but only after the family clears an income test, an asset test and a level-of-care assessment. This South Carolina nursing home medicaid guide gives the 2026 figures, what the spouse at home is allowed to keep, how the five-year look-back works, and where in South Carolina the application actually goes.
Every dollar figure below comes from the state Medicaid agency, CMS or the statute cited, and each resets on its own calendar. Where South Carolina has not published a current figure we say so instead of guessing.
In This South Carolina Nursing Home Medicaid Guide:
South Carolina Nursing Home Medicaid at a Glance (2026)
| Program | South Carolina calls its Medicaid program Healthy Connections, administered by the South Carolina Department of Health and Human Services (SCDHHS). Coverage for care in a nursing home falls under the agency’s Nursing Home / Institutional Medicaid category, sometimes described on SCDHHS materials simply as Nursing Facility Services. The single application covers Nursing Home care, Home and Community-Based waiver services, and Optional State Supplementation (OSS), so families often see all three names on the same paperwork. Long-term care generally is grouped by SCDHHS under “Long Term Living.” |
| 2026 income limit (single applicant) | $2,982 |
| 2026 asset limit (single applicant) | $2,000 |
| Spouse at home may keep (assets) | $32,532 to $162,660 — but see the South Carolina note below |
| Spouse at home income floor | $2,705 to $4,066.50 per month |
| Look-back period | 60 months |
| Penalty divisor | not published here yet — confirm with The South Carolina Department of Health and Human Services takes the application. Families may file online, mail it to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, fax it to [email protected], or hand it in at a local SCDHHS county eligibility office listed at scdhhs.gov/members/where-go-help. The Healthy Connections Members Help Center answers questions and helps complete the form at 1-888-549-0820, TTY 1-888-842-3620. Nursing facility business offices and hospital discharge planners commonly help families assemble and submit the packet. |
| Home equity limit (no spouse at home) | $752,000 (confirm with The South Carolina Department of Health and Human Services takes the application. Families may file online, mail it to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, fax it to [email protected], or hand it in at a local SCDHHS county eligibility office listed at scdhhs.gov/members/where-go-help. The Healthy Connections Members Help Center answers questions and helps complete the form at 1-888-549-0820, TTY 1-888-842-3620. Nursing facility business offices and hospital discharge planners commonly help families assemble and submit the packet.) |
| Over the income limit? | A qualified income trust (Miller trust) is required |
South Carolina Nursing Home Medicaid Income and Asset Limits
Two tests, both applied to the person entering the facility. The income test looks at gross monthly income from every source — Social Security, pensions, IRA withdrawals, annuities, rent. The asset test counts what can be turned into cash: bank accounts, investments, retirement accounts in most states, and any property other than the home.
South Carolina is an income-cap state. If the applicant’s gross monthly income is over the South Carolina nursing home medicaid limit by even a dollar, the application is denied unless a qualified income trust (a Miller trust) is set up first and funded every month.
South Carolina follows the familiar exemptions. The primary home is generally not counted while a spouse or certain dependent relatives live there, or while the resident intends to return home. One vehicle is excluded, along with ordinary personal belongings such as clothing and jewelry and normal household furnishings. Burial spaces are excluded, and set-aside burial funds and prepaid, irrevocable funeral arrangements are treated as non-countable within the state’s rules.
Life insurance is excluded only up to a limited combined face value; larger policies with cash value can count. Exact figures: UNVERIFIED.
South Carolina is an income-cap state for nursing home Medicaid, so an applicant whose gross monthly income exceeds the limit must use a Qualified Income Trust, known locally as an Income Trust or Miller Trust. SCDHHS supplies its own Income Trust Agreement form.
The applicant or an agent under power of attorney signs it, names a trustee who is not the applicant, obtains a tax identification number, and opens a dedicated bank account so the excess income is deposited there each month and paid toward care. The trust must be in place and funded before benefits run.
What the Spouse at Home Keeps Under South Carolina Nursing Home Medicaid
Federal spousal impoverishment rules stop South Carolina nursing home medicaid from bankrupting the husband or wife who stays home. The at-home spouse keeps a protected share of the couple’s assets — between $32,532 and $162,660 in 2026 — and is guaranteed a monthly income floor of at least $2,705, rising to $4,066.50 when housing costs are high. The house is fully exempt while the spouse lives in it.
South Carolina spouse rule: South Carolina does NOT use the 50% split: a single fixed CSRA of $66,480 (State Plan Amendment SC-25-0011; ACOA + MLTC 2026 pages).
South Carolina applies the standard federal spousal impoverishment protections without unusual local twists. At the time the ill spouse enters the facility, the couple’s countable resources are assessed together, and the spouse remaining at home is allowed to keep a Community Spouse Resource Allowance plus the exempt home.
The at-home spouse may also keep a monthly maintenance needs allowance drawn from the institutionalized spouse’s income when their own income is low, and may ask for more through a fair hearing when housing costs or medical expenses are unusually high. Amounts: UNVERIFIED.
The asset snapshot is taken on the first day of the continuous stay, not the application date. Families who spend down before asking for a resource assessment often spend money the spouse was entitled to keep.
The Look-Back Rule and Transfer Penalties
South Carolina reviews every transfer made in the 60 months before the application. Money or property given away, or sold for less than it was worth, is added up and divided by the state’s penalty divisor — its average private-pay nursing home cost — to produce a period during which South Carolina nursing home medicaid will not pay. The divisor in South Carolina is not published here yet — confirm with The South Carolina Department of Health and Human Services takes the application.
Families may file online, mail it to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, fax it to [email protected], or hand it in at a local SCDHHS county eligibility office listed at scdhhs.gov/members/where-go-help. The Healthy Connections Members Help Center answers questions and helps complete the form at 1-888-549-0820, TTY 1-888-842-3620. Nursing facility business offices and hospital discharge planners commonly help families assemble and submit the packet..
60 months, federal standard. The IRS annual gift exclusion has no bearing here: a gift that is tax-free can still trigger a Medicaid penalty. Transfers to a spouse, to a disabled child, or of the home to a child who lived there and provided care for two years are the main exceptions.
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How to Apply for South Carolina Nursing Home Medicaid
Where: The South Carolina Department of Health and Human Services takes the application. Families may file online, mail it to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, fax it to [email protected], or hand it in at a local SCDHHS county eligibility office listed at scdhhs.gov/members/where-go-help. The Healthy Connections Members Help Center answers questions and helps complete the form at 1-888-549-0820, TTY 1-888-842-3620. Nursing facility business offices and hospital discharge planners commonly help families assemble and submit the packet. — start the application.
Medical eligibility is decided separately from money. SCDHHS has designated Community Long Term Care (CLTC) to perform the preadmission review of everyone seeking Medicaid-paid nursing facility care, and that review must be done before Medicaid payment to the facility can begin. The vehicle is DHHS Form 1718, the Long Term Care Assessment, completed by a physician, nurse practitioner, or physician assistant and submitted to CLTC.
It documents diagnoses, medications, cognition, behavior, and how much help the person needs with daily activities such as bathing, dressing, toileting, eating, transferring, and mobility.
Bring five years of bank statements, deeds, vehicle titles, insurance policies, the Medicare and Social Security cards, and any trust or power of attorney documents. Missing paperwork is the most common reason a South Carolina nursing home medicaid decision is delayed.
While the Application Is Pending
The facility usually admits the resident and bills privately, through Medicare, or as a pending Medicaid account while SCDHHS works the case, then rebills Medicaid once approval comes through. Approval is retroactive to the eligibility begin date SCDHHS establishes, and the state’s rules allow a limited period of retroactive coverage for bills incurred before the application month, so families should keep every invoice.
Nursing facility payment cannot start before CLTC completes the level-of-care review. Typical decision time in weeks: UNVERIFIED, though cases needing a disability determination take substantially longer.
After approval, nearly all of the resident’s income goes to the facility each month as the patient share, minus a small personal needs allowance, health insurance premiums and the spouse’s allowance.
Denials, Appeals and What Comes After
Most denials are paperwork problems, not judgment calls: missing bank statements, deed or title documents, life insurance and burial contract information, or verification of a spouse’s income and resources, all of which stall the case until supplied.
Others involve uncompensated transfers of money or property found during the resource review, income above the cap with no funded Income Trust, or a CLTC finding that the applicant does not meet nursing facility level of care. To challenge a decision, or a case sitting too long without one, file with the SCDHHS Division of Appeals and Hearings.
One more thing families should know before they file: after the resident’s death, the state may seek repayment from the estate. That process — what it can reach and the exemptions — is covered in our guide to South Carolina Medicaid estate recovery.
A Realistic South Carolina Nursing Home Medicaid Timeline
Week one: the hospital or family calls the Medicaid office for the level-of-care assessment and starts gathering five years of statements. Weeks two to four: the assessment is done and the financial application is filed, usually with the facility’s admissions office helping. Weeks six to twelve: the caseworker verifies accounts and may ask for more documents; answer within the deadline on each request or the clock resets.
Approval, when it comes, is retroactive to the eligibility date, which is why filing early is the single most valuable thing a family can do.
Where to Get Help Free
Two free doors exist in every state: the South Carolina SHIP counselor for the Medicare side and the state’s Aging and Disability Resource Center for the Medicaid side. Neither sells anything. For a South Carolina nursing home medicaid question involving a house, a spouse at home or a recent gift, a local elder law attorney or legal aid office is the next call.
Key Takeaways: South Carolina Nursing Home Medicaid
- Two tests, not one: South Carolina nursing home medicaid checks income and assets separately, and passing one does not excuse the other.
- The spouse is protected: the at-home spouse keeps a share of assets and an income floor under South Carolina nursing home medicaid before anything is spent down.
- The look-back is five years: any gift inside it is divided by the divisor and becomes months without South Carolina nursing home medicaid coverage.
- The home usually does not count: while a spouse lives there, the house is exempt from the South Carolina nursing home medicaid asset test.
- Apply as Medicaid pending: most facilities admit while South Carolina nursing home medicaid is decided and the state pays back to the eligibility date.
- Assessment first: the level-of-care evaluation is what starts the South Carolina nursing home medicaid clock, so request it on day one.
- Retirement accounts often count: IRAs and 401(k)s are countable in most states under South Carolina nursing home medicaid unless in payout status.
- Income trust or spend-down: whether an over-income applicant needs a Miller trust is the first South Carolina nursing home medicaid question to settle.
- The resource snapshot matters: South Carolina nursing home medicaid measures the couple’s assets on the day the stay began, not the day you apply.
- Prepaid funerals are exempt: an irrevocable funeral trust is one of the few spend-downs South Carolina nursing home medicaid always allows.
Official Sources
- South Carolina calls its Medicaid program Healthy Connections, administered by the South Carolina Department of Health and Human Services (SCDHHS). Coverage for care in a nursing home falls under the agency’s Nursing Home / Institutional Medicaid category, sometimes described on SCDHHS materials simply as Nursing Facility Services. The single application covers Nursing Home care, Home and Community-Based waiver services, and Optional State Supplementation (OSS), so families often see all three names on the same paperwork. Long-term care generally is grouped by SCDHHS under “Long Term Living.” — South Carolina Medicaid: https://www.scdhhs.gov/members/program-eligibility-and-income-limits
- The South Carolina Department of Health and Human Services takes the application. Families may file online, mail it to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, fax it to [email protected], or hand it in at a local SCDHHS county eligibility office listed at scdhhs.gov/members/where-go-help. The Healthy Connections Members Help Center answers questions and helps complete the form at 1-888-549-0820, TTY 1-888-842-3620. Nursing facility business offices and hospital discharge planners commonly help families assemble and submit the packet.: https://www.scdhhs.gov/sites/dhhs/files/documents/FM%203401.pdf — this is DHHS Form 3401, “Application for Nursing Home, Residential or In-Home Care,” the form SCDHHS uses for long-term care Medicaid. Online filing starts at https://apply.scdhhs.gov. A supplemental form, DHHS Form 3400-B, is normally filed with it to report resources and transfers.
- Medicaid.gov spousal impoverishment standards: medicaid.gov
- Medicare.gov Medicare Savings Programs: medicare.gov
This South Carolina nursing home medicaid guide was checked against the state Medicaid agency, CMS and the statute cited above in September 2026. Figures reset on their own calendars (most on January 1); if a number here disagrees with a notice you received, the notice wins — and please tell us. This page is general information, not legal, financial or medical advice.