What Are The Income Limits For Medicaid In SC?

The income limits for Medicaid in SC depend on the specific program you’re applying for, but understanding them is key to accessing essential healthcare benefits. At income-partners.net, we clarify these financial requirements and explore opportunities to navigate eligibility effectively, ensuring you can secure the support you need. Let’s delve into the details and discover pathways to accessing Medicaid benefits.

1. Understanding South Carolina Medicaid Long-Term Care

Medicaid provides healthcare for low-income individuals of all ages. Our primary focus is on long-term care Medicaid eligibility for South Carolina residents aged 65 and over. South Carolina Medicaid, known as Healthy Connections, covers care in nursing homes, community residential care facilities (assisted living facilities), and adult foster care homes. It also pays for non-medical services that enable seniors to live in their homes. South Carolina offers three categories of long-term care Medicaid programs:

• Institutional / Nursing Home Medicaid: An entitlement program providing benefits exclusively in nursing homes. Anyone who is eligible will receive assistance.

• Medicaid Waivers / Home and Community Based Services (HCBS): This program, which isn’t an entitlement, limits the number of participants and may involve waiting lists. It aims to prevent nursing home admissions by offering services at home, in adult day care, adult foster care, or community residential care facilities.

• Regular Medicaid / Aged Blind or Disabled (ABD): As an entitlement, anyone meeting the requirements receives benefits. This program provides long-term care services such as personal care assistance or adult day care.

The South Carolina Department of Health and Human Services (SCDHHS) administers the Medicaid program, which is jointly funded by the state and federal governments but managed by the state according to federal guidelines.

2. Income & Asset Limits for South Carolina Medicaid Eligibility

Financial and medical criteria for Medicaid long-term care programs vary across the three categories. These requirements fluctuate annually and depend on marital status. South Carolina provides multiple eligibility pathways, making the process complex.

Simplified Eligibility Criteria: Single Nursing Home Applicant.
In 2025, a single Medicaid Nursing Home applicant in South Carolina must meet the following criteria:

1. Income under $2,901 / month
2. Assets under $2,000
3. Require a Nursing Home Level of Care.

The following table provides a quick reference to help seniors determine if they may be immediately eligible for long-term care via a South Carolina Medicaid program. Remember, failing to meet all criteria does not necessarily disqualify you from Medicaid eligibility in SC.

2025 South Carolina Medicaid Long-Term Care Eligibility for Seniors
Type of Medicaid
Institutional / Nursing Home Medicaid
Medicaid Waivers / Home and Community Based Services
Regular Medicaid / Aged Blind or Disabled (eff. 3/1/25 – 2/28/26)

*All income, except for a $30 / month Personal Needs Allowance, Medicare premiums, and possibly a Needs Allowance for a non-applicant spouse, must be paid to the nursing home, known as Patient Liability. †Depending on living situation, a program beneficiary may not keep monthly income up to this level. ‡Eligibility for SSI automatically approves persons for Regular Medicaid, including long-term services and supports via Regular Medicaid, given one meets the functional criteria.

3. What is Countable Income for South Carolina Medicaid?

Nearly all income from any source that a Medicaid applicant receives counts toward Medicaid’s income limit, including wages, alimony, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. Some exceptions do exist. Holocaust restitution payments are not counted as income. Also, VA Aid & Attendance and Housebound Allowances that exceed the Basic VA Pension do not count.

4. How Does Medicaid Treat Income for Married Couples?

When only one spouse in a married couple applies for Nursing Home Medicaid or a Medicaid Waiver, only the applicant’s income counts toward the income limit. To prevent spousal impoverishment, the non-applicant spouse may be entitled to a Monthly Maintenance Needs Allowance (MMNA). In 2025, the MMNA in South Carolina is $3,948 / month. Income can be transferred from the applicant spouse to the non-applicant spouse to bring their monthly income up to this level if their income is below this amount. A non-applicant spouse with a monthly income of $3,948 or more is not entitled to a MMNA / Spousal Income Allowance.

For Regular Medicaid / Aged Blind or Disabled, the income of both spouses is calculated toward the applicant’s income eligibility. Additionally, the non-applicant spouse is not entitled to a Monthly Maintenance Needs Allowance.

5. What Assets are Countable vs. Non-Countable for South Carolina Medicaid?

Countable assets include cash, stocks, bonds, investments, bank accounts, and real estate in which one does not reside. Exempt assets include personal belongings, household furnishings, one vehicle, up to $1,500 per spouse in burial funds, life insurance policies with a cash surrender value up to a combined face value of $10,000, and generally one’s primary home. In South Carolina, IRAs / 401Ks of applicants are exempt if they are in “payout status,” meaning that one’s Required Minimum Distribution (RMD) is being withdrawn. IRAs / 401Ks of non-applicant spouses are automatically exempt.

6. How Does Medicaid Treat Assets for Married Couples?

All assets of a married couple are considered jointly owned, regardless of the long-term care Medicaid program. However, the non-applicant spouse of a Nursing Home Medicaid or Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). This Spousal Impoverishment Provision allows the community spouse to retain up to $66,480 of the couple’s assets in 2025.

7. Understanding Medicaid’s Look-Back Rule in South Carolina

It is essential to avoid giving away assets or selling them for under fair market value within 60 months of applying for Nursing Home Medicaid or a Medicaid Waiver in South Carolina. Such actions violate Medicaid’s Look-Back Rule, which reviews all asset transfers in the 60 months preceding the Medicaid application date. Violating this rule results in a Penalty Period of Medicaid ineligibility.

The U.S. Federal Gift Tax Rule does not extend to Medicaid eligibility. The gift tax rule allows gifting up to $19,000 per recipient in 2025 without filing a Gift Tax Return, but gifting under this rule violates Medicaid’s 5-year Look-Back Period.

8. What Are the South Carolina Medicaid Home Exemption Rules?

For home exemption, the Medicaid applicant or their spouse must live in their home. If there is no spouse in the home, there is a home equity interest limit of $730,000 (in 2025). Home equity is the value of the home after subtracting any outstanding debt against it. Equity interest is the amount of the home’s equity owned by the applicant. If neither the applicant nor their spouse lives in the home, the applicant must have Intent to Return. There is no home equity interest limit for Regular Medicaid.

Although one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s Estate Recovery Program. After a long-term care Medicaid beneficiary’s death, South Carolina’s Medicaid agency seeks reimbursement of care costs from the deceased’s remaining estate, often the home. Without proper planning, the home will be used to reimburse Medicaid for care rather than being inherited by family.

9. What Medical / Functional Needs Are Required for South Carolina Medicaid?

Applicants must have a medical need for long-term care Medicaid. Nursing Home Medicaid and Medicaid Waivers require a Nursing Facility Level of Care (NFLOC). Additional criteria may be required for specific program benefits. For example, home modifications covered by a waiver may require demonstrating an inability to live safely at home without the modifications. Long-term care services via the Regular Medicaid program require a functional need with Activities of Daily Living (ADLs), but not necessarily a NFLOC.

10. Qualifying for South Carolina Medicaid When Over the Limits

South Carolina residents aged 65 and over who do not meet the financial eligibility requirements can still qualify for Medicaid through the following methods.

1. Qualified Income Trusts (QIT’s): Also called Miller Trusts or Income Trusts in SC, QITs allow Medicaid applicants over the income limit (called a “Medicaid Cap” in SC) to become income-eligible for Nursing Home Medicaid or a Medicaid Waiver. Money deposited into this type of trust does not count toward Medicaid’s income limit. Excess income is deposited into a trust, and a trustee is named, giving that individual legal control of the money. Trust funds can only be used for specific purposes, such as long-term care services or medical expenses accrued by the Medicaid enrollee. The account must be irreversible, and the South Carolina Department of Health and Human Services must be listed as the remainder beneficiary.

2. Asset Spend Down: Individuals with countable assets exceeding South Carolina’s asset limit can “spend down” assets on non-countable ones. This includes home modifications (wheelchair ramps, roll-in showers, stair lifts), home improvements (replacing faulty wiring, updating plumbing, replacing water heaters), vehicle modifications (wheelchair lifts, adaptive control devices, floor modifications), prepaying funeral and burial expenses, and paying off debt. Assets cannot be gifted or sold under fair market value due to Medicaid’s Look-Back Rule. Documenting how assets were spent is recommended to prove this rule was not violated.

3. Medicaid Planning: Many individuals considering Medicaid are “over-income” and/or “over-asset” and cannot afford the cost of care. Medicaid planning helps families employ strategies to become Medicaid-eligible and protect their home from Medicaid’s Estate Recovery Program.

11. What Specific South Carolina Medicaid Programs Are Available?

In addition to nursing home care, South Carolina Medicaid offers the following programs relevant to the elderly:

1. South Carolina Community Choices Waiver: Provides assistance for elderly and disabled individuals requiring a level of care consistent with nursing homes but who wish to live in their own homes, adult foster care homes, or community residential care facilities. Benefits may include home modifications, adult day health care, specialized medical equipment, and assistance with Activities of Daily Living (ADLs).

2. Healthy Connections Prime: A managed care program providing long-term care services at home and in the community for persons who are “dual eligible” (eligible and enrolled in both Medicaid and Medicare).

3. Program of All-Inclusive Care for the Elderly (PACE): Combines Medicaid, including long-term care services, and Medicare benefits into one program, with additional benefits such as dental and eye care.

4. Money Follows the Person (MFP): Also called Home Again in South Carolina, this federal program helps institutionalized persons eligible for Medicaid transition back home or into the community.

12. How to Apply for South Carolina Medicaid

Seniors can apply for SC Medicaid online at Healthy Connections or submit required forms to their local Healthy Connections county office. Forms for Aged Blind or Disabled Medicaid are available here, and forms for Nursing Home Medicaid or Home and Community Based Services are here. The application process varies depending on the program, which can be confusing. For questions or assistance, contact the Healthy Connections Members Help Center at 888-549-0820.

Before applying, ensure all eligibility requirements are met. Medicaid planning can benefit those with excess income and/or resources. Understanding the application process for long-term care Medicaid is crucial.

13. What are Activities of Daily Living (ADLs)?

Activities of Daily Living (ADLs) are fundamental tasks that individuals must perform on a daily basis to maintain their health and well-being. These activities are often used as a measure of a person’s functional status, particularly in the context of healthcare and long-term care. Needing assistance with ADLs can significantly impact eligibility for various Medicaid programs, as they indicate the level of support an individual requires to live safely and comfortably.

The six basic ADLs include:

1. Bathing: The ability to wash oneself, including getting into and out of the shower or tub.

2. Dressing: The ability to put on and take off clothing, including fastening buttons and zippers.

3. Toileting: The ability to use the toilet, including getting on and off the toilet and managing personal hygiene.

4. Transferring: The ability to move from one position to another, such as getting in and out of bed or a chair.

5. Continence: The ability to control bowel and bladder functions.

6. Eating: The ability to feed oneself, including getting food from a plate to the mouth.

14. What is a Nursing Facility Level of Care (NFLOC)?

A Nursing Facility Level of Care (NFLOC) is a standard used to determine whether an individual requires the level of medical and personal care typically provided in a nursing home. This assessment is crucial for determining eligibility for many Medicaid programs, particularly those that cover long-term care services.

To qualify for a NFLOC, an individual typically needs to demonstrate a significant level of disability or medical complexity that necessitates continuous or regular skilled nursing care. The criteria for determining a NFLOC can vary by state, but generally include the following considerations:

1. Medical Condition: The individual has a medical condition that requires ongoing monitoring, treatment, and management by licensed healthcare professionals.

2. Functional Limitations: The individual has significant limitations in performing Activities of Daily Living (ADLs) such as bathing, dressing, toileting, transferring, continence, and eating. They may require assistance with most or all of these activities.

3. Cognitive Impairment: The individual has cognitive impairments, such as dementia or Alzheimer’s disease, that necessitate supervision and assistance to ensure their safety and well-being.

4. Need for Skilled Nursing Services: The individual requires skilled nursing services on a regular basis, such as medication administration, wound care, and monitoring of vital signs.

5. Therapeutic Needs: The individual requires specialized therapies, such as physical therapy, occupational therapy, or speech therapy, to maintain or improve their functional abilities.

15. How Can Income-Partners.Net Help With South Carolina Medicaid Eligibility?

Navigating the complexities of Medicaid eligibility in South Carolina can be overwhelming. At income-partners.net, we provide valuable resources and expert guidance to help you understand the income limits, asset requirements, and various pathways to qualify for Medicaid. Whether you’re seeking assistance with long-term care, home and community-based services, or regular Medicaid, our platform offers comprehensive information to empower you in making informed decisions.

Our services include:

1. Up-to-Date Information: Access the latest income and asset limits for different Medicaid programs in South Carolina, ensuring you have accurate data for your eligibility assessment.

2. Eligibility Assessment Tools: Utilize our interactive tools to evaluate your potential eligibility based on your income, assets, and medical needs.

3. Expert Guidance: Connect with our network of Medicaid planning professionals who can provide personalized advice and strategies to help you navigate the application process.

4. Resource Library: Explore our library of articles, guides, and videos that cover a wide range of topics related to Medicaid eligibility, including spend-down strategies, qualified income trusts, and estate planning.

5. Community Support: Engage with a supportive community of individuals and families who are also navigating the Medicaid system, sharing experiences and insights.

By leveraging the resources and expertise available at income-partners.net, you can gain a clear understanding of your Medicaid options in South Carolina and take proactive steps to secure the healthcare support you need.

FAQ About South Carolina Medicaid Income Limits

1. What is the income limit for Nursing Home Medicaid in South Carolina for a single applicant in 2025? The income limit is $2,901 per month.

2. What happens if my income exceeds the Medicaid limit in South Carolina? You may still qualify by using a Qualified Income Trust (QIT), also known as a Miller Trust.

3. Are there any income exceptions for Medicaid eligibility in South Carolina? Yes, Holocaust restitution payments and certain VA Aid & Attendance benefits are not counted as income.

4. How is income treated for married couples when only one spouse applies for Medicaid in South Carolina? Only the applicant’s income is counted. The non-applicant spouse may be entitled to a Monthly Maintenance Needs Allowance (MMNA).

5. What is the asset limit for a single applicant for Nursing Home Medicaid in South Carolina in 2025? The asset limit is $2,000.

6. What assets are exempt from Medicaid eligibility in South Carolina? Exempt assets include personal belongings, household furnishings, one vehicle, and certain burial funds and life insurance policies.

7. What is the Medicaid Look-Back Rule in South Carolina? The Look-Back Rule reviews asset transfers within 60 months of applying for Medicaid to ensure assets were not given away to become eligible.

8. How does the home exemption rule work for Medicaid in South Carolina? The applicant or their spouse must live in the home. If there’s no spouse, there’s a home equity interest limit of $730,000 in 2025.

9. What is a Nursing Facility Level of Care (NFLOC) and why is it important for Medicaid eligibility in South Carolina? NFLOC is a standard used to determine if an individual requires the level of care provided in a nursing home, which is essential for Nursing Home Medicaid and Medicaid Waivers.

10. How can income-partners.net help me understand South Carolina Medicaid eligibility? Income-partners.net provides resources, expert guidance, and tools to help you understand income limits, asset requirements, and various pathways to qualify for Medicaid in South Carolina.

Understanding the income limits for Medicaid in SC is crucial for accessing essential healthcare benefits. At income-partners.net, we are dedicated to providing clear, concise information and expert guidance to help you navigate the complexities of Medicaid eligibility. By exploring our resources and connecting with our network of professionals, you can confidently pursue the support you need to enhance your quality of life.

Ready to explore your Medicaid eligibility options? Visit income-partners.net today to discover how we can help you navigate the system, understand your opportunities, and connect with the resources you need. Don’t wait – take the first step toward securing your healthcare future now!