South Carolina Medicaid Definition
In South Carolina, Medicaid is called Healthy Connections and is administered by the South Carolina Department of Health and Human Services (SCDHHS).
Medicaid is a wide-ranging, jointly funded state and federal health care program for low-income individuals of all ages. However, this page is focused on Medicaid eligibility for South Carolina elderly residents, aged 65 and over, and specifically for long term care, whether that be at home, in a nursing home, or in an assisted living facility.
Income & Asset Limits for Eligibility
There are several different Medicaid long-term care programs for which South Carolina seniors may be eligible. These programs have slightly different financial and medical eligibility requirements, as well as differing benefits. Further complicating eligibility are the facts that the requirements vary with marital status and that South Carolina offers multiple pathways towards Medicaid eligibility.
1) Institutional / Nursing Home Medicaid – this is an entitlement program, meaning anyone who is eligible will receive assistance, and is provided only in nursing home facilities.
2) Medicaid Waivers / Home and Community Based Services (HCBS) – these programs limit the number of participants. Therefore, wait lists may exist. Services are provided at home, adult day care, or in assisted living.
3) Regular Medicaid / Aged Blind and Disabled (ABD) – this is an entitlement program and is provided at home or adult day care.
The table below provides a quick reference to allow seniors to determine if they are immediately eligible for long term care from an South Carolina Medicaid program. Alternatively, take the Medicaid Eligibility Test. IMPORTANT, not meeting all the criteria below does not mean one is not eligible or cannot become eligible. More.
|2018 South Carolina Medicaid Long Term Care Eligibility for Seniors|
|Type of Medicaid||Single||Married (both spouses applying)||Married (one spouse applying)|
|Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required||Income Limit||Asset Limit||Level of Care Required|
|Institutional / Nursing Home Medicaid||$2,250 / month||$2,000||Nursing Home||$4,500 / month||$4,000||Nursing Home||$2,250 / month for applicant||$2,000 for applicant & $66,480 for non-applicant||Nursing Home|
|Medicaid Waivers / Home and Community Based Services||$2,250 / month||$2,000||Nursing Home||$4,500 / month||$4,000||Nursing Home||$2,250 / month for applicant||$2,000 for applicant & $66,480 for non-applicant||Nursing Home|
|Regular Medicaid / Aged Blind and Disabled||$1,012 / month||$7,560||None||$1,372/ month||$11,340||None||$1,012 / month||$7,560||None|
What Defines “Income”
For Medicaid eligibility purposes, any income that a Medicaid applicant receives is counted. To clarify, this income can come from any source. Examples include employment wages, alimony payments, Veteran’s benefits, pension payments, Social Security Disability Income, Social Security Income, IRA withdrawals, and stock dividends. That said, when only one spouse of a married couple is applying for Medicaid, only the income of the applicant is counted. Said another way, the income of the non-applicant spouse is not counted towards eligibility purposes. For married couples in South Carolina, with non-applicant spouses’ with insufficient income in which to live, there is what is called a Minimum Monthly Maintenance Needs Allowance (MMMNA). This is the minimum amount of monthly income to which the non-applicant spouse is entitled, and it allows applicant spouses to transfer a portion of their income to their non-applicant spouses. (As of July 2018, this figure falls between $2,057.50 / month and $3,090 / month). This rule prevents non-applicant spouses from becoming impoverished.
What Defines “Assets”
Countable assets include cash, stocks, bonds, investments, credit union, savings, and checking accounts, and real estate in which one does not reside. However, for Medicaid eligibility, there are many assets that are considered exempt (non-countable). Exemptions include personal belongings, such as clothing and jewelry, household furnishings, one vehicle, burial funds (up to $1,500 for the applicant and up to $1,500 for the applicant’s spouse in 2018), cash value of life insurance plans (up to a total maximum of $10,000 in 2018), and one’s primary home, given the Medicaid applicant or their spouse lives in the home and the equity value is under $572,000 (in 2018). For married couples, as of 2018, the community spouse (the non-applicant spouse) can retain up to a maximum of $66,480 of the couple’s joint assets, as the chart indicates above. This, in Medicaid terminology, is called the Community Spouse Resource Allowance (CSRA).
Please make note, it’s important that one does not give away assets or sell them for under fair market value in an attempt to meet South Carolina’s Medicaid asset limit. Doing so can violate Medicaid’s 5-year look-back rule, a period of 60 months from the date of application in which all past asset transfers are reviewed. If one is found to be in violation of this rule, a penalty period in which the applicant is ineligible for Medicaid benefits will result.
Qualifying When Over the Limits
For South Carolina elderly residents, aged 65 and over, who do not meet the eligibility requirements in the table above, there are other ways to qualify for Medicaid.
1) Qualified Income Trusts (QIT’s) – QIT’s, also referred to as Miller Trusts, are special trusts for Medicaid applicants who are over the income limit (also known as the “Medicaid Cap” in South Carolina), but still cannot afford to pay for their long-term care. (For South Carolina Medicaid purposes, a Miller Trust is often simply called an Income Trust.) This type of trust offers a way for individuals over the Medicaid income limit to still qualify for long-term care Medicaid, as money deposited into a QIT does not count towards Medicaid’s income limit. In simple terms, one’s excess income (over the Medicaid Cap) is directly deposited into a trust, in which a trustee is named, giving that individual legal control of the money. The account must be irreversible, meaning once it has been established, it cannot be changed or canceled, and must have South Carolina Department of Health and Human Services listed as the remainder beneficiary. In addition, the money in the account can only be used for very specific purposes, such as paying long term care services / medical expenses accrued by the Medicaid enrollee. As previously stated, the income in this account is exempt from Medicaid’s income limit.
Unfortunately, Income Only Trusts do not assist one with extra assets in qualifying for Medicaid. Said another way, if one meets the income requirements for Medicaid eligibility, but not the asset requirement, the above option cannot assist one in reducing their extra assets. However, one can “spend down” assets by spending excess assets on non-countable assets, such as home modifications (wheelchair ramps, roll-in showers, and stair lifts), home improvements (replacing faulty electrical wiring, updating plumbing, and replacing old water heaters), vehicle modifications (wheelchair lifts, adaptive control devices, and floor modifications to allow one to drive from a wheelchair), prepaying funeral and burial expenses, and paying off debt.
2) Medicaid Planning – the majority of persons considering Medicaid are “over-income” or “over-asset” or both, but still cannot afford their cost of care. For persons in this situation, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible. Read more or connect with a Medicaid planner.
Specific South Carolina Medicaid Programs
1. South Carolina Community Choices Waiver – Provides assistance for elderly and disabled individuals who require a level of care consistent to that which is provided in a nursing home, but who wish to remain living in their own homes. A variety of benefits are available, including home modifications, adult day care, durable medical equipment, and assistance with Activities of Daily Living (ADLs), such as bathing, mobility, and eating.
2. South Carolina Community Supports – Intended for South Carolina residents who are intellectually disabled or have a related disability. Program participants are able to self-direct their own care, including hiring select relatives to provide personal care services.