South Carolina Medicaid Eligibility for Long Term Care: Income & Asset Limits

Last updated: January 17, 2022

 

South Carolina Medicaid Definition

In South Carolina, Medicaid is called Healthy Connections. The program 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. While there are various coverage groups, including pregnant women, children, and disabled individuals, this page focuses on Medicaid eligibility, specifically long-term care, for South Carolina senior residents (aged 65 and over). In addition to providing care in nursing homes and assisted living facilities, SC Medicaid pays for non-medical services and supports to help frail seniors remain living in their homes.

  The American Council on Aging now offers a free, quick and easy Medicaid eligibility test for seniors.

 

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 varying financial and medical eligibility requirements, as well as 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; Anyone who is eligible will receive assistance. Benefits are provided only in nursing home facilities.

2) Medicaid Waivers / Home and Community Based Services (HCBS) – This is not an entitlement program; The number of participants is limited and wait lists may exist. Intended to delay the need for nursing home admissions, services are provided at home, adult day care, or in assisted living. More on Waivers.

3) Regular Medicaid / Aged Blind or Disabled (ABD) – This is an entitlement program; Meeting the eligibility requirements ensures one will receive benefits. Various long-term care services, such as personal care assistance or adult day care, may be available.

The table below provides a quick reference to allow seniors to determine if they might be immediately eligible for long term care from a South Carolina Medicaid program. Alternatively, one can take the Medicaid Eligibility Test. IMPORTANT: Not meeting all the criteria does not mean one is ineligible or cannot become eligible for Medicaid in SC. More.

2022 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 $2,523 / month* $2,000 Nursing Home $2,523 / month* $4,000 Nursing Home $2,523 / month for applicant* $2,000 for applicant & $66,480 for non-applicant Nursing Home
Medicaid Waivers / Home and Community Based Services $2,523 / month† $2,000 Nursing Home $2,523 / month† $4,000 Nursing Home $2,523 / month for applicant† $2,000 for applicant & $66,480 for non-applicant Nursing Home
Regular Medicaid / Aged Blind or Disabled $1,074 / month (eff. 3/1/21 – 2/28/22) $7,970 Help with ADLs $1,452 / month (eff. 3/1/21 – 2/28/22) $11,800 Help with ADLs $1,452 / month (eff. 3/1/21 – 2/28/22) $11,960 Help with ADLs
*All of a beneficiary’s income, with the exception of a personal needs allowance of $30 / month, Medicare premiums, and a monthly income allowance for a non-applicant spouse (if applicable), must go towards the cost of nursing home care.
†Based on one’s living setting, a program beneficiary may not be able keep monthly income up to this level.

 

What Defines “Income”

Any income that a Medicaid applicant receives is counted. This 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. Holocaust restitution payments and Covid-19 stimulus checks are not considered income and do not impact Medicaid eligibility.

When only one spouse of a married couple applies for nursing home Medicaid or a Medicaid Waiver, only the applicant’s income is counted. This means the income of the non-applicant spouse does not impact their spouse’s eligibility. The non-applicant spouse, however, may be entitled to a Minimum Monthly Maintenance Needs Allowance (MMMNA) from their applicant spouse to prevent spousal impoverishment. In 2022, the MMMNA in South Carolina is $3,435 / month. If a non-applicant spouse has monthly income under this amount, income can be transferred from the applicant spouse to the non-applicant spouse to bring their monthly income up to this level. A non-applicant spouse who already has a monthly income of $3,435 or more is not entitled to a MMMNA / spousal income allowance.

Income is counted differently when only one spouse applies for Regular Medicaid / Aged Blind or Disabled; The income of both the applicant spouse and non-applicant spouse is calculated towards the applicant’s income eligibility. More on how Medicaid counts income.

 

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. There are also many assets that are considered exempt (non-countable). Exemptions include personal belongings, such as clothing and jewelry, household furnishings, one vehicle, up to $1,500 per spouse in burial funds, the cash value of life insurance policies up to a combined face value of $10,000, and generally one’s primary home. For home exemption, one of two circumstances must be met. 1) The Medicaid applicant must live in the home or have intent to return, and in 2022, their home equity interest must not be more than $636,000. Equity interest is the amount of the home’s value owned by the applicant. OR 2) A non-applicant spouse lives in the home.

 While one’s home is generally exempt from Medicaid’s asset limit, it is not exempt from Medicaid’s estate recovery program. Following a long-term care Medicaid beneficiary’s death, South Carolina’s Medicaid agency attempts reimbursement of care costs through whatever estate of the deceased still remains. This is often the home. Without proper planning strategies in place, the home will be used to reimburse Medicaid for providing care rather than going to family as inheritance.

All assets of a married couple are considered jointly owned regardless of the long-term care Medicaid program for which one is applying. However, the non-applicant spouse of a nursing home Medicaid or Waiver applicant is permitted a Community Spouse Resource Allowance (CSRA). This is a spousal impoverishment provision, and in 2022, the community spouse (the non-applicant spouse) can retain up to $66,480 of the couple’s assets, as shown in the chart above.

It is vital that one does not give away assets or sell them for under fair market value within 60-months of applying for long-term care Medicaid in South Carolina. Doing so is a violation of Medicaid’s 5-year look-back rule, a period that immediately precedes one’s Medicaid application date in which all asset transfers are reviewed. Violating this rule results in a penalty period of Medicaid ineligibility.

 Non-Financial Eligibility Requirements – For South Carolina long-term care Medicaid eligibility, an applicant must have a functional need for such care. For nursing home Medicaid and Medicaid Waivers, a nursing facility level of care (NFLOC) is required. Furthermore, additional criteria may need to be met for specific program benefits. For example, for a Waiver to cover the cost of home modifications, an inability to safely live at home without modifications may be necessary. For long-term care services via the Regular Medicaid program, a functional need with the activities of daily living is required, but a NFLOC is not necessarily required.

 

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) – Also called Miller Trusts, or specifically Income Trusts in SC, QITs offer a way for Medicaid applicants over the Medicaid income limit (called a “Medicaid Cap” in SC) to still qualify for nursing home Medicaid or a Medicaid Waiver. For eligibility purposes, money deposited into this type of trust 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. Trust funds can only be used for very specific purposes, such as paying for long term care services / medical expenses accrued by the Medicaid enrollee. The account must be irreversible, meaning once it has been established, it cannot be changed or canceled, and the South Carolina Department of Health and Human Services must be listed as the remainder beneficiary.

2) Asset Spend Down – Persons who have assets over South Carolina’s asset limit can “spend down” assets on ones that are non-countable. Examples include making 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. Remember, assets cannot be gifted or sold under fair market value, as this violates Medicaid’s look back rule. It is recommended one keep documentation of how assets were spent as proof the look back rule was not violated.

 Our SC Medicaid spend down calculator can assist persons in determining if they might have a spend down, and if so, provide an estimate of the amount. Calculate your spend down.

3) Medicaid Planning – The majority of persons considering Medicaid are “over-income” or “over-asset” or both, but they still cannot afford their cost of care. For these persons, Medicaid planning exists. By working with a Medicaid planning professional, families can employ a variety of strategies to help them become Medicaid eligible, as well as to protect their home from Medicaid’s estate recovery program.  Read more or connect with a Medicaid planner.

 

Specific South Carolina Medicaid Programs

Like all states, South Carolina Medicaid pays for nursing home care for state residents who are medically and financially eligible for such care. SC Medicaid also offers Medicaid programs for seniors who require nursing home level care or have slightly lesser care requirements and do not wish to reside in a nursing home. These programs provide care at home or “in the community”.

1) South Carolina Community Choices Waiver – This 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, specialized medical equipment, and assistance with Activities of Daily Living (ADLs), such as bathing, mobility, and eating.

2) Program of All-Inclusive Care for the Elderly (PACE) – The benefits of Medicaid, including long-term care services, and Medicare are combined into one program. Additional benefits, such as dental and eye care, may be available.

 

How to Apply for South Carolina Medicaid

Seniors can apply for SC Medicaid online at Healthy Connections. Alternatively, they can complete and submit the required forms to their local Healthy Connections county office. Forms for Aged Blind or Disabled Medicaid can be found half way down this webpage. Forms for nursing home Medicaid or home and community based services via a Medicaid Waiver can be found at the bottom of this webpage. Since the application process varies based on the program for which a senior is applying, it can be confusing. For Medicaid related questions or for assistance, persons can contact Healthy Connections at 888-549-0820.

Prior to applying for long-term care Medicaid in South Carolina, it is imperative that seniors are certain all eligibility requirements are met. Persons who have income and / or resources in excess of the limit(s) can benefit from Medicaid planning for the best chance of acceptance into a Medicaid program. To learn more about the long-term care Medicaid application process, click here.

 

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