South Carolina Medicaid (Healthy Connections) Community Choices Waiver

Last updated: October 19, 2021

 

Overview of South Carolina’s Community Choices Waiver

The South Carolina Community Choices Waiver provides home and community-based services (HCBS) for seniors and disabled adults who require assistance with their activities of daily living (ADLs). ADLs are activities that are essential to day-to-day living, such as bathing, personal hygiene, dressing, toiletry, eating, and mobility. Intended to allow persons to continue living independently rather than require nursing home care, a variety of long-term services and supports are available. These include in-home personal care assistance, home accessibility modifications, personal emergency response systems, adult day health care, and specialized equipment, such as a handheld shower and shower chair.

Personal assistance services offered under Community Choices can be participant directed. This means program participants can hire the person of their choosing to provide care rather than have their care provided by licensed agency workers. Friends, and some relatives, such as adult children, can be hired. Spouses, unfortunately, cannot be hired. Program participants who cannot direct their own care may have a representative do so on their behalf. A financial management services agency handles the financial aspects of employment responsibilities such as tax withholding and caregiver payments.

Program beneficiaries can reside in their own home, the home of a loved one, an adult foster care home, or an assisted living residence (also called a community residential care facility).

Community Choices is not an entitlement program, which means meeting eligibility requirements does not equate to immediate receipt of program benefits. Instead, the waiver has a limited number of participant enrollment slots, and when these slots are full, a waitlist for program participation forms.

The Community Choices Waiver is a 1915(c) Home and Community Based Services (HCBS) Medicaid waiver. It is a Community Long Term Care (CLTC) Medicaid program. Medicaid in SC is called Healthy Connections.

 What are 1915(c) HCBS Medicaid Waivers?
Historically Medicaid only paid for long-term care in nursing homes. 1915(c) HCBS Medicaid Waivers allow states to offer benefits outside of these institutions. “HCBS” stands for “Home and Community Based Services. The goal of HCBS is to delay or prevent institutionalization, and to that end, care may be provided in one’s home, the home of a relative, assisted living, or adult foster care / adult family living. Waivers can target specific groups who require a nursing home level of care and are at risk of institutionalization such as the elderly, disabled, or persons with Alzheimer’s. Waivers are not entitlements. This means that meeting eligibility criteria does not guarantee receipt of benefits, as there are a limited number of slots for program participants.

 

Benefits of the Community Choices Waiver

In addition to case management, follows is a list of benefits available via the Community Choices Waiver. An individual care plan will determine which services and supports a program participant will receive.

– Adult Day Health Care – daytime care and supervision, limited nursing services, and meals in a community group setting. May include transportation to and from the facility.
– Attendant Care – personal care assistance, nursing care, medication management, meal preparation and cleanup, light housecleaning, and laundry
– Companion Care – supervision, care (non-medical), and socialization
– Home Delivered Meals
– Home Modifications – i.e., installing wheelchair ramps, modifying bathrooms for wheelchair access, and specialized electric for medical equipment
– Personal Care Assistance – includes assistance with essential daily activities, light housecleaning, and chores
– Pest Control
– Personal Emergency Response Systems
– Specialized Medical Equipment / Supplies – i.e., raised bariatric toilet seat, hand held shower, shower chair, transfer bench, nutritional supplements, and adult diapers
– Respite Care – in-home and out-of-home care to relieve a primary caregiver
– Telemonitoring – health status monitoring (i.e., blood pressure, body weight, blood glucose levels)

 

Eligibility Requirements for Community Choices Waiver

Community Choices is for South Carolina residents who are elderly (65+ years of age) or younger (18-64) if physically disabled and at risk of nursing home placement. Disabled persons enrolled in the waiver can continue to receive waiver services upon turning 65. Additional eligibility criteria are as follows below.

 The American Council on Aging provides a Medicaid eligibility for South Carolina seniors that require long term care. Start here.

 

Financial Criteria: Income, Assets & Home Ownership

Income
The 2021 applicant income limit, which increases on an annual basis in January, is set at $2,382 / month. When both spouses are applicants, each spouse is considered individually, with each spouse allowed income up to $2,382 / month. When only one spouse is an applicant, the income of the non-applicant spouse is not counted towards the income eligibility of his/her spouse. Furthermore, monthly income from the applicant spouse can be transferred to the non-applicant spouse as a spousal income allowance, also called a monthly maintenance needs allowance. There is a minimum income allowance, set at $2,177.50 / month (effective July 2021 – June 2022), which is intended to bring a non-applicant spouse’s monthly income up to this amount. There is also a maximum income allowance, which is $3,259.50 / month (effective January 2021 – December 2021), and is dependent on the non-applicant spouse’s shelter and utility costs. This monthly maintenance needs allowance is intended to ensure the non-applicant spouse does not become impoverished.

Assets
In 2021, the asset limit is $2,000 for a single applicant. For married couples, with both spouses as applicants, the asset limit is $3,000. When only one spouse is an applicant, the assets of both the applicant and non-applicant spouse are limited, though the non-applicant spouse is allocated a larger portion of the assets to prevent spousal impoverishment. (Unlike with income, Medicaid considers the assets of a married couple to be jointly owned). In this case, the applicant spouse can retain up to $3,000 in assets and the non-applicant spouse can keep up to $130,380. This larger allocation of assets to the non-applicant spouse is called a community spouse resource allowance.

Some assets are not counted towards Medicaid’s asset limit. These generally include an applicant’s primary home, household furnishings and appliances, personal effects, and a vehicle.

Assets should not be given away or sold under fair market value within 60-months of long-term care Medicaid application. This is because Medicaid has a look back rule and violating it results in a penalty period of Medicaid ineligibility.

 To determine if you might have assets over Medicaid’s countable limit, and if so, receive an estimate of the amount, use our spend down calculator.  

Home Ownership
The home is often the highest valued asset a Medicaid applicant owns, and many persons worry that SC Medicaid will take it. Fortunately, for eligibility purposes, Medicaid considers the home exempt (non-countable) in the following circumstances.

– The applicant lives in the home or has “intent” to return to the home and his / her home equity interest is no greater than $603,000. Home equity interest is the current value of the home minus any outstanding mortgage.
– A spouse lives in the home.
– The applicant has a minor child living in the home.
– The applicant has a disabled child living in the home.

To learn more about the potential of Medicaid taking the home, click here.

 

Medical Criteria: Functional Need

An applicant must require a nursing facility level of care (NFLOC).  An inability to independently complete activities of daily living (ADLs) are frequently indicative of a NFLOC need. ADLs include mobility, eating, toileting, bathing, dressing, and transitioning. Persons with Alzheimer’s disease or a related dementia may be eligible for program services if NFLOC is met. However, a diagnosis of dementia in and of itself does not mean one will meet this level of care need.

 For more information about long-term care Medicaid in South Carolina, click here.

 

Qualifying When Over the Limits

Having income and / or assets over SC Healthy Connections’ / Medicaid’s limit(s) does not mean an applicant cannot still qualify for Medicaid. There are a variety of planning strategies that can be used to help persons who would otherwise be ineligible to become eligible. Some of these strategies are fairly easy to implement, and others, exceedingly complex. Below are the most common.

When persons have income over the limits, Miller Trusts, also called qualified income trusts or qualifying income trusts, can help. “Excess” income is deposited into the trust, no longer counting as income.

When persons have assets over the limits, Irrevocable Funeral Trusts are an option. These are pre-paid funeral and burial expense trusts that Medicaid does not count as assets. Persons can also “spend down” countable assets in other ways in which they are not counted towards Medicaid’s asset limit. This includes making home accessibility modifications, updating the heating and plumbing systems in one’s home, and purchasing personal items, such as clothing. Another option, which also protects assets from Medicaid’s estate recovery program, is a Medicaid asset protection trust (MAPTs). MAPTs, however, violate Medicaid’s 60-month look back rule, and must be implemented well in advance of the need for long-term care Medicaid. There are many other options when the applicant has assets exceeding the limit.

Inadequate planning or improperly implementing a Medicaid / Healthy Connections planning strategy can result in a denial or delay of Medicaid benefits. Professional Medicaid planners are educated in the planning strategies available in the state of South Carolina to meet Medicaid’s financial eligibility criteria without jeopardizing Medicaid eligibility. While there are a variety of planning strategies, some do violate Medicaid’s 60-month look back rule. However, there are some workarounds, and Medicaid planners are aware of them. For all of these reasons, it is highly suggested one consult a Medicaid planner for assistance in qualifying for Medicaid when over the income and / or asset limit(s). Find a Medicaid planner.

 

How to Apply for South Carolina’s Community Choices Waiver

Before You Apply

Prior to submitting an application for The Community Choices Waiver, applicants need to ensure they meet the eligibility criteria. Applying when over the income and / or asset limit(s) will be cause for denial of benefits. The American Council on Aging offers a free Medicaid eligibility test to determine if one might meet Medicaid’s eligibility criteria. Take the Medicaid eligibility test.

As part of the application process, applicants will need to gather documentation for submission. Examples include copies of Social Security and Medicare cards, bank statements up to 60-months prior to application, proof of income, and copies of life insurance policies, property deeds, and pre-need burial contracts. Unfortunately, a common reason applications are held up is required documentation is missing or not submitted in a timely manner.

Since the Community Choices Waiver is not an entitlement program, there may be a waitlist for program participation. The waiver is approved for a maximum of approximately 25,382 beneficiaries each year. In the case of a waitlist, typically an applicant’s access to a participant slot is prioritized on one’s date of application.

 

Application Process

To apply for the Community Choices Waiver, applicants should contact their local Health and Human Services’ Community Long Term Care (CLTC) office. Offices by location can be found here. The Application for Nursing Home, Residential or In-Home Care can be found here, and the Additional Information for Nursing Home and In-Home Care form can be found here.

For more information about Community Choices, click here. Persons can also call Healthy Connections at 888-549-0820. The South Carolina Department of Health and Human Services (SCDHHS) administers the Community Choices Waiver.

 

Approval Process & Timing

The Medicaid / Healthy Connections application process can take up to 3 months, or even longer, from the beginning of the application process through the receipt of the determination letter indicating approval or denial. Generally, it takes one several weeks to complete the application and gather all of the supportive documentation. If the application is not properly completed, or required documentation is missing, the application process will be delayed even further. In most cases, it takes between 45 and 90 days for the Medicaid agency to review and approve or deny one’s application. Based on law, Medicaid offices have up to 45 days to complete this process (up to 90 days for disability applications). Despite the law, applications are sometimes delayed even further. Furthermore, as wait-lists may exist, approved applicants may spend many months waiting to receive benefits.

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