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South Carolina · Healthy Connections

Healthy Connections long-term care,
in plain English.

Penalty divisor $9,759/mo. CSRA up to $66,480. Home-equity limit $752,000. Estate recovery: TEFRA-minimum (probate-only).

A warm impressionist landscape evoking South Carolina

How does Medicaid long-term-care planning work in South Carolina?

South Carolina's Medicaid program is Healthy Connections, with Community Choices Waiver delivering long-term services and supports. The penalty divisor is $9,759/month, paired with a state-specific CSRA cap of $66,480, TEFRA-minimum (probate-only) estate recovery, and a $752,000 home-equity limit. The 5-year lookback applies to every asset transfer — planning before a crisis always outperforms planning during one.

The numbers that matter in South Carolina

  • Penalty divisor (2026): $9,759/month — every $9,759 in gifted assets during the 5-year lookback = 1 month of Medicaid ineligibility.
  • Nursing-home cost (2026, semi-private): ~$8,030/month = $96,360/year.
  • CSRA ceiling: $66,480 (community-spouse resource allowance).
  • MMMNA band: $2,643.75 to $4,066.50/month (minimum monthly maintenance needs allowance).
  • Home equity limit: $752,000.
  • Applicant asset cap: $2,000 (non-exempt).
  • Applicant income cap: $2,901/month (state-federal common threshold, 2026).
  • Managed long-term care: No — direct state Medicaid agency application.
  • Estate recovery posture: Minimum (only TEFRA-required).

Programs and acronyms in South Carolina

If you're searching for help with long-term-care Medicaid in South Carolina, these are the names and acronyms you'll encounter on state-agency forms, in elder-law conversations, and in nursing-facility paperwork.

  • Healthy Connections — South Carolina Medicaid. The state's Medicaid program brand.
  • South Carolina Department of Health and Human Services (SCDHHS) — administers Healthy Connections and processes long-term-care eligibility decisions.
  • Community Choices Waiver — HCBS waiver for SC seniors and adults with physical disabilities at nursing-facility level of care providing home modifications and ADL assistance.
  • Mechanical Ventilator Dependent Waiver — HCBS waiver for South Carolinians dependent on mechanical ventilators living in the community.
  • HASCI Waiver (HASCI) — Head and Spinal Cord Injury Waiver — services for adults with traumatic brain or spinal injuries.
  • Intellectual Disability / Related Disabilities Waiver (ID/RD) — HCBS waiver for South Carolinians with intellectual disabilities or autism providing residential and day supports.
  • PACE South Carolina (PACE) — Program of All-Inclusive Care for the Elderly — combined Medicare/Medicaid in select SC counties (now SC's primary integrated dual option after Healthy Connections Prime ended 1/1/26).
  • apply.scdhhs.gov — South Carolina's online Medicaid application portal: apply.scdhhs.gov/
  • HCP — Healthy Connections Prime (ended 1/1/26) (SC's former MMP for duals).
  • DDSN — Department of Disabilities and Special Needs (Administers ID/RD and HASCI).
  • ELED — Enhanced Life Estate Deed (SC 2025 statute protecting life-estate property from recovery).

The South Carolina planning levers

Every Medicaid plan in South Carolina pulls some combination of five levers: (1) community-spouse asset re-allocation inside the CSRA ceiling, (2) spend-down on exempt assets (home improvements, new car for the community spouse, pre-paid funeral), (3) irrevocable trust transfer outside the 5-year window, (4) caregiver-child exception or disabled-child exception on the home, and (5) personal-service contracts paying a family member for documented caregiving hours.

Which lever fits depends on the specific assets, the crisis timeline, and — critically — whether the applicant is already in a facility. If a family member is already admitted, the playbook narrows to levers (1), (2), and (5) only.

What planning looks like, by timeline

5+ years out: full menu available. Irrevocable-trust transfers, gifting, long-term-care insurance — all work if executed cleanly. Time is the most valuable asset in Medicaid planning.

1–5 years out: half-menu. Transfers still trigger the lookback but a known penalty period can be absorbed by private pay. Community-spouse re-allocation is still a big lever.

Already in a facility: crisis planning. Most gifting is off the table. Spend-down, community-spouse allowance, personal-service contracts, and exempt-asset purchases become primary. See the crisis playbook.

South Carolina's Medicaid program is Healthy Connections (South Carolina Medicaid). It's administered by South Carolina Department of Health and Human Services (SCDHHS). Long-term-care Medicaid applicants apply through Healthy Connections (South Carolina Medicaid) just like any other Medicaid benefit, but eligibility is governed by the LTC-specific asset, income, and lookback rules detailed below.
Healthy Connections (South Carolina Medicaid)'s 2026 penalty divisor is approximately $9,759/month. Every $9,759 of uncompensated transfers during the 5-year lookback produces one month of Medicaid ineligibility. The divisor roughly tracks South Carolina's private-pay nursing-home cost.
South Carolina uses a state-specific CSRA cap of $66,480. The federal 2026 CSRA ceiling is $162,660; the floor is $32,532. The non-applicant spouse can retain assets inside the state's cap without affecting the applicant's eligibility.
A primary residence is exempt while you or your spouse lives there. South Carolina's 2026 home-equity limit is $752,000; equity above that disqualifies the applicant. After the applicant's death, South Carolina pursues TEFRA-minimum (probate-only) estate recovery.
No. South Carolina runs long-term-care Medicaid on a fee-for-service basis — applications go directly to South Carolina Department of Health and Human Services rather than through a managed-care enrollment.
Semi-private nursing-home rooms in South Carolina run approximately $8,030/month ($96,360/year) in 2026. Private rooms add 10-25%. This figure drives the state's Medicaid penalty divisor and also signals how quickly private-pay assets deplete.
Next step — South Carolina

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