SCDHHS Medicaid Application: How to Apply for Long-Term Care Medicaid in South Carolina

The Application You Need (It's Not the Standard Medicaid Form)

When families hear "apply for Medicaid," they often start with the general Healthy Connections Medicaid application on the SCDHHS website. That application handles basic Medicaid coverage — the kind that covers doctor visits and prescriptions. But long-term care Medicaid — the program that funds nursing facilities and the Community Choices Waiver for home care — requires a different submission.

For long-term care Medicaid in South Carolina, you need two forms:

1. Form 3400 — the Healthy Connections Application (the base application)
2. Form 3400-B — Additional Information for Nursing Home and In-Home Care (the supplement that triggers long-term care eligibility review)

Submitting Form 3400 without Form 3400-B puts your parent into the standard Medicaid processing queue. The long-term care financial eligibility review — the one that evaluates the $2,982 income cap, the $2,000 asset limit, and the 60-month look-back — only starts when 3400-B is submitted alongside it.

Where to Submit

Both forms go to the SCDHHS Central Mail Office in Columbia:

By mail: SCDHHS Central Mail Office, P.O. Box 8206, Columbia, SC 29202

By fax: (888) 820-1204

A mailed application is legally considered filed on the postmark date, not the date SCDHHS receives it. This matters if you are racing against a deadline — for example, if your parent is in a nursing facility and private-pay costs are depleting assets toward the $2,000 threshold.

You can also initiate an application through the local SCDHHS county office, but the Central Mail Office processes long-term care applications centrally. Filing directly to the central address avoids the extra step of a county office forwarding the paperwork.

The Financial Documentation Package

The long-term care Medicaid application triggers a comprehensive financial review going back 60 months (five years). SCDHHS will examine every financial transaction, asset transfer, and account balance for both the applicant and their spouse during this window. Families who submit the application without the full documentation package face delays — requests for additional information reset the processing clock.

Prepare these before submitting:

Income verification (current)

• Social Security benefit statements (SSA-1099)
• Pension or annuity statements
• Any other income sources (rental income, dividend statements, interest)

Asset documentation (current)

• Bank statements for all accounts (checking, savings, money market, CDs) — most recent 3 months
• Investment account statements (brokerage, mutual funds, IRAs, 401(k))
• Life insurance policies with face values
• Vehicle titles
• Deed to real property with most recent property tax assessment
• Burial fund documentation or prepaid funeral contracts

60-month look-back records

• 5 years of bank statements for every account in the applicant's name, the spouse's name, or jointly held
• 5 years of brokerage and investment statements
• Records of any property transfers, gifts, or sales
• Records of any trust creation or modification
• Documentation of any financial transactions with family members

Identification and status

• Proof of U.S. citizenship or eligible immigration status
• South Carolina residency documentation
• Social Security card
• Medicare card
• Any existing Medicaid card

The 60-month look-back is where most applications stall. If your parent made gifts to grandchildren, donated to charity, sold property below market value, or transferred assets to family members during the five-year window, each transaction must be documented and justified. Uncompensated transfers trigger a penalty period during which Medicaid will not pay for care.

The Processing Timeline

SCDHHS has up to 45 calendar days to process a standard Medicaid application. Long-term care applications — because of the financial complexity — frequently take longer. The 45-day clock starts when SCDHHS receives a complete application with all supporting documentation.

If SCDHHS requests additional documentation after submission, the clock pauses until you respond. This is the most common source of delays: families submit Form 3400 and 3400-B but leave out two years of bank statements, and the processing timeline resets when SCDHHS sends a request letter.

A practical strategy: compile the full documentation package before submitting the application. Do not file first and gather records later.

The Parallel Track: Clinical + Financial

Long-term care Medicaid requires both clinical and financial eligibility. The clinical assessment — conducted by a CLTC Nurse Consultant using Form 1718 — determines whether your parent meets the Nursing Facility Level of Care (NFLOC) standard. The financial application through SCDHHS determines whether they meet the income and asset limits.

These two processes should run in parallel:

1. Call CLTC intake at (888) 971-1637 to initiate the clinical referral and place your parent on the Community Choices Waiver interest list
2. Submit Form 3400 + Form 3400-B to SCDHHS Central Mail with the full financial documentation package
3. Both tracks process simultaneously — the clinical assessment through the regional CLTC area office, the financial review through SCDHHS centrally

Your parent must pass both to receive funded services. If they pass the clinical assessment but fail the financial review (income above $2,982), you need to establish a Qualified Income Trust (Miller Trust) before reapplying. If they pass the financial review but fail the clinical assessment, you can appeal within 30 days.

The Income Cap Problem: When $2,983 Disqualifies You

South Carolina is a strict income-cap state. If your parent's gross monthly income exceeds $2,982 — even by one dollar — they are financially ineligible for long-term care Medicaid. There is no "spend-down" pathway for long-term care (unlike standard Medicaid in some categories).

The solution is a Qualified Income Trust (QIT), commonly called a Miller Trust. This is an irrevocable trust that receives your parent's income above the cap and disburses it in a specific priority order set by state rules: personal needs allowance ($60/month), spousal income allowance (if applicable), Medicare premiums, and then the remainder to the care provider as patient liability.

The Miller Trust must be established and funded in the same calendar month for which Medicaid eligibility is sought. You cannot retroactively create one — if your parent's application is denied for excess income in January and you create the trust in March, Medicaid eligibility cannot begin until March at the earliest.

An elder-law attorney should draft the trust document. Typical legal fees range from $1,500 to $3,000 in South Carolina.

If the Application Is Denied

SCDHHS must send a written notice of denial that explains the specific reason and your appeal rights. You have exactly 30 calendar days from the date on the notice to file a formal appeal. The appeal goes to the SCDHHS Division of Appeals and Hearings:

By mail: P.O. Box 8206, Columbia, SC 29202 By fax: (888) 820-1204

The appeal is considered filed on the postmark date if sent by mail. If you miss the 30-day window, the denial becomes final and you must reapply from scratch.

Common denial reasons that are fixable on appeal: incomplete financial documentation (submit the missing records), income above the cap (establish a Miller Trust), or asset limit exceeded (document exempt assets like the primary residence, one vehicle, or prepaid burial funds that were miscounted).

The South Carolina Home Care Coordination Guide includes an application document checklist organized by the exact categories SCDHHS reviews, plus a financial eligibility worksheet that helps you calculate whether your parent's income and assets fall within the 2026 thresholds before you submit.

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