South Carolina Medicaid Long Term Care: Eligibility, Income Limits, and How to Apply

Your parent's savings are disappearing into nursing home bills at $8,669 per month, and you need to know whether Medicaid will cover long-term care before the money runs out. South Carolina's Medicaid program — called Healthy Connections — covers nursing home care and home-based services for qualifying seniors, but the state's eligibility rules are among the most restrictive in the country.

South Carolina is an "income-cap" state. There is no spend-down pathway for long-term care Medicaid. Either your parent's income is below the cap, or they need a Miller Trust. There is no middle ground.

2026 Income and Asset Limits

Gross monthly income limit: $2,982 per month (300% of the Federal Benefit Rate of $994). This includes all gross income — Social Security, pensions, traditional IRA distributions, and any other regular income. If your parent's income exceeds this cap by even one dollar, they are ineligible without a Miller Trust.

Countable asset limit: $2,000 for a single applicant, $4,000 for a married couple when both are applying. Countable assets include bank accounts, retirement funds, CDs, non-primary real estate, and secondary vehicles.

Home equity exemption: The primary residence is exempt up to $752,000 in equity, provided the applicant intends to return home or a spouse or dependent child lives there. After the applicant's death, South Carolina's Medicaid Estate Recovery Program (MERP) can file a claim against the estate to recover long-term care costs — which may require selling the home.

The Miller Trust Requirement

If your parent's gross monthly income exceeds $2,982, the only path to eligibility is establishing a Qualified Income Trust (QIT), commonly called a Miller Trust. This irrevocable trust requires:

• A designated trustee (cannot be the applicant)
• A dedicated bank account
• All income exceeding the Medicaid limit deposited monthly
• Upon the beneficiary's death, remaining trust funds are paid to South Carolina up to the total Medicaid benefits received

The Miller Trust must be drafted by an attorney and submitted with the Medicaid application. Errors in the trust document can result in a denied application, so this is not a DIY project.

Spousal Protections

When only one spouse needs long-term care, the at-home spouse (community spouse) receives specific financial protections:

Community Spouse Resource Allowance (CSRA): South Carolina enforces a flat $66,480 — the at-home spouse can retain this amount from the couple's joint countable assets. This is one of the lowest allowances in the nation. Many states use a sliding scale up to the federal maximum of $162,660.

Monthly Maintenance Needs Allowance (MMNA): If the at-home spouse's independent monthly income is below $4,066.50, a portion of the applicant spouse's income can be transferred to bring them up to this threshold.

Personal Needs Allowance: The nursing home resident keeps $60 per month for personal expenses. Everything else goes to the facility as "patient liability."

The Five-Year Lookback

South Carolina reviews all financial transactions from the 60 months before the Medicaid application. Any assets gifted, transferred, or sold below fair market value trigger a penalty period during which Medicaid will not pay for care. The penalty is calculated by dividing the total uncompensated transfer value by the statewide average daily nursing home rate.

A common and costly mistake: assuming that annual gifts within the federal gift tax exclusion ($19,000 per recipient in 2026) are exempt from Medicaid penalties. They are exempt from tax reporting, but they are fully countable by the state and will trigger a penalty.

How to Apply

1. Contact CLTC — call the Centralized Intake line at 1-888-971-1637 to request a Nursing Facility Level of Care (NFLOC) assessment. A nurse consultant will conduct a face-to-face evaluation.
2. Gather documentation — five years of bank statements, tax returns, property deeds, vehicle titles, life insurance policies, and Social Security benefit verification.
3. Submit the application — apply through the local SCDHHS county office or online at apply.scdhhs.gov with the completed CLTC assessment, financial records, and Miller Trust (if applicable).
4. Monitor the timeline — processing can take 45 to 90 days. If your parent is in a hospital, work with the discharge planner to expedite the application.

If the application is denied, you have 60 calendar days to file an appeal. To prevent services from being terminated during the appeal, request continuation of benefits within 10 calendar days of the denial notice mailing date.

Planning Ahead

The families that navigate Medicaid most successfully are the ones who start planning before the money runs out — not after. Understanding the asset limits, structuring a compliant spend-down, and establishing a Miller Trust early prevents crisis-mode decisions that are more expensive and harder to reverse.

The South Carolina Elder Care Decision Guide walks you through the entire Medicaid planning process with financial worksheets, a patient liability calculator, and a document gathering checklist designed to be completed before your first meeting with an elder law attorney.

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