South Carolina Medicare Savings Program Application Documents: What You Need for Form 3400

The Form 3400 Problem

South Carolina uses one application — SCDHHS Form 3400 ("Application for Medicaid and Affordable Health Coverage") — for every type of Medicaid, including Medicare Savings Programs. That means the form contains entire sections about nursing home care, disability determinations, and children's health coverage that have nothing to do with MSP eligibility.

For a family applying only for QMB, SLMB, or QI, the form is intimidating. Most of it does not apply. But skipping a section that does apply — or submitting without the right supporting documents — triggers an Information Request Notice that pauses the 45-day processing clock until SCDHHS receives what is missing.

The fastest way through is to know exactly which sections matter and what documents to attach before you submit.

Documents You Need

SCDHHS routinely requests hard-copy verification for non-MAGI Medicare Savings Program applications, even when federal rules encourage electronic data matching. Gather everything before submitting:

Medicare entitlement proof:

• Copy of the red, white, and blue Medicare card showing Part A and/or Part B enrollment
• If your parent only has Part B, note this — it affects whether conditional Part A enrollment is needed

Income verification (all sources):

• Most recent Social Security award letter showing the gross monthly benefit amount (before any Part B or tax deductions)
• Private pension statements showing gross monthly payments
• VA benefit adjustment letters (Aid and Attendance and Housebound allowances are excluded from income; baseline VA disability compensation and pensions count)
• Any annuity payment statements
• If your parent works: pay stubs showing gross monthly earned income

Asset documentation:

• Complete bank statements for checking, savings, and CDs for the month of application and prior months — SCDHHS wants the full statement, not just a balance printout
• Brokerage or investment account statements (stocks, bonds, mutual funds)
• Life insurance policy documents showing face value and cash surrender value (if total face value of all policies exceeds $1,500, the cash surrender value counts toward the asset limit)

Asset exclusion documentation (if applicable):

• Pre-paid burial contract showing irrevocability (irrevocable pre-need contracts are fully excluded)
• Documentation of funds set aside for burial expenses — must be in a separate, designated account to claim the $1,500 per-person burial fund exclusion
• Vehicle title or registration (one primary vehicle is fully excluded regardless of value)

Identity and residency:

• Government-issued photo ID
• Proof of South Carolina residency (utility bill, lease, or other document showing physical presence in the state)

For joint accounts:

• If your parent holds a joint bank account with a non-spouse (such as an adult child), SCDHHS presumes 100% of the funds belong to the applicant. To rebut this, submit financial tracing records showing the co-owner deposited the funds. Without documentation, the full balance counts against the $9,950 individual asset limit.

Which Form 3400 Sections Apply to MSP

The form is long. For an MSP-only application, focus on:

• Applicant identification — name, date of birth, Social Security number, address
• Medicare enrollment section — Medicare Beneficiary Identifier (MBI), Part A and Part B effective dates
• Income section — list every income source with gross monthly amounts
• Financial resources section — bank accounts, investments, life insurance, burial funds
• Signature and date — the applicant (or authorized representative with Form 1282) must sign

Skip the sections about children, pregnancy, employer-sponsored insurance, nursing home care, and disability unless they specifically apply to your parent's situation.

Additional Forms That May Apply

Form 1282 — "Authorization for Release of Information and Appointment of Authorized Representative." Required if an adult child or other person will communicate with SCDHHS on the applicant's behalf. Both parties must sign.

Form 3400-C — "Retroactive Medicaid Request." Attach this if your parent met SLMB or QI criteria in the three months before the application date and you want the state to pay those past premiums retroactively. Without this form, only prospective coverage is processed.

Form 3400-B — "Additional Information for Nursing Home and In-Home Care." Only needed if your parent also needs long-term care services or waiver coverage alongside MSP.

How to Submit

Five channels, all leading to the same central processing unit:

1. Online at apply.scdhhs.gov
2. Fax to (888) 820-1204
3. Email the completed packet as a PDF to [email protected]
4. Mail to SCDHHS Central Mail, P.O. Box 100101, Columbia, SC 29202-3101
5. In person at any county SCDHHS eligibility office

For out-of-state caregivers, fax or email are remote submission options. Include all supporting documents in the same submission — SCDHHS processes applications faster when the complete packet arrives together rather than in pieces.

What Happens If Documents Are Missing

SCDHHS sends an Information Request Notice listing exactly what is needed. The 45-day processing clock pauses until the missing items arrive. Respond promptly and follow the instructions in the notice.

The South Carolina Medicare Savings Programs & Extra Help Guide includes a pre-organized document checklist with the specific items SCDHHS requires, plus an annotated walkthrough of the Form 3400 sections that apply to MSP-only applications.

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