South Carolina Medicaid Eligibility: Income, Assets, and Look-Back Rules

South Carolina Medicaid eligibility, income, and asset limits work on a two-part test: you have to fit into one of the specific groups the state covers, and your income (and in some cases your assets) has to fall under that group’s ceiling. The state’s Healthy Connections program, run by the South Carolina Department of Health and Human Services (SCDHHS), covers children, pregnant women, parents or caretaker relatives of dependent children, and people who are 65 or older, blind, or disabled. Because South Carolina has not expanded Medicaid under the Affordable Care Act, most non-disabled adults without children do not qualify at any income level.¹

Income Limits by Eligibility Category

Each covered group has its own income ceiling, expressed as a percentage of the Federal Poverty Level (FPL). For 2026, the FPL is $15,960 per year for a single person and $33,000 for a family of four.² The thresholds below use those figures.

Children

Partners for Healthy Children (PHC) covers kids in households at or below 213% of the FPL — roughly $70,290 a year for a family of four. South Carolina folded its separate CHIP program into expanded Medicaid, so children who qualify get full Medicaid benefits rather than a lesser CHIP package.¹

Pregnant Women

Pregnant applicants qualify at or below 199% of the FPL. Coverage lasts through pregnancy and for 60 days after delivery regardless of income changes in that window.³ Babies born to Medicaid-covered mothers are automatically eligible for their first year.

Parents and Caretaker Relatives

Parents or relatives caring for a dependent child in the home qualify at or below 67% of the FPL. For a single parent with two children, that works out to roughly $18,304 a year. You must be related to the child by blood, adoption, or marriage. This is the most restrictive income threshold in the program and the main reason so many working South Carolina adults have no Medicaid option: earn even slightly above that line and this door closes.¹

Aged, Blind, and Disabled

If you are 65 or older, legally blind, or meet federal disability standards, the income ceiling is 100% of the FPL — $15,960 for an individual in 2026. This category also has a resource test, covered below.

Several related programs cover people in this population with higher incomes or more specific needs:

Working Disabled coverage reaches employed individuals with disabilities whose income is up to 250% of the FPL, provided unearned income stays at or below 100% of the FPL.
The Qualified Medicare Beneficiary (QMB) program pays Medicare premiums, deductibles, and copays for people at or below 100% of the FPL.
The Specified Low-Income Medicare Beneficiary (SLMB) program covers Medicare Part B premiums for those between 100% and 120% of the FPL.
The Qualifying Individual (QI) program also covers Part B premiums for those between 120% and 135% of the FPL.

QMB, SLMB, and QI are not full Medicaid. They pay Medicare costs only.¹

Family Planning and Other Limited Programs

Applicants at or below 199% of the FPL who do not fit any full-benefit category may qualify for Family Planning coverage, which pays only for preventive screenings, contraception, and related reproductive health services. It is not minimum essential coverage under the Affordable Care Act. Women diagnosed with breast or cervical cancer through CDC-funded screening programs can qualify up to 200% of the FPL. A Transitional Medicaid program gives up to 24 months of continued coverage to families who lose eligibility because of increased earned income, as long as that income stays at or below 185% of the FPL.¹

Asset Limits and When They Apply

Asset limits only matter if you are applying under an Aged, Blind, or Disabled category. MAGI-based categories — children, pregnant women, and parents — have no resource test. SCDHHS looks at your income and household size and that’s it.

For ABD applicants, the resource limit for a single individual is approximately $9,430, with the figure adjusted periodically.¹ Countable resources include cash, bank account balances, stocks, bonds, and similar liquid holdings. Check the current SCDHHS guidelines before you apply, since the number shifts.

Several significant assets do not count:

Your primary home is excluded as long as you live in it or intend to return. In 2026 the home equity cap for most states, South Carolina included, is $752,000. Equity above that must be reduced (through a loan or reverse mortgage) or the home sold. The equity cap does not apply if a spouse, or a dependent child under 21, lives in the home.
One vehicle is excluded regardless of value.
Life insurance policies with a combined face value under $1,500 are typically excluded; higher-face-value policies count at cash surrender value.
Burial funds in a designated account are excluded up to $1,500 per person.

How Income Is Counted

The counting method depends on the category. For children, pregnant women, and parents, SCDHHS uses Modified Adjusted Gross Income (MAGI). MAGI starts with your adjusted gross income from your tax return, adds back certain deductions, and compares the result to the FPL for your household size.

For Aged, Blind, and Disabled applicants, the state uses a different method that counts nearly all income coming in — Social Security benefits, pensions, support payments, and so on — alongside the resource test described above. The two methodologies can produce very different results for the same household, so it matters which door you are applying through.

Spousal Rules When One Spouse Needs Long-Term Care

When one spouse enters a nursing facility or receives home and community-based services through Medicaid, federal spousal impoverishment rules protect the spouse who stays at home.

The community spouse can keep a protected share of the couple’s combined resources, called the Community Spouse Resource Allowance (CSRA). In 2026 the federal minimum CSRA is $32,532 and the federal maximum is $162,660.⁴ South Carolina sets its CSRA within that federal range. The community spouse also receives a Monthly Maintenance Needs Allowance — a portion of the institutionalized spouse’s income redirected to cover household living expenses. The 2026 federal maximum for that monthly allowance is $4,066.50.

The 60-Month Look-Back on Asset Transfers

If you apply for Medicaid to pay for long-term care, SCDHHS reviews every asset transfer you made during the 60 months before your application date. The look-back catches gifts, title changes, and sales for less than fair market value.⁵ Typical problem transfers include cash gifts to children, deeding your home to a relative, and buying an annuity that does not name the state as a remainder beneficiary.

If the state finds a disqualifying transfer, it calculates a penalty period by dividing the value of what you gave away by the average monthly cost of private-pay nursing care in South Carolina. During the penalty period Medicaid will not pay for your long-term care, even if you otherwise qualify. The penalty does not start running until you are in a facility, have applied, and would otherwise be eligible, which means a penalty period can trap you in a facility with no way to pay the bill.⁶

Not every transfer is penalized. Transfers to a spouse are safe. So are transfers to a trust for a disabled child under 65, and transfers of your home to a child who lived with you and provided care that delayed your need for a facility for at least two years before admission. The exceptions are narrow and the documentation matters.

Residency, Citizenship, and Social Security Numbers

You have to live in South Carolina with the intent to stay — physical residency, not just property ownership. You also have to be a U.S. citizen or national, or a qualified non-citizen, and the state verifies citizenship electronically.⁷

Legal permanent residents who entered before August 1996 may qualify immediately. Those who entered after that date generally face a five-year waiting period before they can receive full Medicaid; during the bar, coverage is limited to emergency services. Refugees, asylees, Cuban and Haitian entrants, and trafficking victims are exempt from the five-year wait.⁸

Every household member applying must provide a valid Social Security number or proof that one has been applied for.¹

What Eligibility Doesn’t Mean: Estate Recovery

Qualifying for Medicaid is not the same as having a free ride. Federal law requires South Carolina to seek recovery of Medicaid costs from the estate of any recipient who was 55 or older when they received benefits, or who was in a nursing facility at death. Recovery covers nursing facility services, home and community-based services, and related hospital and prescription drug costs.⁹

Recovery cannot start until after the death of the recipient’s surviving spouse, and not while a surviving child under 21 or a child who is blind or permanently disabled is still living. The state must waive recovery when an heir shows undue hardship. If you own a home and later receive nursing facility coverage after age 55, the state may have a claim against that home once you and your spouse are both gone — a planning issue worth raising with a lawyer before you apply, not after.

1
South Carolina Department of Health and Human Services. Program Eligibility and Income Limits
2
U.S. Department of Health and Human Services. 2026 Poverty Guidelines
3
South Carolina Legislature. South Carolina Code of Regulations Chapter 126 – Section 126-365
4
Medicaid.gov. 2026 SSI and Spousal Impoverishment Standards
5
Office of the Law Revision Counsel. 42 USC 1396p – Liens, Adjustments and Recoveries, and Transfers of Assets
6
Centers for Medicare & Medicaid Services. Deficit Reduction Act of 2005 – Medicaid Asset Transfer Provisions
7
eCFR. 42 CFR 435.406 – Citizenship and Noncitizen Eligibility
8
Medicaid.gov. Overview of Eligibility for Non-Citizens in Medicaid and CHIP
9
South Carolina Legislature. South Carolina Code 43-7-460 – Recovery of Medical Assistance From Estate of Recipient