Page Reviewed / Updated - Feb. 2019
The Community Choices Medicaid Waiver program is also referred to as the Elderly and Disabled Waiver. It allows individuals who require nursing home level care and assistance with their activities of daily living to receive care in their communities or homes instead of in nursing homes. This waiver states that the cost of care provided at home cannot exceed a certain percentage of the cost for the same care in a nursing home.
Community Choices allows for consumer or participant direction of some services; meaning individuals receiving care can self-direct or choose the care providers from whom they receive assistance. Program participants can hire their own personal assistance providers, respite care providers, and companion services providers. Certain family members, such as the adult children of aged parents, are eligible to serve in these roles provided they pass the necessary background checks and are approved by the state. In addition to personal assistance, adult day care, medical equipment and supplies, home modifications, and a variety of other home supports are covered under this program.
South Carolina Medicaid is also referred to as Healthy Connections. This program is sometimes called South Carolina Community Long Term Care or CLTC, and is administered by the South Carolina Department of Health and Human Services (SCDHHS).
This waiver has eligibility criteria related to the age, functional need, income and assets of the applicant.
Age - South Carolina residents must be between the ages of 18 and 64 and disabled, or 65 years of age and older.
Functional Need – Applicants must require “nursing facility level of care”.
Income – Single applicants are permitted up to $2,313 per month in income. If an applicant is married and his or her spouse is not applying for Medicaid assistance as well, some of the applicant’s income can be allocated to his or her spouse as a needs allowance. This is formally called the Maximum Monthly Maintenance Needs Allowance and in 2019, the maximum amount is $3,160.50 / month. Another option if over the income limit is to use a Miller Trust to lower’s one's countable income.
Assets – Single applicants are permitted “countable assets” valued at up to $2,000. Certain assets are considered exempt, such as a single vehicle, burial plots, and the home in which an applicant resides, given it is valued under $585,000. Married couples with a single applicant are permitted to retain a significantly higher level of assets. (Medicaid considers all resources jointly owned by the couple. Learn more here.) The non-applicant spouse, also called the community spouse, is able to retain up to $66,480 in assets. This is called a Community Spouse Resource Allowance. The applicant spouse is still able to keep as much as $2,000 in assets. If over the asset limit, it is extremely important that one not give away cash and other valuables in an attempt to meet the asset limit. Doing so is a violation of Medicaid’s look-back rule and can delay acceptance into the Medicaid program. If over the asset limit, there are certain complicated financial products to reduce one’s countable assets.
Applicants are assessed and approved for services individually which can include any of the following. Most of these services are available to be self-directed by the program participant.
This program is available in all South Carolina counties. To apply one should contact their DHHS County Office.
Very detailed information about this waiver is available for download here. However, the reader should be aware that the downloadable PDF file is not intended for a consumer audience and readers may find it to be very confusing.