South Carolina Community Choices Medicaid Waiver

What is a Medicaid Waiver?
For persons with limited financial resources, Medicaid pays for nursing home care. For those who wish to live at home or in assisted living, sometimes Medicaid will pay for care in those locations if it can be obtained at a lower cost than in a nursing home. It does this through "Medicaid Waivers," which are also called Home and Community Based Services (HCBS) Waivers or Waiver Funded Services.

Waiver Description

 Under Community Choices, adult children can work as paid caregivers to their aging parents.

This Medicaid 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. The 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.

This waiver allows for consumer or participant direction of some services; meaning the individual 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).

 

Eligibility Guidelines

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 $2,250 per month in income. If an applicant is married and their spouse is not applying for Medicaid assistance as well, some of the applicant’s income can be allocated to their spouse as needs allowance. This is formally called the Maximum Monthly Maintenance Needs Allowance and in 2018, the maximum amount is $3,090. Another option if over the income limit is to use a Miller Trust to lower’s one

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 $572,000. Married couples with a single applicant are permitted to retain a significantly higher level of assets, if one spouse is not applying for Medicaid. Another option if over the asset limit is to use certain complicated financial products to reduce one’s countable assets. Note that Medicaid prohibits one from simply giving away their assets to qualify for the program.

 Persons Over the Financial Limits
Medicaid planning experts can help families qualify when they exceed the limits. In brief, Medicaid planners help to restructure income into Miller Trusts and assets into exempt assets, allowing an applicant to meet the limits and to save money for the applicant's spouse. Learn more here.

 

Benefits and Services

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.  

  • Adult Day Health Care (Adult Day Care) and Transportation
  • Community Residential Care Facility (Assisted Living Facility) - Personal care assistance and supervision, and skill training
  • Attendant Care – Nursing care and homemaking activities 
  • Companion Services
  • Case Management
  • Congregate and Home Respite Care
  • Disposable Medical Supplies – Supplies for incontinence, wipes, etc. 
  • Durable Medical Equipment – Hand held showerheads, shower chairs, transfer benches, etc. 
  • Home Delivered Meals
  • Home Modifications to Increase Accessibility – Ramps, grab bars, widening of doorways, etc. 
  • Nursing Home Transition Services
  • Nutritional Supplements
  • Personal Care – Assistance with daily living activities, such as bathing, eating, dressing, shopping & preparing meals, etc. 
  • Personal Emergency Response System (PERS) 
  • Telemonitoring – Daily monitoring of blood sugar, blood pressure, heart rate, etc.

 

How to Apply / Learn More

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.