The Community Choices Medicaid Waiver program 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. 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.
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. To be clear, spouses cannot be paid to provide care.
South Carolina Medicaid is also referred to as Healthy Connections. This program is administered by South Carolina’s Community Long Term Care Division of the Department of Health and Human Services.
What is a Medicaid Waiver?
Medicaid Waivers, also known as Home and Community Based Services (HCBS) Waivers, allow qualifying program participants to receive services outside of a nursing home. Medicaid’s standard benefit is to pay for nursing home care. However, those who wish to live at home, in assisted living or in adult foster care, sometimes Medicaid will pay for nursing-home-level care in those locations if it can be obtained at a lower cost than in a nursing home.
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.
Single applicants are permitted up to $2,742 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 Monthly Maintenance Needs Allowance, and in 2023, the maximum amount is $3,715.50 / month. Another option if over the income limit is to use a Miller Trust to lower one’s countable income.
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 the equity value is under $688,000.
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.
Over the Financial Limits?
Please Note: If over the asset limit, it is extremely important that one not give away cash or 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.
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)
- Transportation to and from adult day care
- 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 – Handheld showerheads, shower chairs, transfer benches, etc.
- Home Delivered Meals
- Home Modifications to Increase Accessibility – Ramps, grab bars, widening of doorways, etc.
- 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.
More information about the program can be found here.