Please apply if you are unsure about eligibility!
If you are not sure if you’re eligible for Medicaid programs using the guidelines below, we urge you to apply for Medicaid anyway OR apply for federally subsidized healthcare at Healthcare.gov. If you apply through Healthcare.gov and are eligible for Medicaid, they will automatically send us your application.
If you need help, please call our Member Help Center at (888) 549-0820. You can also visit SC Thrive for help filling out your application!
How it works
People who have Medicaid qualify for the program in one or more different eligibility categories. The Medicaid category or categories that you are in will determine the level of benefits and services you are eligible to receive and whether you need to choose a Managed Care Organization (MCO) to help manage your health care.
When you are approved for Medicaid, we will mail you a notice telling you which Medicaid category or categories you qualified for. You will also be informed whether you need to pick an MCO or not, and provided with instructions and next steps for how to proceed.
Healthy Connections Medicaid Programs
- Aged, Blind or Disabled (ABD)
Eligibility
An applicant must be at least 65 years of age or blind or living with a disability.
If the Social Security Administration has not established disability, it will need to be determined before Medicaid eligibility can be established.
Income Limits
Family Size Monthly Income
(Eff. 03/01/2024)
Annual Income
(Eff. 03/01/2024)
Resources
(Eff. 01/01/2024)
1 $1,255 $15,060 $9,430 2 $1,704 $20,440 $14,130 Benefits
Individuals who are eligible will receive all Medicaid covered services.
To Apply
Apply Online
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.Download Healthy Connections Application Form (PDF)
Additional Forms You May Need
Additional Information for Select Medicaid Programs (PDF)
Authorization to Disclose Health Information – FM 921 (PDF)
Adult Disability Report – FM 3218 ME (PDF)
Disability Application Cover Letter – FM 3213-F ME (PDF)
Adult Application Checklist – FM 3218-G ME (PDF)- Breast and Cervical Cancer Program
Healthy Connections provides full Medicaid benefits to uninsured individuals who are found in need of treatment for breast or cervical cancer or pre-cancerous lesions (CIN 2/3 or atypical hyperplasia).
Eligibility
A person who may qualify for the Breast and Cervical Cancer program must:
- Be under age 65
- Be screened by a physician or through the South Carolina Breast and Cervical Cancer Early Detection Program-Best Chance Network (BCN) and found in need of treatment for one of the following:
- Breast cancer
- Cervical cancer
- Pre-cancerous lesions (CIN 2/3 or atypical hyperplasia)
- Not have other insurance coverage that would cover treatment for breast or cervical cancer or pre-cancerous lesions (CIN 2/3 or atypical hyperplasia), including Medicare Part A or B
- Be at or below 200% of the Federal Poverty Level (FPL) (BCN family income guideline)
- Not be eligible for another Medicaid eligibility group
Income Limits
Family Size Monthly Income (Eff. 03/01/2024) Annual Income (Eff. 03/01/2024) 1 $2,510.00 $30,120.00 2 $3,407.00 $40,880.00 3 $4,304.00 $51,640.00 4 $5,200.00 $62,400.00 5 $6,097.00 $73,160.00 6 $6,994.00 $83,920.00 7 $7,890.00 $94,680.00 8 $8,787.00 $105,440.00 Each Additional Member $897.00 $10,760.00 Benefits
Individuals who are eligible will receive all Medicaid covered services.
To Apply
Apply Online
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.Download Healthy Connections Application Form (PDF)
Additional Forms You May Need
Additional Information for Select Medicaid Programs (PDF)
Breast and Cervical Cancer Program Application Addendum 913-A (PDF)- Disabled Children
"Katie Beckett" TEFRA Children
Healthy Connections provides benefits to certain children with disabilities who would not ordinarily be eligible because their parents’ income and/or resources exceed the limit.
In 1981, the federal government created the Katie Beckett waiver, named after the child who inspired it, which allowed children to receive institutional care at home while retaining their Medicaid coverage, regardless of parents’ income. In 1982, the Tax Equity and Fiscal Responsibility Act (TEFRA) expanded the waiver.
Eligibility
A child who may be eligible for this program must:
- Be age 18 or under
- Live at home
- Meet the Supplemental Security Income (SSI) definition of disability
- Have gross monthly income below $2,829 and countable resources at or below $2,000 (only the child's income and resources are counted)
- Meet an institutional level of care. The three levels of care are:
- Intermediate care for the intellectually disabled (ICF-IID)
- Nursing facility (skilled or intermediate care)
- Hospital care
Meeting a level of care does not mean a child must be institutionalized.
In addition, it must be appropriate to provide care to the child at home. The estimated cost of caring for the child outside the institution does not exceed the estimated cost of treating the child in the institution.
Income Limit
(300% of the Federal Benefit Rate-FBR)
January 1, 2024Family Size Monthly Income Limit Individual $2,829 Benefits
A child who meets these requirements is eligible for the full range of Medicaid covered services. If the child needs special services, which are available only under the home and community based waiver, they must apply for and be accepted into one of the waiver programs to receive these special services.
Family Connection of South Carolina
If you have a child with a disability or special health care need, Family Connection of South Carolina can provide you with information, support and hope for the future.
To Apply
Apply Online
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.Additional Forms You May Need
Child Under Age 19 Disability Report
Disability Application Cover Letter FM 3218-F ME
Childhood Application Checklist FM 3218-H ME
Authorization to Disclose Health Information- Family Planning
Family Planning is available to individuals (men and women) whose annual family income is at or below 194% of the Federal Poverty Level (FPL).
Eligibility
Individuals who may be eligible for Family Planning must:
- Be a South Carolina resident
- Be a U.S. citizen or Lawful Permanent Resident Alien
- Have a Social Security Number or verify an application for one
- Be ineligible for full Medicaid coverage under any other eligibility category
Family Size Eff. 03/01/2024 Monthly Income Annual Income 1 $2,434.70 $29,216.40 2 $3,304.46 $39,653.60 3 $4,174.23 $50,090.80 4 $5,044.00 $60,528.00 5 $5,913.76 $70,965.20 6 $6,783.53 $81,402.40 7 $7,653.30 $91,839.60 8 $8,523.06 $102,276.80 Each Additional Member $869.76 $10,437.20 Benefits
Family Planning is a limited-benefit program, which provides coverage for preventive health care, family planning services and family planning-related services. This program does not meet the standard for Minimum Essential Coverage under the Affordable Care Act. You may, however, still be eligible for federal programs that will help you pay for insurance through tax subsidies. To learn more about health insurance coverage options or qualifying for an exemption, visit www.healthcare.gov or call 1-800-318-2596.
To Apply
Apply Online
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.- Former Foster Care (Up to Age 26)
Healthy Connections provides benefits to individuals up to the age of 26 who were formerly in the South Carolina foster care program.
Eligibility
A person who may qualify for the Former Foster Care program must:
- Have been a Medicaid recipient in the State of South Carolina at the time they aged out of foster care
The individual is eligible through the end of the month of their 26th birthday as long as they are a resident of South Carolina.
Income Limit
Income is not considered for this coverage group.
Benefits
Individuals who are eligible will receive all Medicaid covered services.
To Apply
Apply Online
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.Download Healthy Connections Application Form (PDF)
Authorized under Title XXI of the Social Security Act
- Individuals in Nursing Facilities and/or Receiving Home and Community-Based Waiver Services
Healthy Connections sponsors the payment of long-term care for individuals who reside in licensed and certified nursing facilities. The program also pays for special services for those individuals who participate in Home and Community-Based Services (HCBS) waivers and the Program for All-Inclusive Care of the Elderly (PACE). The same eligibility requirements apply for both programs. The difference is that the individuals who need nursing home care but who choose to stay at home rather than going to an institution, can receive special services through a waiver to help them remain at home.
Generally, an individual must be age 65 or older or blind or disabled. Disability is determined by using the Supplemental Security Income (SSI) guidelines. An individual who receives assistance through the Parent/Caretaker Relative program may also be eligible to participate in the home and community-based waiver.
Eligibility
A person who may qualify for these benefits must:
- Be a South Carolina resident.
- Be a U.S. citizen or Lawful Permanent Resident Alien.
- Require nursing facility level of care either in the home or in a facility. If receiving care in the home, contact Healthy Connections for information about obtaining a Community Long Term Care (CLTC) determination prior to completing your application.
- Reside in a medical institution or receive home and community-based waiver services or a combination of these services for a period of 30 consecutive days.
- Have a Social Security number or verify an application for one.
Income Limit
Individuals may be eligible if they meet an income limit less than or equal to 300% of the current SSI Federal Benefit Rate (FBR). January 1, 2024.
Family Size Monthly Income Limit 1 (Individual) $2,829 Spousal Allocation $3,853.50 To Apply
Apply Online
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.Download Healthy Connections Application Form (PDF)
Additional Forms You May Need
Application for Nursing Home, Residential or In-Home Care
Additional Information for Nursing Home and In-Home Care- Medically Indigent Assistance Program
This Healthy Connections program sponsors inpatient hospital care for individuals meeting eligibility criteria.
Eligibility
A person who may qualify for the MIAP must:
- Be a South Carolina resident
- Be a U.S. citizen or Lawful Permanent Resident Alien
- Inmates or residents of other governmental institutions are not eligible
Income Limit
Family income cannot exceed 200% of the Federal Poverty Level (FPL)
Additionally, an applicant’s resources and assets cannot exceed the following thresholds:
Primary Residence (the home you live in)
- $35,000 limit on equity value
- A family farm of 50 acres or less on which the applicant or his family has lived for at least 25 years is excluded from resources.
Personal Property
- Equity interest in real property and taxable personal property (such as motor vehicles) cannot exceed a combined total value of $6,000
Liquid Assets
- Assets in cash cannot exceed $500
An applicant with excess liquid assets may establish eligibility by spending the family's excess liquid assets on valid debts such as rent/mortgage, utilities and medical expenses.
Benefits
Individuals who are eligible will receive all Medicaid covered services.
To Apply
Apply Online
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.Download Healthy Connections Application Form (PDF)
You can also contact your hospital's social services department for help.
Additional Forms You May Need
- Optional State Supplementation Program
The OSS program is for individuals residing in approved, licensed Community Residential Care Facilities (CRCF) who meet Supplemental Security Income (SSI) eligibility requirements, except for income.
Eligibility
A person who may qualify for the OSS program must:
- Be at least 65 years old or blind or disabled
- Be a resident of a facility that is enrolled with SCDHHS to participate in the OSS program
- Be a resident of South Carolina
- Be a U.S. citizen or Lawful Permanent Resident Alien
Income Limit
Monthly Net Income Limit may not exceed $1,753 per month. The individual’s resources must not exceed $2,000. January 1, 2024.
Benefits
Individuals receive full Medicaid benefits. In addition, state-funded cash assistance payment is provided to the facility.
To Apply
Apply Online
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.Download Healthy Connections Application Form (PDF)
Additional Forms You May Need
Application for Nursing Home, Residential or In-Home Care
Additional Information for Select Medicaid Programs- Parent/Caretaker Relatives (Formally LIF)
The Parent/Caretaker Relatives program (formally known as Low Income Families (LIF)) is established for parents or other caretaker relatives who meet financial eligibility criteria.
Eligibility
A person who may qualify for the Parent/Caretaker Relatives program must:
- Have a dependent child living in the home
- Show a specified degree of relationship to the child
- (Example: relative by blood, adoption or marriage)
- Be a South Carolina resident
- Be a U.S. citizen or a Lawful Permanent Resident Alien
- Have a Social Security number or verify an application for one
Income Limits
Family Size Monthly Income (Eff. 03/01/2024 ) 1 $778.10 2 $1,056.06 3 $1,334.03 4 $1,612.00 5 $1,889.96 6 $2,167.93 7 $2,445.90 8 $2,723.86 Each Additional Member $277.96 Benefits
Individuals who are eligible will receive all Medicaid covered services.
To Apply
Apply Online
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.- Partners for Healthy Children
Healthy Connections provides health insurance plans for children who live in families with income at or below 208% of the Federal Poverty Level (FPL).
Eligibility
A person who may qualify for the PHC program must:
- Be under 19 years of age
- Be resident of South Carolina
- Be a U.S. citizen or a Lawful Permanent Resident Alien
- Have a Social Security number or verify an application for one
Income Limits
Family Size Monthly Income (Effective 03/01/2024 ) 1 $2,610.40 2 $3,542.93 3 $4,475.46 4 $5,408.00 5 $6,340.53 6 $7,273.06 7 $8,205.60 8 $9,138.13 Each Additional Member $932.53 Benefits
Individuals who are eligible will receive all Medicaid covered services.
To Apply
Apply Online
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.Download Healthy Connections Application Form (PDF)
The Partners for Healthy Children program was authorized under Title XXI of the Social Security Act. This program provides Medicaid coverage for children who live in families with income at or below 208% of the Federal Poverty Level. The available plans include Medicaid and the Children’s Health Insurance Program (CHIP).
- Pregnant Women and Infants
Healthy Connections provides coverage to pregnant women with low income. This coverage for the mother continues for 12 months after the baby's birth. The infant is covered up to age one.
Eligibility
A woman who may qualify for this program must:
- Be pregnant
- Be a South Carolina resident
- Be a U.S. citizen or Lawful Permanent Resident Alien
- Have a Social Security number or verify an application for one
Income Limits
Family Size Eff. 03/01/2024 Monthly Income Annual Income 1 $2,434.70 $29,216.40 2 $3,304.46 $39,653.60 3 $4,174.23 $50,090.80 4 $5,044.00 $60,528.00 5 $5,913.76 $70,965.20 6 $6,783.53 $81,402.40 7 $7,653.30 $91,839.60 8 $8,523.06 $102,276.80 Each Additional Member $869.76 $10,437.20 Benefits
Individuals who are eligible will receive all Medicaid covered services.
To Apply
Apply Online
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.Download Healthy Connections Application Form (PDF)
Provider Form
FM 1716 – Request for Medicaid ID of NewbornThe Omnibus Budget Reconciliation Act of 1986 (OBRA 86) gave states the option to provide Medicaid coverage to pregnant women with low income.
- Qualified Medicare Beneficiaries (QMB)
This program may help pay your Medicare Part "B" Premiums. Healthy Connections will make a QMB determination for a Medicaid-eligible individual in any full benefits category if that individual is covered under Medicare Part A.
Eligibility
To be eligible as a QMB, an individual must be entitled to Medicare Part A and:
- Be aged 65 or over or
- Blind or
- Disabled
Benefits
QMB coverage offers payment of Medicare premiums, co-pays and deductibles.
Income Limits
FAMILY SIZE MONTHLY INCOME
(Eff. 03/01/2024 )
ANNUAL INCOME
(Eff. 03/01/2024 )
Resources
(Eff. 01/01/2024
1 $1,255 $15,060 $9,430 2 $1,704 $20,440 $14,130 To Apply
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.
Download Healthy Connections Application Form (PDF)
Additional Forms You May Need
Additional Information for Select Medicaid Programs (PDF)
Section 303 of the Medicare Catastrophic Coverage Act of 1988 (MCCA) required the State Medicaid program to pay the premiums (Part A and/or B) and cost sharing for individuals/couples with limited resources and incomes at or below 100% of the Federal Poverty Level.
- Specified Low Income Medicare Beneficiaries (SLMB) and Qualifying Individuals (QI)
These programs may help pay your Medicare Part "B" Premiums.
Eligibility
- Is entitled to Medicare Part A hospital insurance
- Has countable income between 120% and 135% of the Federal Poverty Level (FPL)
- Has countable resources below the limit ($9,430 for an individual and $14,130 for a couple)
- Is not otherwise eligible for full Medicaid benefits
Income Limits
Family Size SLMB 120%
(Eff. 03/01/2024 )
QI 135%
(Eff. 03/01/2024 )
Resources
(Eff. 01/01/2023)
1 (Individual) $1,506 $1,695 $9,430 2 (Couple) $2,044 $2,300 $ 14,130 Benefits
For a SLMB or a QI, Healthy Connections is required to pay the Medicare Part B premium only. These individuals are not entitled to any other Medicaid benefits; therefore, they do not receive a Medicaid card.
To Apply
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.
Download Healthy Connections Application Form (PDF)
Additional Forms You May Need
- Working Disabled
Section 4733 of the Balanced Budget Act of 1997 created an optional coverage group for working disabled individuals with family income below 250% of the Federal Poverty Level (FPL). This provision enabled states to provide the full range of Medicaid services to working disabled individuals with relatively high income. South Carolina adopted this option in its 1998 Appropriations Act. The South Carolina Medicaid program began covering these individuals effective October 1, 1998.
Eligibility
A person who may qualify for the Working Disabled program must:
- Be under age 65
- Be totally and permanently disabled according to the Supplemental Security Income (SSI) definition of disability
- Be a South Carolina resident
- Be a United States citizen or Lawful Permanent Resident Alien
- Have a Social Security number or verify one has been applied for
- Assign rights to medical support
- Be working--have earned income
Financial Criteria
The income eligibility determination is a two-step process.
1. The first step determines if the family's total net income, after certain deductions, is at or must be less than 250% of the Federal Poverty Level for a family of that size.
2. The second step determines if the individual's unearned income is equal to or less than 100% of the Federal Poverty Level for an individual.
The applicant's countable resources must be below the $9,430 Aged, Blind or Disabled resource limit for an individual.
Family Size Monthly Income (Eff. 03/01/2024 ) Annual Income (Eff. 03/01/2024 ) 1 $3,138.00 $37,650.00 2 $4,259.00 $51,100.00 3 $5,380.00 $64,550.00 4 $6,500.00 $78,000.00 5 $7,621.00 $91,450.00 6 $8,742.00 $104,900.00 7 $9,863.00 $118,350.00 8 $10,984.00 $131,800.00 Each Additional Member $1,121.00 $13,450.00 For family sizes over 8, add the amount shown for each additional person to income limit for 8.
If applicant's household meets income requirement of 250% FPL, it must also be determined whether the applicant has unearned income equal to or less than 100% FPL.
Applicant’s Unearned Income (Eff. 03/01/2023) Monthly Income Annual Income $1,215 $13,590 Benefits
Individuals who meet these requirements are eligible for the full range of Medicaid covered services.
To Apply
Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office.
Download Healthy Connections Application Form (PDF)
Additional Forms You May Need