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.
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
Eligible individuals must meet a special income limit known as the Medicaid Cap. The Medicaid Cap is equal to 300% of the current SSI Federal Benefit Rate (FBR). 300% FBR
March 1, 2014
|Family Size||Monthly Income Limit|
If monthly income is greater than the limit, an individual may establish an income trust to become eligible for Medicaid. Contact Healthy Connections to learn more about the income trust provisions. Resource Limits Resources are generally defined as those assets including both real and personal property that an individual owns and can use to meet basic needs of food, clothing and shelter. The value of resources owned by the individual cannot exceed $2,000 (after exclusions).
Individuals who are eligible will receive all Medicaid covered services.