South Carolina Medicaid Long Term Care Eligibility
South Carolina Long Term Care
South Carolina is an income cap state, meaning that in order to be eligible for Medicaid long term care benefits there is a hard income limit. Non income cap states allow applicants to spend down money for their care, whereas income cap states require the amount to be no higher than their limit at time of application.
- Nursing home care
- Assisted Living
- Home waiver services, and a
- Medicaid health insurance card
1. Residency and Citizenship – the applicant must be a resident of South Carolina and a U.S. citizen or have proper immigration status.
2. Age/Disability – the applicant must be age 65 or older, or blind, or disabled. The applicant must meet certain medical requirements consistent with the level of care requested. Persons must need care for thirty (30) consecutive days.
- In South Carolina, an applicant must have health issues, which result in assistance with at least five activities of daily living (ADLs). The five ADLs are: feeding, dressing, ambulation (movement), dressing, and incontinence.
3. Income Limitations – If single, the applicant’s monthly income (wages, Social Security benefits, pensions, veteran’s benefits, annuities, SSI payments, IRAs, etc.) must be no higher than $2,205 to become eligible for Medicaid. Income that is above the limit can be placed into a qualified trust, which designates funds solely for the costs accrued by Medicaid. There is a personal needs allowance of $30/month that is not factored into the total countable income.
4. Asset Limitations (Exempt vs. Available) – Medicaid divides assets into two categories: Exempt and Available. Exempt assets are specifically designated under the rules, and ownership of an exempt asset by the applicant will not result in a denial of benefits. If an asset is not listed as exempt then it needs to be liquidated and applied toward the costs of nursing home care before the applicant can receive Medicaid benefits. The state has a look back period of 5 years with a penalty for people who sell assets below fair market price, transfer assets to others, or give money and property away. Basically, all money and property, and any item that can be valued and turned into cash, is a countable asset unless it is listed as exempt.
- Under South Carolina law, the transfer of assets to certain recipients will not trigger a period of ineligibility. A home can be transferred to (A) one’s spouse or permanently blind or disabled child (B) into a trust for other disabled dependents (C) a child under age 21 (D) a sibling who has lived in the home for at least a year before the applicant’s institutionalization and holds equity interest in the home (D) a child who has taken care of the applicant for at least two years, thus delaying the need to move into a nursing home.
Exempt Assets for an applicant in South Carolina include:
i. $2,000 or less in cash/non-exempt assets if single.
ii. One home is exempt (equity limit $572,000) if planning to return, a spouse, a child under 21, or a disabled person resides in it. Whenever an institutionalized person sells a previously exempted residence, the money from the sale becomes a countable asset. The recipient may then lose eligibility for Medicaid until he/she has spent down the money and their countable resources are once again less than the maximum.
iii. One automobile, no equity amount specified.
iv. Irrevocable burial trust with a value of $1,500 or less per individual.
v. Non-saleable property, household furnishings, furniture, clothing, jewelry, and other personal effects are not counted.
vi. Value of life insurance if face value is $1,500 or less.
vii. Retirement funds that cannot be converted into cash.
Amount of assets community spouse may retain: The community spouse can keep non-exempt resources owned by one or both spouses with a maximum of $66,480. If the community spouse’s assets do not equal $66,480, the community spouse is able to retain assets from the institutionalized spouse until the maximum is reached.
Community spouse impoverishment protection: The community spouse can keep part of the institutionalized spouse’s income if the community spouse has a monthly income of less than $3,090. The maximum amount of income that can be retained is $3,090.
South Carolina long term care insurance partnership:
This is a program between the state and private insurance companies. Partnership policies protect assets by matching dollar for dollar what policy holders pay into their policies. For example, if you bought a Partnership Policy with a maximum benefit payout of $155,000 then you are able to protect $155,000 of your assets. For married couples each spouse needs to purchase their own policy. Once the $155,000 worth of long term care coverage is used, you may apply for Medicaid with $155,000 worth of assets exempted.
South Carolina Long Term Care general information and Long Term Care Partnership information: http://www.doi.sc.gov/DocumentCenter/View/2218