This page provides a plain-English summary of key elder care and estate planning information specific to South Carolina residents. It covers South Carolina Medicaid limits, estate tax rules, advance directive information, and links to important South Carolina agencies and resources.
Information on this page is updated periodically but laws and limits change frequently. Always verify current figures with the relevant agency or a licensed attorney.
South Carolina Medicaid — 2026 Eligibility Limits for Long Term Care
South Carolina’s Medicaid program is called Healthy Connections and is administered by the South Carolina Department of Health and Human Services — SCDHHS. South Carolina has not expanded Medicaid under the Affordable Care Act meaning most healthy adults aged 19 to 64 without disabilities or dependent children do not qualify for standard Medicaid coverage.
Income limit — single applicant The income limit for a single South Carolina nursing home Medicaid applicant is $2,982 per month in 2026. South Carolina is an income cap state meaning applicants whose income exceeds this limit must establish a Qualified Income Trust — also called a Miller Trust or QIT — to qualify.
Asset limit — single applicant A single applicant must have $2,000 or less in countable assets. Exempt assets include the primary residence with equity up to $752,000 — South Carolina uses the federal minimum home equity limit — if the applicant intends to return home, one vehicle, personal belongings and household furnishings, and up to $1,500 in burial funds per spouse.
IRA and retirement account treatment — unique rule in South Carolina South Carolina has a notably favorable rule for IRAs and 401(k)s. An applicant’s IRA or 401(k) is exempt from the asset limit if it is in payout status — meaning the Required Minimum Distribution is actively being withdrawn. IRAs and 401(k)s of the non-applicant spouse are automatically exempt regardless of payout status. This is more favorable than most states which count retirement accounts as countable assets.
Community Choices Waiver — important CSRA difference South Carolina’s HCBS program is the Community Choices Waiver. A critical difference from most states is that South Carolina’s Community Spouse Resource Allowance — CSRA — is only $66,480 in 2026. Most other states allow the community spouse to retain up to $162,660. South Carolina’s much lower CSRA means married couples have significantly less asset protection when one spouse needs long term care. Advance planning with an elder law attorney is especially important for South Carolina married couples.
Community Choices Waiver — waitlist warning The Community Choices Waiver is not an entitlement program. Enrollment is capped and waitlists are active in many areas of South Carolina. Families should apply as early as possible and explore all options while waiting.
Healthy Connections Prime ended January 1 2026 South Carolina’s combined Medicare-Medicaid managed care plan — Healthy Connections Prime — ended on January 1 2026. Former Prime members were directed to switch to a Dual Special Needs Plan — D-SNP — through a private Medicare Advantage insurer. Some members were automatically transitioned. If you or a family member were enrolled in Healthy Connections Prime contact SCDHHS at 1-888-549-0820 to confirm current coverage status.
Married couples — one spouse applying When only one spouse applies for South Carolina Medicaid the community spouse may retain up to $66,480 — significantly lower than the $162,660 maximum in most states. The minimum the community spouse may retain is $32,532. The applicant spouse retains $2,000.
Monthly Maintenance Needs Allowance The minimum Monthly Maintenance Needs Allowance for the community spouse is $2,643.75 per month in 2026. The maximum is $4,066.50 per month for community spouses with high housing costs.
Personal needs allowance South Carolina nursing home Medicaid recipients are allowed to keep $60 per month as a personal needs allowance. The remainder of income is applied toward the cost of care.
Look-back period and divestment penalty South Carolina has a 60-month — five year — look-back period for nursing home Medicaid and Community Choices Waiver applications. Asset transfers made within 60 months of applying that were for less than fair market value may result in a penalty period of ineligibility. The 2026 divestment penalty divisor in South Carolina is approximately $9,546 per month.
Estate recovery South Carolina requires Medicaid estate recovery for recipients who received long term care services. After a Healthy Connections recipient dies the state seeks reimbursement from the estate for long term care costs paid after age 55. Planning with an elder law attorney can help protect assets from estate recovery.
How to apply for South Carolina Healthy Connections Medicaid Applications can be submitted online at mySCDHHS.gov, by phone at 1-888-549-0820, or in person at your local county SCDHHS office.
South Carolina Medicaid administering agency South Carolina Department of Health and Human Services — scdhhs.gov
South Carolina Estate Tax — 2026
No South Carolina state estate tax South Carolina does not impose a state estate tax. South Carolina’s estate tax was tied to the federal state death tax credit which was eliminated by federal law and effectively ended the state tax. No South Carolina estate tax applies to any estate regardless of size.
No South Carolina inheritance tax South Carolina does not impose an inheritance tax. Beneficiaries who receive assets from a South Carolina decedent owe no South Carolina inheritance tax regardless of the size of the inheritance or their relationship to the deceased.
Federal estate tax South Carolina residents may be subject to the federal estate tax. The federal estate tax exemption is $15,000,000 per person in 2026 following enactment of the One Big Beautiful Bill Act. The exemption is portable between spouses meaning a married couple can protect up to $30,000,000 from federal estate tax with proper planning. The top federal estate tax rate is 40 percent on amounts above the exemption.
No South Carolina gift tax South Carolina does not impose a state gift tax. Federal gift tax rules apply — the annual gift tax exclusion is $19,000 per recipient in 2026.
South Carolina income tax South Carolina has a flat income tax rate of 6.2 percent in 2026 — the state has been gradually reducing its top rate in recent years. Social Security benefits are not taxed in South Carolina. Retirement income including pension income and IRA withdrawals may qualify for a deduction for residents aged 65 and older.
Step-up in basis Inherited assets in South Carolina receive a stepped-up tax basis to fair market value at the date of the original owner’s death. This can significantly reduce capital gains taxes when beneficiaries later sell inherited property.
South Carolina Advance Directives
South Carolina law recognizes the following advance directive documents:
South Carolina Advance Directive for Health Care South Carolina uses a combined Advance Directive for Health Care that includes both the appointment of a healthcare agent and treatment instructions. Must be signed and witnessed by two adults who are not the healthcare agent.
South Carolina POLST — Physician Orders for Life-Sustaining Treatment South Carolina uses a POLST form for seriously ill patients that documents specific medical orders regarding CPR hospitalization and artificial nutrition. Must be signed by a physician or nurse practitioner.
South Carolina Do Not Resuscitate Order A physician order directing emergency personnel not to perform CPR. South Carolina has standardized out-of-hospital DNR protocols.
South Carolina Advance Directive Registry South Carolina does not maintain a statewide advance directive registry. Copies of your advance directive should be given to your healthcare agent physician and any hospital or care facility where you receive care.
Free South Carolina advance directive forms Free South Carolina-specific advance directive forms are available at caringinfo.org and from the South Carolina Medical Association at scmanet.org.
South Carolina Key Agencies and Resources
South Carolina Department of Health and Human Services — SCDHHS Administers Healthy Connections — South Carolina Medicaid — including long term care programs. Website: scdhhs.gov Member Portal: mySCDHHS.gov Phone: 1-888-549-0820
South Carolina Lieutenant Governor’s Office on Aging — LGOA Coordinates programs and services for older South Carolinians including home care nutrition programs caregiver support and the South Carolina SHIP program for free Medicare counseling. Website: aging.sc.gov Phone: 1-800-868-9095 South Carolina SHIP — free Medicare counseling: 1-800-868-9095
South Carolina Area Agencies on Aging South Carolina is served by 10 Area Agencies on Aging that coordinate local services for older adults and caregivers. Eldercare Locator: 1-800-677-1116 or eldercare.acl.gov
South Carolina Long Term Care Ombudsman Program Advocates for the rights of residents of nursing homes and assisted living facilities. Investigates complaints and helps resolve problems free of charge. Website: aging.sc.gov/ombudsman Phone: 1-800-868-9095
South Carolina Bar Lawyer Referral Service Connects South Carolinians with attorneys including those who specialize in elder law and estate planning. Website: scbar.org Phone: 1-800-868-2284
South Carolina Legal Services Provides free civil legal services to low income South Carolinians including seniors on issues related to Medicaid benefits housing and elder law. Website: sclegal.org Phone: 1-888-346-5592
South Carolina Veterans Resources
South Carolina Department of Veterans Affairs — SCDVA Provides services and benefits to South Carolina veterans and their families including free VA claims assistance and connections to South Carolina veterans resources. Website: va.sc.gov Phone: 1-803-734-0200
South Carolina State Veterans Homes South Carolina operates veterans homes providing long term care to eligible veterans and their spouses. Facilities are located in Anderson Columbia and Walterboro. Website: va.sc.gov/veterans-homes
South Carolina Senior Property Tax Benefits
Homestead Exemption for Seniors South Carolina homeowners aged 65 and older who have been legal residents of South Carolina for at least one year qualify for a homestead exemption that exempts the first $50,000 of fair market value of their primary residence from property taxes. This is a significant benefit available to qualifying seniors statewide. Apply through your county auditor’s office.
Agricultural Property Tax Assessment South Carolina farmland that qualifies for agricultural use assessment is taxed at a much lower rate than residential property. This can be relevant for rural South Carolina seniors with farm property.
Disabled Veteran Property Tax Exemption South Carolina veterans who are totally and permanently disabled due to a service-connected disability are exempt from property taxes on their primary residence. The exemption also applies to surviving spouses of qualifying veterans who have not remarried. Apply through your county auditor’s office.
Finding Elder Law and Estate Planning Attorneys in South Carolina
The following resources can help you find a qualified elder law or estate planning attorney in South Carolina:
- National Academy of Elder Law Attorneys — NAELA — naela.org — searchable directory by location
- South Carolina Bar Lawyer Referral Service — scbar.org — 1-800-868-2284
- South Carolina Chapter of NAELA — South Carolina has an active NAELA chapter with members throughout the state
- South Carolina Legal Services — sclegal.org — free legal assistance for income-qualifying seniors — 1-888-346-5592
The information on this page is for general informational purposes only and does not constitute legal or financial advice. South Carolina Healthy Connections Medicaid rules and other figures change frequently. Always verify current information with the relevant agency or a licensed attorney. Laws vary and individual circumstances differ significantly.
Last updated: April 2026