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Medicaid Program - Financial Eligibility - South Carolina

Individuals must meet specific financial criteria in order to be eligible for Medicaid in South Carolina. Both income and resources are evaluated to determine eligibility.

Income

Gross income limits for a number of coverage groups are shown in the tables below. A separate table for the Partners for Healthy Children program may be found in that topic. In most cases, the income limits are based on percentages of the Federal Poverty Guidelines. The tables were current as of 07/28/2008.

If the individual is eligible for Medicaid except that his/her gross monthly income is greater than income limit, s/he may establish an income trust to become eligible for Medicaid. The individual should contact the County Department of Social Services to obtain more information about the income trust provisions.

General Hospital, Nursing Home, TEFRA/Katie Beckett and
Home and Community Based Waiver Services
(300% of the Federal Benefit Rate-FBR)

(Effective January 1, 2008)

Optional State Supplementation (OSS)

(Effective January 1, 2008)

Aged, Blind And Disabled
(100% Of Poverty Level)

(Effective March 1, 2008)

NOTE: For each additional family member, add $3,600 to the annual income. Divide by 12 and round up to the next whole dollar for the monthly income.

Optional Coverage For Pregnant Women And Infants
(185% Of Poverty Level)

(Effective March 1, 2008)

NOTE: For each additional family member, add $6,660 to the annual income. Divide by 12 and round up to the next whole dollar for the monthly income.

Partners For Healthy Children (PHC)
Coverage For Children Age 1 To 19
(150% of Poverty Level)

(Effective March 1, 2008)

NOTE: For each additional family member, add $5,400 to the annual income. Divide by 12 and round up to the next whole dollar for the monthly income.

200% Of Poverty Level

(Effective March 1, 2008)

NOTE: For each additional family member, add $7,200 to the annual income. Divide by 12 and round up to the next whole dollar for the monthly income.

Specified Low-Income
Medicare Beneficiaries (SLMB)
(135% of Poverty Level)

(Effective July 1, 2008)

Working Disabled
(250% Of Poverty Level)

(Effective March 1, 2008)

NOTE: For each additional family member, add $9,000 to the annual income. Divide by 12 and round up to the next whole dollar for the monthly income.

Low-Income Families (LIF)

(Effective October 1, 2007)

NOTE: For family sizes over 8, add $145 for each extra person to the net income limit for 8. To calculate the gross income limit, multiply the net income limit by 185%.

Breast and Cervical Cancer Program (BCCP)
(200% Of Poverty Level)

(Effective March 1, 2008)

NOTE: For each additional family member, add $7,200 to the annual income. Divide by 12 and round up to the next whole dollar for the monthly income.

Resources

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 (after exclusions). Resource limits vary by coverage group and marital status.

The value of resources owned cannot exceed $2000 for an individual and $3000 for a couple (after exclusions) for those receiving Supplemental Security Income (SSI) or the Optional State Supplement. For the Working Disabled group, the limit is also $2000.

In the TEFRA/Katie Beckett Children coverage group, parents' resources are not counted and the child's resources must not exceed $2000.

For the SSI-Related Medical Assistance Only (MAO) coverage group, the resource limit is $2000 for an individual (excluding home) with a community spouse resource limit of $66,480.

The resource limit is $4000 for an individual and $6000 for a couple in the Aged, Blind, Disabled (ABD) group and also for the QMB and SLMB groups.

There is no resource limit for the Breast and Cervical Cancer coverage group or those eligible for the Gap Assistance Pharmacy Program For Seniors (GAPS) -- which replaced the now-discontinued SILVERxCARD program.

Resources are not considered for the following coverage groups: Low-Income Families (LIF), Ribicoff Children, Foster Children, Pregnant Women and Infants Under 185% Poverty Level, and Children Age 1-19 Under Poverty Level.

The following resources are excluded:

·      the value of the home;

·      the value of one automobile;

·      the value of life estate interest in real property;

·      the value of household goods and personal effects;

·      the value of undivided interest in heirs' property;

·      up to $1500 set aside for the individual’s burial (an additional $1500 for a spouse, if living); and

·      the cash value of life insurance policies owned by the individual when the total face value of all policies is $5000 or less.

Resource determinations are not restricted to the first moment of the first day of the month. An individual who is otherwise eligible and whose resources are within the limit at any time during the month is eligible for Medicaid the entire month.

Also see:

Medicaid Program - Non-Financial Eligibility

Medicaid Program - Services

Medicaid Program - Mandatory Group Coverage

Medicaid Program - Optional Group Coverage

Medicaid Program - Payments for Services

Medicaid Program - Overview

Source

http://www.dhhs.state.sc.us/dhhsnew/incomeLimitations.asp

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