Jane Dotson
South Carolina's Medicaid program, called Healthy Connections, is a medical assistance program that helps pay for medical bills for eligible low-income families and individuals. Healthy Connections is administered by the South Carolina Department of Health and Human Services (SCDHHS) and pays medical bills with state and federal tax money. Eligibility is usually based on applicants' income and assets, and financial requirements change annually. Healthy Connections provides full Medicaid benefits to uninsured individuals who are found in need of treatment for breast or cervical cancer or precancerous lesions. It also provides coverage to pregnant women with low income, and that coverage continues for 12 months after the baby's birth.
| Characteristics | Values |
|---|---|
| Name of the program | Healthy Connections |
| Administered by | South Carolina Department of Health and Human Services (SCDHHS) |
| Type of program | Medical assistance program |
| Who is eligible | Low-income families and individuals whose income is insufficient to meet the cost of necessary medical services |
| Income limits | Set each year by the federal Department of Health and Human Services; based on the Federal Poverty Level (FPL) and vary for different family sizes and programs |
| Application | Online or by submitting forms to the local Healthy Connections county office |
| Coverage | All Medicaid-covered services |
| Additional benefits | Coverage for children, pregnant women, individuals up to the age of 26 who were formerly in foster care, and individuals requiring treatment for breast or cervical cancer |
| Other options | Federally Qualified Health Centers (FQHC) and other Community Health Centers (CHC) offer comprehensive medical services to patients with no health insurance |
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What You'll Learn
Who is eligible for Medicaid in South Carolina?
The South Carolina Department of Health and Human Services (SCDHHS) determines eligibility for Medicaid in South Carolina. The state's Medicaid program is called Healthy Connections.
Healthy Connections provides full Medicaid benefits to individuals who meet certain criteria. To be eligible for Medicaid in South Carolina, you must fall into one of the following categories:
- Pregnant women with low income: Coverage for the mother continues for 12 months after the baby's birth, and the infant is covered up to age one.
- Children under the age of 19 with a disability or special health care need.
- Individuals who are 65 or older, blind, or have a disability: Disability is determined by using the Supplemental Security Income (SSI) guidelines.
- Individuals with very low or no income: Income limits are set each year by the federal Department of Health and Human Services and are based on the Federal Poverty Level (FPL).
- Individuals who are uninsured and require treatment for breast or cervical cancer or precancerous lesions: Applicants must be screened by a physician or through the South Carolina Breast and Cervical Cancer Early Detection Program and must not have other insurance coverage that would cover treatment.
- Individuals up to the age of 26 who were formerly in foster care.
Additionally, the Working Disabled program in South Carolina offers Medicaid to individuals who are totally and permanently disabled according to SSI definitions.
If you are unsure about your eligibility for Medicaid in South Carolina, you can apply and allow Healthy Connections to determine your eligibility. You can also call the Member Help Center at (888) 549-0820 for assistance.
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What are the income requirements for Medicaid?
Medicaid is a medical assistance program that provides free or low-cost medical benefits to eligible low-income individuals and families. The income requirements for Medicaid vary depending on the state, the size of the family, and the specific Medicaid program.
In general, Medicaid eligibility is based on a combination of income and other factors, such as family size, age, and pregnancy or parenting status. Each state has its own requirements, and income limits are set each year by the federal Department of Health and Human Services, based on the Federal Poverty Level (FPL). For example, the Partners for Healthy Children program in South Carolina provides Medicaid coverage for children in families with incomes at or below 208% of the FPL. Similarly, the state's Breast and Cervical Cancer program covers individuals at or below 200% of the FPL.
It's important to note that income is not the sole criterion for Medicaid eligibility. There are also asset limits and level of care requirements, which vary by state and the type of Medicaid program. For instance, individuals residing in Medicaid-funded nursing homes are typically allowed to have a monthly income of up to $2,901 in 2025, but they must contribute most of it towards their care costs, retaining only a small Personal Needs Allowance.
Additionally, certain groups are exempt from the income requirements. For instance, individuals aged 65 or older, or those who are blind or have a disability, may have their eligibility determined using the income methodologies of the Supplemental Security Income (SSI) program. Moreover, young adults who are former foster care recipients are eligible at any income level.
If you are unsure about your eligibility, it is recommended to apply for Medicaid or seek assistance from federally qualified health centers or community health centers, which offer services based on what you can afford.
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How do I apply for Medicaid?
The process of applying for Medicaid depends on the state in which you live. Here is a general overview of the process, along with specific details for New York and South Carolina.
General
Medicaid is a program that pays medical bills for eligible low-income families and individuals whose income is insufficient to meet the cost of necessary medical services. The federal Marketplace will forward your information to your state's Medicaid program for a final eligibility determination. You can apply for Medicaid at any time of the year.
New York
If you receive Medicaid through the NY State of Health, you may fill out form DOH-5085 and submit it to NY State of Health. Blind or visually impaired applicants can submit form DOH-5130 to request information in an alternative format. If you are applying with your Local Department of Social Service (LDSS) or with a spenddown, you should fill out form DOH-4220. If you are applying for a non-MAGI Medicaid Application, you must also fill out form DOH-5178A.
Pregnant individuals and children can apply at many clinics, hospitals, and provider offices. If you are in a facility operated by the New York State Office of Mental Health, contact the patient resource office. If you are in a facility operated by the New York State Office for People With Developmental Disabilities, contact the Revenue Support Field Office. Enrollment Assistors offer free personalized help, which you can access by calling (855) 355-5777.
South Carolina
Healthy Connections is the name of the South Carolina Medicaid program. It provides coverage for children who live in families with income at or below 208% of the Federal Poverty Level, as well as pregnant women with low income. Healthy Connections also provides full Medicaid benefits to uninsured individuals who are found in need of treatment for breast or cervical cancer or precancerous lesions.
You can apply for Healthy Connections online or by submitting the Healthy Connections Application Form by mail or to your local county office.
Online Application
If you are applying for Medicaid online, you will be asked to create a secure account. By law, Medicaid must keep your information private and secure. Your application should take about 30 to 45 minutes to complete. Once your application is submitted, you will see a tracking number, which you should write down and keep somewhere safe.
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Can I have Medicaid and Medicare at the same time?
Yes, it is possible to have both Medicare and Medicaid at the same time. This situation is known as being "dual eligible", and around 12.3 million people in the US fall into this category. Dual eligibility allows beneficiaries to combine Medicare and Medicaid benefits to expand coverage and assist with costs.
Medicare is a federal health insurance program for people aged 65 and over or who have received Social Security disability benefits for a minimum of 24 months. Medicare is available at specific times during the year, including initial enrollment, Medicare’s Open Enrollment Period, the Medicare Advantage Open Enrollment, and Special Enrollment Periods (SEP).
Medicaid, on the other hand, is a state-based health insurance program for individuals with limited incomes and resources. Unlike Medicare, Medicaid does not have age restrictions for members.
When a person qualifies for both Medicare and Medicaid, they may get additional assistance with their healthcare costs. Medicare pays first, and Medicaid pays last. Medicaid covers any qualified medical costs not covered by Medicare up to a state’s payment limit. A person's state Medicaid program may also cover services that Medicare doesn't, such as prescription drugs, eyeglasses, and hearing aids.
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What is the Medicaid Eligibility Test?
Medicaid is a federal-state program that provides health coverage to millions of Americans, including children, pregnant women, parents, seniors, and individuals with disabilities. The South Carolina Medicaid program, called Healthy Connections, is administered by the South Carolina Department of Health and Human Services (SCDHHS) and pays medical bills with state and federal tax money.
The Medicaid Eligibility Test is a tool that helps seniors determine if they are immediately eligible for Medicaid long-term care benefits. It is important to note that this is not an application and the results are not binding. The test is designed to inform seniors if they are eligible, or if they need to adjust their income or assets or consult a professional to become eligible. Every state has different financial criteria for Medicaid eligibility, and these criteria change annually.
The eligibility criteria for Medicaid consider various factors, including income, family size, age, pregnancy or parenting status, and citizenship or residency status. Income limits are set annually by the federal Department of Health and Human Services and are based on the Federal Poverty Level (FPL), varying with family size and program. Certain eligibility groups do not require an income determination, such as children with an adoption assistance agreement under Title IV-E of the Social Security Act and young adults who are former foster care recipients.
In South Carolina, Healthy Connections provides full Medicaid benefits to uninsured individuals requiring treatment for breast or cervical cancer or precancerous lesions. It also covers children in families with incomes at or below 208% of the FPL and pregnant women with low income for 12 months after birth, with the infant covered up to one year of age. Individuals who are eligible will receive all Medicaid-covered services.
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Frequently asked questions
Yes, SC people can have insurance with Medicaid. The South Carolina Medicaid program, called Healthy Connections, is administered by the South Carolina Department of Health and Human Services (SCDHHS) and pays medical bills with state and federal tax money.
You can apply for Healthy Connections online at apply.scdhhs.gov or by submitting the required forms to your local Healthy Connections county office.
Eligibility for Healthy Connections is usually based on applicants' income and assets. Income limits are set each year by the federal Department of Health and Human Services and vary based on family size and the specific Medicaid program.
