Applying for Medicaid in South Carolina can feel overwhelming, but the process is more straightforward than most people think. South Carolina's Medicaid program, called Healthy Connections Medicaid, provides free or low-cost health coverage to eligible residents including children, pregnant women, seniors, and people with disabilities. This guide walks you through everything you need to know about eligibility, income limits, and how to submit your application.
Not sure if you qualify? Use our free benefits screener to check your eligibility for Medicaid and other assistance programs in just a few minutes. You can also visit our South Carolina Benefits Overview page for a complete look at all available programs in the state.
Understanding South Carolina Medicaid Eligibility
South Carolina has not expanded Medicaid under the Affordable Care Act. This is one of the most important things to understand because it means eligibility is more limited than in expansion states. In South Carolina, most adults without dependent children, a disability, or a pregnancy do not qualify for Medicaid, regardless of how low their income is.
Eligibility for Healthy Connections Medicaid is based on your household size, income, age, and specific circumstances such as pregnancy or disability status.
Who Can Qualify for Medicaid in South Carolina?
The following groups may be eligible for Medicaid in South Carolina:
- Children under 19 through Medicaid or the Partners for Healthy Children (CHIP) program
- Pregnant women and infants up to 12 months postpartum
- Parents or caretaker relatives with dependent children living in the home
- Adults 65 and older who meet income and resource limits
- People with disabilities who receive SSI or meet other disability criteria
- Working adults with disabilities who have earned income
- Women diagnosed with breast or cervical cancer through screening programs
Who Falls in the Coverage Gap?
Because South Carolina has not expanded Medicaid, adults between 19 and 64 who do not have dependent children, are not pregnant, and do not have a qualifying disability may fall into a "coverage gap." Their income may be too low for ACA Marketplace subsidies but too high (or their category not covered) for traditional Medicaid. If you fall into this situation, you may still want to apply through Healthcare.gov to see if you qualify for subsidized marketplace plans.
South Carolina Medicaid Income Limits (2025-2026)
Income limits vary depending on which eligibility category you fall under. The table below shows monthly income limits based on household size for the most common categories.
Parents and Caretaker Relatives (62% FPL)
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 2 | $1,097 | $13,163 |
| 3 | $1,385 | $16,622 |
| 4 | $1,674 | $20,082 |
| 5 | $1,963 | $23,541 |
Children: Medicaid and CHIP (208% FPL)
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 2 | $3,680 | $44,158 |
| 3 | $4,647 | $55,765 |
| 4 | $5,614 | $67,371 |
| 5 | $6,582 | $78,978 |
Pregnant Women (194% FPL)
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 | $2,530 | $30,361 |
| 2 | $3,432 | $41,186 |
| 3 | $4,334 | $52,011 |
| 4 | $5,237 | $62,837 |
Aged, Blind, or Disabled (100% FPL)
| Household Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 | $1,304 | $15,650 |
| 2 | $1,769 | $21,230 |
Resource limits for ABD category: $9,950 for an individual, $14,910 for a couple (effective January 1, 2026).
Note: These figures are based on the 2025 Federal Poverty Level guidelines. Income limits are updated each year, typically in March. Always verify current limits with SCDHHS or use our benefits screener for the latest figures.
How to Apply for Medicaid in South Carolina: Step by Step
There are several ways to apply for Healthy Connections Medicaid. Choose the method that works best for you.
Step 1: Gather Your Documents
Before you start your application, collect the following documents and information:
- Proof of identity such as a driver's license, state ID, or birth certificate
- Social Security numbers for all household members applying
- Proof of income including recent pay stubs, W-2 forms, or tax returns
- Proof of South Carolina residency such as a utility bill or lease agreement
- Proof of citizenship or immigration status such as a U.S. passport or permanent resident card
- Information about current health insurance if you have any
- Proof of pregnancy if applicable (doctor's note or medical records)
- Disability documentation if applying under a disability category
Step 2: Choose Your Application Method
Option A: Apply Online (Recommended)
The fastest way to apply is through the SCDHHS online portal:
- Visit apply.scdhhs.gov
- Create an account or log in if you already have one
- Complete the application with your personal and financial information
- Upload required documents
- Submit the application
Option B: Apply by Phone
Call the Healthy Connections Member Help Center at (888) 549-0820. A representative can help you complete your application over the phone. Phone lines are open Monday through Friday during business hours.
Option C: Apply Through Healthcare.gov
You can also apply through the federal Health Insurance Marketplace at Healthcare.gov. When you fill out a Marketplace application, the system will automatically check if you or your family members qualify for Medicaid. If you do, your information will be forwarded to SCDHHS.
Option D: Apply In Person
Visit your local county Department of Social Services (DSS) office. You can find your nearest office at dss.sc.gov. Bring all your documents with you.
Option E: Apply by Mail
Download a paper application from the SCDHHS website, fill it out, and mail it to your local county DSS office.
Step 3: Complete Your Application
Whether you apply online, by phone, or in person, you will need to provide:
- Personal details for every household member (name, date of birth, Social Security number)
- Household income information from all sources
- Information about any current health coverage
- Details about your living situation
Answer every question as accurately as possible. Incomplete applications can cause delays.
Step 4: Wait for a Decision
After submitting your application, SCDHHS will review it and determine your eligibility. The typical processing time is up to 45 days for most categories. For pregnant women, decisions are often expedited.
You may receive a request for additional documentation. Respond as quickly as possible to avoid delays.
Step 5: Receive Your Decision and Medicaid Card
If approved, you will receive a Healthy Connections Medicaid card in the mail. This card allows you to access medical services from any provider that accepts South Carolina Medicaid. You will also be enrolled in a managed care organization (MCO) that will coordinate your care.
If denied, you will receive a letter explaining the reason. You have the right to appeal the decision.
What Does South Carolina Medicaid Cover?
Healthy Connections Medicaid covers a wide range of medical services, including:
- Doctor visits and specialist care
- Hospital stays (inpatient and outpatient)
- Prescription medications
- Lab tests and X-rays
- Mental health and substance abuse treatment
- Preventive care and wellness visits
- Dental care (primarily for children)
- Vision care
- Home health services
- Nursing facility care
- Transportation to medical appointments
Children enrolled through the Partners for Healthy Children (CHIP) program receive comprehensive coverage including dental and vision services.
Tips for a Successful Application
- Apply even if you are unsure. SCDHHS encourages residents to apply. The agency will determine which programs you qualify for.
- Keep copies of everything. Make copies of all documents you submit and note the date you submitted your application.
- Respond to requests promptly. If SCDHHS asks for additional information, send it as soon as possible.
- Get help if you need it. Organizations like SC Thrive offer free assistance with benefits applications.
- Complete your annual review. Medicaid eligibility is reviewed each year. Make sure to respond to renewal notices to keep your coverage active.
What If You Are Denied Medicaid?
If your Medicaid application is denied, you have several options:
- Review the denial letter to understand exactly why you were denied
- Appeal the decision if you believe there was an error. Instructions for filing an appeal will be included in your denial letter.
- Check Healthcare.gov for subsidized health insurance plans through the ACA Marketplace
- Use our benefits screener to check if you qualify for other assistance programs like SNAP, LIHEAP, or WIC
- Contact SC Thrive at scthrive.org for help exploring other options
Frequently Asked Questions
Can I apply for Medicaid in South Carolina at any time?
Yes. Unlike ACA Marketplace plans, there is no open enrollment period for Medicaid. You can apply at any time of the year.
How long does it take to get approved for Medicaid in South Carolina?
Most applications are processed within 45 days. Applications involving a disability determination may take longer. Pregnant women may receive expedited processing.
Does South Carolina have Medicaid expansion?
No. As of 2026, South Carolina has not expanded Medicaid under the Affordable Care Act. This means eligibility for adults is more restricted than in states that have expanded. Legislative efforts continue, but no expansion has been approved.
Can single adults without children get Medicaid in South Carolina?
In most cases, no. Because South Carolina has not expanded Medicaid, single adults without children who are not pregnant, elderly, or disabled generally do not qualify. They may be eligible for subsidized plans through Healthcare.gov.
What is the income limit for children's Medicaid in South Carolina?
Children under 19 may qualify for Medicaid or the Partners for Healthy Children (CHIP) program with household incomes up to 208% of the Federal Poverty Level. For a family of three, that is about $4,647 per month or $55,765 per year.
What documents do I need to apply for Medicaid in South Carolina?
You will need proof of identity, Social Security numbers, proof of income, proof of residency, and proof of citizenship or legal immigration status. Additional documents may be required depending on your situation.
Can I apply for Medicaid and SNAP at the same time?
While Medicaid and SNAP are managed by different state agencies (SCDHHS and DSS respectively), applying for one does not automatically enroll you in the other. However, you can apply for both simultaneously. Use our free screener to see all the programs you may qualify for.
Where can I get help with my Medicaid application?
You can call the Healthy Connections Member Help Center at (888) 549-0820, visit your local county DSS office, or contact SC Thrive for free application assistance.
Take the Next Step
Applying for Medicaid in South Carolina does not have to be complicated. Start by checking your eligibility with our free benefits screener, then follow the steps above to submit your application. If you qualify, you could gain access to comprehensive health coverage at little or no cost to you and your family.
For more information about all the assistance programs available in the Palmetto State, visit our South Carolina Benefits Overview.
