South Carolina provides Medicaid coverage through its Healthy Connections program, serving nearly one million residents across the state. As a state that has not expanded Medicaid under the Affordable Care Act, South Carolina has more limited eligibility compared to expansion states. Understanding who qualifies and how to apply is essential if you or your family need affordable health coverage in 2026. This guide covers every major eligibility category, current income limits effective March 1, 2026, step-by-step application instructions, and important details about the coverage gap.
For a broader look at all assistance programs available in the state, visit our South Carolina Benefits Overview.
South Carolina Medicaid: Key Facts for 2026
South Carolina's Medicaid program is called Healthy Connections and is administered by the South Carolina Department of Health and Human Services (SCDHHS). Here are the most important things to know:
- South Carolina has not expanded Medicaid under the ACA
- Eligibility is limited to specific categories: children, pregnant women, parents/caretakers with dependent children, aged/blind/disabled individuals, and certain other groups
- Non-disabled adults without children generally do not qualify for Medicaid in South Carolina, regardless of income
- Income limits were updated effective March 1, 2026, based on the 2026 Federal Poverty Level (FPL)
Who Qualifies for Medicaid in South Carolina?
Healthy Connections Medicaid covers several distinct groups, each with its own income thresholds. Below are the main eligibility categories and their 2026 income limits, sourced directly from the SCDHHS.
Children: Partners for Healthy Children (PHC)
Children under age 19 can qualify for Medicaid or the Children's Health Insurance Program (CHIP) through the Partners for Healthy Children program. The income limit is set at 208% of the Federal Poverty Level.
| Family Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 | $2,766 | $33,196 |
| 2 | $3,751 | $45,008 |
| 3 | $4,735 | $56,824 |
| 4 | $5,720 | $68,640 |
| 5 | $6,705 | $80,456 |
| 6 | $7,689 | $92,272 |
| 7 | $8,674 | $104,084 |
| 8 | $9,658 | $115,900 |
Income limits effective 03/01/2026. Source: SCDHHS.
Pregnant Women and Infants
Pregnant women can qualify with household income up to 194% of the FPL. Coverage for the mother continues for 12 months after the baby is born. Infants are covered through their first birthday.
| Family Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 | $2,530 | $30,361 |
| 2 | $3,419 | $41,031 |
| 3 | $4,308 | $51,701 |
| 4 | $5,198 | $62,371 |
| 5 | $6,087 | $73,041 |
| 6 | $6,976 | $83,711 |
| 7 | $7,865 | $94,381 |
| 8 | $8,754 | $105,051 |
Income limits effective 03/01/2026. Source: SCDHHS.
Parents and Caretaker Relatives
Parents or caretaker relatives with a dependent child living in the home may qualify if their income is at or below 62% of the FPL. This is one of the lowest parent eligibility thresholds in the country.
| Family Size | Monthly Income Limit |
|---|---|
| 1 | $825 |
| 2 | $1,118 |
| 3 | $1,412 |
| 4 | $1,705 |
| 5 | $1,998 |
| 6 | $2,292 |
| 7 | $2,585 |
| 8 | $2,879 |
Income limits effective 03/01/2026. Source: SCDHHS.
Aged, Blind, or Disabled (ABD)
Individuals who are 65 or older, blind, or living with a disability may qualify at 100% of the FPL. There is also a resource limit.
| Family Size | Monthly Income | Annual Income | Resource Limit |
|---|---|---|---|
| 1 | $1,330 | $15,960 | $9,950 |
| 2 | $1,804 | $21,640 | $14,910 |
Income limits effective 03/01/2026. Resource limits effective 01/01/2026. Source: SCDHHS.
Working Disabled
Individuals under 65 who are permanently disabled and have earned income may qualify through the Working Disabled program. Family income must be below 250% of the FPL, and the individual's unearned income must be at or below 100% of the FPL.
| Family Size | Monthly Income Limit | Annual Income Limit |
|---|---|---|
| 1 | $3,325 | $39,900 |
| 2 | $4,509 | $54,100 |
| 3 | $5,692 | $68,300 |
| 4 | $6,875 | $82,500 |
Income limits effective 03/01/2026. Source: SCDHHS.
Other Medicaid Programs in South Carolina
South Carolina also offers Medicaid coverage through several additional programs:
- Family Planning (194% FPL): Limited benefits covering preventive and family planning services for men and women who do not qualify for full Medicaid
- Breast and Cervical Cancer Program (200% FPL): Full Medicaid for uninsured individuals needing treatment for breast or cervical cancer
- Former Foster Care (up to age 26): No income limit for individuals who aged out of foster care while on Medicaid
- Katie Beckett/TEFRA Children: Children with disabilities whose parents' income exceeds standard limits, with a monthly income cap of $2,982
- Nursing Facility and Home/Community Based Waiver Services: Income limit of $2,982 per month (300% of the Federal Benefit Rate)
- Medically Indigent Assistance Program (MIAP): Inpatient hospital coverage for those at or below 200% FPL with limited assets
The Medicaid Coverage Gap in South Carolina
Because South Carolina has not expanded Medicaid, a significant number of residents fall into what is known as the coverage gap. These are adults who earn too much to qualify for Medicaid under the state's strict income limits but too little to qualify for subsidized Marketplace insurance through Healthcare.gov (which generally requires income of at least 100% of the FPL).
According to the Kaiser Family Foundation, approximately 105,000 South Carolinians fall into this coverage gap. Most are non-disabled adults without dependent children. Several bills have been introduced in the South Carolina legislature to expand Medicaid, including Bill 3109 in the 2025-2026 session, but none have advanced as of early 2026.
If you fall into the coverage gap, some options to explore include:
- Community health centers that offer sliding-scale fees
- Free clinics in your area
- Hospital financial assistance programs
- The Medically Indigent Assistance Program (MIAP) for emergency inpatient care
- Check our free eligibility screener to see if you qualify for other assistance programs
How to Apply for Medicaid in South Carolina
Applying for Healthy Connections Medicaid is free and can be done year-round. There is no limited enrollment period. Follow these steps:
Step 1: Gather Your Documents
Before applying, collect the following:
- Social Security numbers for all household members
- Proof of income (pay stubs, tax returns, or employer statements)
- Proof of South Carolina residency (utility bill, lease, or state ID)
- Proof of U.S. citizenship or lawful permanent resident status
- Proof of age (birth certificate or government ID)
- For disability-based programs: medical records and disability documentation
Step 2: Choose Your Application Method
You can apply through any of these channels:
- Online: Visit apply.scdhhs.gov to submit your application electronically
- Through Healthcare.gov: Apply at Healthcare.gov. If you qualify for Medicaid, your application will automatically be sent to SCDHHS
- By phone: Call the SCDHHS Member Help Center at (888) 549-0820
- By mail: Download the Healthy Connections Application Form and mail it to SCDHHS Central Mail, P.O. Box 100101, Columbia, SC 29202-3101
- In person: Visit your local county SCDHHS office
Step 3: Submit Your Application
Complete all required fields and attach supporting documentation. If you need help filling out your application, contact SC Thrive for free assistance.
Step 4: Wait for a Determination
After submitting your application, SCDHHS will review it and make a determination. The standard processing time is up to 45 days for most applications, or up to 90 days if a disability determination is needed.
Step 5: Choose a Managed Care Organization (MCO)
If approved, you will receive a notice explaining your eligibility category and whether you need to select a Managed Care Organization to coordinate your care. Follow the instructions in your approval letter.
What Does South Carolina Medicaid Cover?
Individuals who qualify for full Medicaid benefits through Healthy Connections have access to a wide range of services, including:
- Doctor visits and specialist care
- Hospital inpatient and outpatient services
- Prescription medications
- Lab tests and diagnostic imaging
- Mental health and substance use treatment
- Preventive care and wellness visits
- Dental services (limited for adults, more comprehensive for children)
- Vision care
- Home health services
- Nursing facility care
- Transportation to medical appointments
Children covered through CHIP or PHC receive a comprehensive benefits package that includes dental and vision care.
Tips for a Successful Application
- Apply even if you are unsure: SCDHHS encourages all residents to apply if they think they might be eligible. The worst that can happen is your application is denied.
- Use Healthcare.gov as a backup: If you apply through the federal marketplace and are found Medicaid-eligible, your application will be forwarded to South Carolina automatically.
- Report income accurately: Medicaid eligibility is based on Modified Adjusted Gross Income (MAGI) for most categories. Include all sources of household income.
- Keep copies: Save copies of everything you submit for your records.
- Respond promptly: If SCDHHS requests additional information, respond as quickly as possible to avoid delays.
- Check other programs: Use our free benefits screener to discover additional programs you may qualify for, including SNAP, LIHEAP, WIC, and more.
Frequently Asked Questions
Can I apply for South Carolina Medicaid at any time?
Yes. Unlike Marketplace insurance, Medicaid enrollment is open year-round. You can apply whenever your circumstances change or whenever you need coverage.
What if I am a non-disabled adult without children?
Unfortunately, South Carolina does not currently provide Medicaid coverage for non-disabled childless adults, regardless of income level. You may want to explore Marketplace plans at Healthcare.gov, community health centers, or free clinics in your area.
How long does it take to get approved?
Most applications are processed within 45 days. Applications requiring a disability determination may take up to 90 days.
What is the difference between Medicaid and CHIP in South Carolina?
Both are part of the Healthy Connections program. Medicaid covers children in families with lower incomes, while CHIP (through the Partners for Healthy Children program) covers children in families with slightly higher incomes, up to 208% of the FPL. Benefits are similar for both programs.
Does South Carolina have a Medicaid asset or resource test?
For most categories using MAGI-based eligibility (children, pregnant women, parents), there is no asset test. For aged, blind, or disabled individuals, there is a resource limit of $9,950 for individuals and $14,910 for couples as of January 1, 2026.
Will South Carolina expand Medicaid?
As of early 2026, South Carolina has not expanded Medicaid. Several bills have been introduced in the legislature, but none have passed. The state's governor has also opposed expansion. Check back for updates, as the legislative landscape can change.
How can I check if I qualify for Medicaid or other benefits?
Use our free eligibility screener to quickly check your potential eligibility for Medicaid and over 10 other federal and state assistance programs in just a few minutes.
