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Learn About Requirements for Medicaid in South Carolina

What are the requirements for Medicaid in South Carolina? The Medicaid eligibility requirements in SC differ in comparison to other U.S. states. Who is eligible for Medicaid in South Carolina is not the same as those eligible for Medicaid in say, New York.

Requirements to be eligible for Medicaid vary mainly because several states, including South Carolina, did not implement the Medicaid expansion when it was proposed through the Affordable Car Act. That said, how to qualify for Medicaid in SC is harder than in states that accepted the Medicaid expansion terms. Currently, more than 120,000 residents in South Carolina do not qualify for Medicaid benefits eligibility, and remain in a coverage gap.

Do you meet the Medicaid qualifications for Healthy Connections in the state? Continue on to learn more about the general requirements for Medicaid and download our guide for comprehensive information.

Who meets the requirements for Medicaid in South Carolina?

Unsure of how to qualify for Medicaid or if you already meet the state’s eligibility standards? As mentioned prior, Medicaid eligibility requirements vary depending on your state of residence. What are the Medicaid application guidelines for different groups of patients in South Carolina?

You have eligibility for Medicaid benefits in South Carolina if you are:

  • Blind, elderly disabled or working disabled.
  • A female with breast cancer or with cervical cancer.
  • A disabled child.
  • A former foster care child up to age 26.
  • A pregnant woman with an infant on the way.
  • A family in need of medical assistance.
  • A parent or a caretaker of a relative.
  • An individual in a nursing facility or receiving home- and/or community-based care.
  • A qualified Medicare beneficiary or a specified low-income Medicare beneficiary.

You also qualify for Medicaid in SC if you are medically indigent, if you are a member of Partners for Healthy Children or if you are a part of the Optional State Supplementation program. Download our helpful guide to learn about the different requirements for Medicaid.

If you belong to one of the above patient groups, continue below to review further Medicaid eligibility requirements, both general and relative to your financial situation. If you do not meet all of the criteria adhered to by the state’s health department, you will not be deemed eligible for Medicaid and will not be able to complete your application for government-sponsored Medicaid benefits in South Carolina.

What are the requirements for Medicaid?

Now that you have reviewed who is eligible for Medicaid in South Carolina in patient-specific groups, the next step is to review the mandatory requirements for Medicaid. Review the below items, which apply to the majority of Medicaid benefits eligibility applications nationwide:

You must be a United States citizen – Your U.S. citizenship is a non-negotiable factor when it comes to whether or not you qualify for Medicaid benefits in South Carolina. You must have documentation that supports either your citizenship or your legal status to reside in the country.

You must have a Social Security Number – Your Social Security Number acts as a type of federal identification number when it comes to government-monitored programs. And, because your federal income tax paperwork will confirm your annual wages, your Social Security Number will aid with the confirmation of your Medicaid eligibility status when you apply for Medicaid benefits in SC.

You must be a resident of South Carolina – Since you are trying to qualify for Medicaid in South Carolina, you must be able to prove that you are a current resident within the state borders in order to be eligible for Medicaid. In most cases, your valid driver’s license or DMV ID card will suffice.

You must have additional forms, if applicable – If you belong to a different health program (independent or government-based), have a disability, are a former foster care child or have an illness included in the list of covered items under SC Medicaid, then you must be able to fill out and provide the specified forms through Healthy Connections to fully meet the application guidelines for Medicaid.

If you are able to meet these Medicaid requirements, then you are one step closer to the South Carolina Medicaid application process. Continue on to review the Medicaid income requirements.

What are the Income Requirements for Medicaid?

The income requirements for Medicaid are specific to South Carolina. So, when researching your Medicaid eligibility, be sure to only refer to those standards outlined by Healthy Connections in SC. Even though you may be eligible for Medicaid regarding the above listed requirements, you must financially qualify for Medicaid as well.

The Medicaid income requirements vary, depending on the type of patient you are and the eligibility group to which you belong. In South Carolina, financial Medicaid requirements are determined by the Modified Adjusted Gross Income (MAGI) system. The income requirements for Medicaid are broken down below :

Pregnant women – Your expectant child and you will be covered by Medicaid benefits in SC if you remain within 194 percent of the federal poverty level.

Infants and children less than 19 years old – As part of the Partners for Health Children initiative, your household must remain at or below 208 percent of the federal poverty level to meet Medicaid qualifications.

Parents and other caretakers – Those who belong to the Low-Income Families group must earn no more than 62 percent of the federal poverty level to qualify for Medicaid.

Non-IV-E adoption assistance – If you are special needs and belong to Adoption Assistance, your household income must remain at or less than 62 percent of the federal poverty level to financially qualify for Medicaid.

Former foster children ages 18 to 26 – As part of the new, mandatory Medicaid coverage group, you qualify for Medicaid in South Carolina regardless of your income, meaning there are no Medicaid income requirements you must meet.

Families – If you fall under the Family Planning category, you can be eligible for Medicaid so long as your household income remains below 194 percent of the federal poverty level.