South Carolina Medicaid 2026: Who Qualifies, How to Apply

Healthy Connections is public health coverage, not a grant, and SCDHHS doesn't charge to apply. For every income line by household size, see our South Carolina Medicaid income limits guide.

Healthy Connections Medicaid at a Glance (November 2026)

SCDHHS lists 7 kinds of people who are usually eligible: children, parents and caretaker relatives, pregnant women, people over 65, people with disabilities, children with developmental delays, and breast and cervical cancer patients. Here's how the main groups line up, from SCDHHS's pages on November 13, 2026:

Grantsights analysis of the SCDHHS income charts shows how far the lines spread within one family of three in 2026: a child qualifies up to $4,735.46 a month, a pregnant mother up to $4,416.73, and her partner as a caretaker only up to $1,411.53. The child's line is about 3.4 times the parent's.

Who Qualifies for Healthy Connections in 2026

SCDHHS's eligibility page sorts coverage into 10 or more programs, each with its own rules. The ones most families use:

1. Partners for Healthy Children (PHC): children under 19 in families at or below 208% of poverty. SCDHHS says the plans available include Medicaid and the Children's Health Insurance Program (CHIP).
2. Pregnant Women and Infants: coverage during pregnancy and for 12 months after the birth, with the infant covered to age 1. SCDHHS notes that a pregnant woman may be able to get care while the application is processed; call (888) 549-0820 to ask.
3. Parent/Caretaker Relatives: a parent or relative by blood, adoption or marriage with a dependent child living in the home, at or below 62% of poverty.
4. Aged, Blind or Disabled (ABD): people 65 or older, blind or with a disability, at or below 100% of poverty ($1,330 a month for one person), with a resource limit of $9,950 for one (effective January 1, 2026). If SSA hasn't decided disability, it has to be decided before Medicaid can be approved.
5. Nursing home and home and community based waiver care: income up to 300% of the SSI rate ($2,982 a month for one person from January 1, 2026) and a need for nursing facility level of care.
6. TEFRA (Katie Beckett): children 18 and under with disabilities who need an institutional level of care but live at home, counting only the child's income and resources.
7. Former foster care: young adults who were on Medicaid when they aged out, through the end of the month of their 26th birthday, with no income test.
8. Breast and Cervical Cancer Program: uninsured people under 65 found in need of treatment, up to 200% of poverty.
9. Family Planning: preventive and family planning services for men and women up to 194% of poverty who can't get full Medicaid. SCDHHS says it doesn't count as minimum essential coverage.

Every applicant must live in South Carolina, be a U.S. citizen or qualifying non-citizen, and have a Social Security number or proof of applying for one. For the full chart, see our South Carolina Medicaid income limits guide; for a state-by-state comparison, see the national Medicaid income limits guide.

The non-citizen change that took effect October 1, 2026. SCDHHS's August 31, 2026 public notice says it amended its state plan, effective October 1, 2026, to follow section 71109 of Public Law 119-21. The notice says the change doesn't affect green card holders who've met the 5-year wait plus 40 work quarters (or didn't need to), Cuban and Haitian entrants, COFA citizens from the Marshall Islands, Micronesia and Palau, or lawfully present pregnant women and children. SCDHHS said current members who might be affected would be reassessed first, and anyone who loses full coverage may still get Emergency Services coverage.

What Healthy Connections Covers and the 5 Health Plans

With 5 plans to choose from, the benefits are the same and the networks differ. Per the SCDHHS program pages, people eligible for full Medicaid programs, such as PHC, pregnancy, parents and ABD, receive all Medicaid covered services, while Family Planning is limited to preventive and family planning care. Most members get those services through a managed care organization (MCO), a health plan with its own doctor network and incentive programs.

The 5 Healthy Connections health plans SCDHHS listed on November 13, 2026:

Source: SCDHHS managed care member page (opens in a new tab), checked November 13, 2026. SCDHHS points members to NCQA's health plan report cards to compare them.

Choosing a plan. When you're approved, SCDHHS mails a notice that says which category you qualified for and whether you need to pick an MCO, with next steps. You can choose an MCO when you first enroll, and SCDHHS points members to its enrollment site, SCChoices.com, for help choosing.

Who moved into managed care in 2026. According to the SCDHHS managed care carve-in program page, from January 1, 2026, members 18 and older who have both Medicare and Medicaid, people in the HIV/AIDS, ventilator-dependent and Community Choices waivers, and nursing facility residents were added to MCOs for medical services. SCDHHS calls that Phase I complete. Phase II, still in progress, moves waiver, nursing facility and hospice services for those same members into managed care.

Copays and adult dental: the SCDHHS member pages Grantsights checked on November 13, 2026 don't list copay amounts or the adult dental rules. Ask your MCO's member services line, listed on your plan card, before you get dental or vision care.

How to Apply for Healthy Connections, Step by Step

SCDHHS gives you 6 ways to apply and generally decides within 45 days. Here's the order that usually works fastest for a family in Columbia, Charleston, Greenville or a rural county.

Step 1: Gather information for everyone in the household

According to the SCDHHS application guide on its Getting Started page, you'll need:

• Dates of birth and Social Security numbers
• Income from jobs or training
• Benefits received now or in the past, such as Social Security, SSI, veterans' benefits or child support
• Money in checking, savings and other resources
• Rent or mortgage and utility bills
• Payments for adult or child care, health coverage or medical benefits you have now

Step 2: Apply

Free application help is available from SC Thrive, which SCDHHS names on its Getting Started page.

Step 3: Ask for retroactive coverage if you have old bills

SCDHHS form FM 3400-C says Medicaid may cover medical bills back to three months before your application date. You list each household member with bills in those months and the household's income for each month, and SCDHHS asks you to return the form within 15 days.

Step 4: Watch for your category notice and card

SCDHHS says it generally decides within 45 days, and your card should arrive within about one week of approval. Check status any time under "Check Status/Update Information" at apply.scdhhs.gov.

For example, one applicant in Florence, a married father of two earning $1,900 a month while his wife cares for the children, is a household of four. He's over the $1,705 parent line for four, but both children are far under the PHC line, so they'd get full Medicaid. At $1,900 a month, the family is also under 100% of poverty, the floor for Marketplace tax credits, so the parents would fall in the coverage gap that the Palmetto Pathways waiver is meant to address (an illustration from SCDHHS's 2026 figures, not a real case).

Renewals, the Waiver and 2027 Changes

South Carolina Medicaid must be renewed every year, according to the SCDHHS annual review guide. SCDHHS first tries to renew you using information it already has; if that works, you get a "Continuation of Benefits" notice and no form. If it can't, it mails an annual review form and texts you if it has your cell number. Return the form by its due date, even if some information is missing; SCDHHS says it'll follow up. Once your form arrives, Medicaid continues while SCDHHS reviews it.

Ways to return the review form: online at apply.scdhhs.gov, through the Document Upload Tool, by mail to SCDHHS-Central Mail, by fax to (888) 820-1204, by email to 8888201204@fax.scdhhs.gov, or in person at a county office.

Palmetto Pathways to Independence. SCDHHS's waiver page says it sent this section 1115 waiver to federal officials on June 23, 2025, after a public comment period from April 30 to May 31, 2025. It would open a pathway for adults 19 to 64 who otherwise fit the parent and caretaker group with income between 67% and 100% of poverty, and they'd need 80 hours a month of community engagement to get and keep coverage. The page listed no federal approval when Grantsights checked it on November 13, 2026, so the program isn't running.

Federal 2027 changes. The federal community engagement rule published in the Federal Register on June 3, 2026 (opens in a new tab) and the 6-month renewal rule in section 71107 both target expansion adults, starting by January 1, 2027, so they don't change coverage for South Carolina's current groups. Retroactive coverage is different: section 71112 of Public Law 119-21 shortens the look-back for applications made on or after January 1, 2027, to 2 months for groups like South Carolina's, and CMS's April 2026 slides (opens in a new tab) say more guidance is coming. SCDHHS's form still described 3 months on November 13, 2026. Families with unpaid bills from fall 2026 should apply before January 1, 2027.

What SCDHHS Doesn't Tell You About Healthy Connections

SCDHHS's pages are clear, but 6 points are easy to miss:

1. The appeal clock is short. SCDHHS gives 30 days to ask for a fair hearing, a third of the 90 days Florida and Ohio allow. Ask within 10 days to keep coverage during the appeal.
2. Hearings aren't by phone. SCDHHS says fair hearings are in person, usually at Jefferson Square, 1801 Main Street in Columbia, though you can ask for another location.
3. The retroactive form has its own deadline. FM 3400-C asks for a reply within 15 days, separate from the main application.
4. Your login changed. Old apply.scdhhs.gov logins stopped working on January 26, 2024, and SCDHHS now requires a free identity-verified account to see notices and report changes.
5. Having private insurance doesn't rule you out. SCDHHS's FAQ says a low-income parent with minor children can have private insurance and still qualify, along with the children.
6. Not filing taxes doesn't rule you out either. SCDHHS says filing taxes isn't required; it looks at current income and asks about next year's filing plans.

Common Mistakes and Red Flags

A common mistake is letting a renewal form sit. SCDHHS says that if you don't return it by the deadline, it sends a notice with the date your Medicaid will end. Keep your address, phone and email current at apply.scdhhs.gov or by calling (888) 549-0820; SCDHHS stresses that current contact information is how you get the review form at all.

Other mistakes that cost South Carolina families coverage:

• Measuring the children against the parent line. A parent over $1,411.53 for three can still have children who qualify at more than 3 times that amount.
• Not reporting changes. Changes in address, income, job, household size or marriage go through your online account or the member contact center.
• Underestimating Family Planning. Adults over the parent line may still get preventive and family planning care up to 194% of poverty.
• Appealing to the wrong place. A HealthCare.gov denial goes to the Marketplace; a Healthy Connections denial goes to SCDHHS. SCDHHS says neither can handle the other's appeal.

Red flags: SCDHHS posts its own scam warning. Avoid anyone who charges to apply, promises approval, or asks for your portal password or Medicaid number by text. Free help comes from SCDHHS, a county office or SC Thrive.

If SCDHHS Denies You or Ends Coverage

You have 30 calendar days from the date of the eligibility decision to request a fair hearing, according to SCDHHS's member FAQ. If you ask within 10 days, you may keep Medicaid until the hearing decision, though you may have to repay costs if you lose. The same FAQ gives 30 days to send new information or anything SCDHHS asked for.

• Ways to appeal: online at scdhhs.gov/appeals, by fax to (803) 255-8251, by email to appeals@scdhhs.gov, by phone at (888) 549-0820, by mail to SCDHHS Division of Appeals and Hearings, P.O. Box 8206, Columbia, SC 29202, or in person at a county office.
• Urgent cases: you can ask for an expedited hearing if waiting could put your health at risk; otherwise appeals follow a 90-day timeframe.
• Health plan denials: SCDHHS's appeals page also covers services an MCO denied or delayed.
• Turned down entirely: SCDHHS points people to HealthCare.gov and to federally qualified and community health centers, which charge by income.

Other Help for South Carolina Families

Healthy Connections pays for care, not groceries or the power bill. These Grantsights guides cover the 4 other programs South Carolina families on Medicaid most often pair with it:

• Food: our South Carolina food stamps guide and the South Carolina SNAP benefits guide.
• Power bills: our South Carolina LIHEAP guide.
• Pregnancy and young children: the national WIC income limits guide.
• Housing: the rental assistance programs guide.

For anything else, Grantsights' free eligibility checker lists official South Carolina and federal programs to look at; SCDHHS alone decides Medicaid eligibility.

FAQ: South Carolina Medicaid

How do I apply for Medicaid in South Carolina?

Online at apply.scdhhs.gov, by phone at (888) 549-0820, in person at a county office, health center or hospital, or by mail or email.

Can a single adult get Medicaid in South Carolina?

Usually not, because South Carolina didn't expand Medicaid; Family Planning covers preventive care up to 194% of poverty.

What is the South Carolina Medicaid income limit for parents?

$1,411.53 a month for a family of three (62% of poverty), effective March 1, 2026.

How long does SCDHHS take to decide a Medicaid application?

Generally up to 45 days, with the card about a week after approval.

Does South Carolina Medicaid have work requirements?

No; the Palmetto Pathways waiver that would add them for some parents was still awaiting federal approval on November 13, 2026.

Can South Carolina Medicaid pay bills from before I applied?

Yes, back to 3 months before the application date, using form FM 3400-C.

How often do I renew South Carolina Medicaid?

Every year, either automatically or with an annual review form.

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Sources

1. SCDHHS: Getting Started (how to apply) (opens in a new tab), checked November 13, 2026
2. SCDHHS: Program Eligibility and Income Limits (opens in a new tab), limits effective March 1, 2026
3. SCDHHS: Annual Reviews (opens in a new tab), checked November 13, 2026
4. SCDHHS: Member FAQs (timing, cards, appeals) (opens in a new tab), checked November 13, 2026
5. SCDHHS: File an Appeal and hearing FAQs (opens in a new tab), checked November 13, 2026
6. SCDHHS: Healthy Connections Medicaid Managed Care (opens in a new tab) and managed care carve-in (opens in a new tab)
7. SCDHHS: Palmetto Pathways to Independence Waiver (opens in a new tab), checked November 13, 2026
8. SCDHHS Form FM 3400-C: Request for Retroactive Medicaid Coverage (opens in a new tab)
9. SCDHHS: Public Notice on Alien Medicaid Eligibility (opens in a new tab), August 31, 2026
10. Medicaid.gov: South Carolina in the state eligibility table (opens in a new tab), as of December 1, 2023
11. CMS slides cited for South Carolina's 2027 look-back (opens in a new tab), April 2026
12. Federal Register: work rule outside South Carolina's groups (opens in a new tab), June 3, 2026