Medicaid Eligibility in South Carolina: Income Limits & How to Apply
Medicaid Eligibility in South Carolina
South Carolina has not expanded Medicaid under the Affordable Care Act. This means the state's Medicaid program (Healthy Connections) does not cover most low-income adults. Traditional Medicaid in South Carolina is limited to specific groups such as children, pregnant women, parents with very low incomes, seniors, and people with disabilities.
Coverage gap in South Carolina: Adults earning below $15,650 per year (100% FPL for an individual) may fall into the coverage gap — too much income for traditional Medicaid but too little to qualify for ACA marketplace subsidies. An estimated hundreds of thousands of South Carolina residents are affected.
Without Medicaid expansion, coverage in South Carolina is generally limited to:
- Children in families with income up to 200-300% FPL (via CHIP)
- Pregnant women with income up to 185-200% FPL
- Parents with very low incomes (often well below 50% FPL)
- Seniors and people with disabilities meeting strict income/asset limits
- Adults in the coverage gap have limited options: community health centers, hospital charity care, and free clinics
About Healthy Connections
In South Carolina, your ability to qualify for Medicaid, known as Healthy Connections, is limited because the state has not expanded its program under the Affordable Care Act. This means most adults, particularly childless adults, will not be eligible regardless of how low their income is, creating a "coverage gap." Healthy Connections primarily serves children with household incomes up to 213% of the federal poverty level (FPL), pregnant women with household incomes up to 199% FPL, parents and caretaker relatives with dependent children if their household income does not exceed 100% FPL, and individuals who are aged, blind, or disabled. For example, a single parent with one child would need to have a monthly income below approximately $1,763 to qualify as a parent. For individuals 65 or older, blind, or disabled, the monthly income limit is $1,330 for a single person and $1,804 for a household of two, with asset limits of $9,950 for an individual and $14,910 for a couple. In 2024, approximately 1.42 million South Carolinians were covered by Medicaid, representing about 26.1% of the state's population.
If your income is near the Medicaid cutoff, you might transition to marketplace coverage on HealthCare.gov. If your income is above 100% FPL (for an individual, that's $15,060 annually in 2024), you could be eligible for significant subsidies to help pay for a plan. For instance, with a benchmark Silver plan costing around $529 per month in South Carolina, subsidies can drastically reduce what you actually pay. It's important to report any income changes to the marketplace, as this could shift your eligibility between Medicaid and subsidies. During the recent unwinding of continuous Medicaid coverage, many South Carolinians lost their benefits, but if your circumstances change, you can reapply at any time.
Healthy Connections covers a wide range of medically necessary services, including doctor visits, hospital care, prescriptions, and medical equipment. The program generally has no cost-sharing for most services for those with full benefits. South Carolina also has specific programs like Healthy Connections Prime, a voluntary managed care program for seniors who are eligible for both Medicaid and Medicare, offering comprehensive benefits including home and community-based services. Additionally, the state resumed annual eligibility reviews for Medicaid members starting April 1, 2023, so if you receive a renewal form, completing it promptly is crucial to maintain your coverage.
For South Carolinians in the coverage gap—those with incomes too high for Medicaid but too low for marketplace subsidies—practical alternatives exist. Community health centers often offer services on a sliding scale based on your income. Many hospitals provide charity care programs to help uninsured patients with medical bills. Some counties may also have indigent care programs. Free clinics, such as the MUSC CARES Clinic in Mount Pleasant, offer free primary care and preventive services to uninsured adults. If your income increases and you rise above 100% FPL, remember to recheck HealthCare.gov, as you would then become eligible for marketplace subsidies to make health insurance more affordable. South Carolina's uninsured rate was approximately 9%, or 469,000 residents, in 2023, higher than the national average of 8.2%.
South Carolina Medicaid Income Limits 2026
The following table shows the key income thresholds for South Carolina in 2026:
| Household Size | 100% FPL | 138% FPL | 400% FPL (Subsidy Limit) |
|---|---|---|---|
| 1 | $15,650 | N/A | $62,600 |
| 2 | $21,150 | N/A | $84,600 |
| 3 | $26,650 | N/A | $106,600 |
| 4 | $32,150 | N/A | $128,600 |
| 5 | $37,650 | N/A | $150,600 |
| 6 | $43,150 | N/A | $172,600 |
Because South Carolina has not expanded Medicaid, the 138% FPL threshold does not apply for adult eligibility. Adults earning between 0-100% FPL may fall into the coverage gap. Those earning between 100-400% FPL can access marketplace subsidies.
The benchmark Silver plan in South Carolina costs about $529/month before subsidies, which is in line with the national average. Subsidies can significantly reduce this cost for qualifying households.
Marketplace Insurance in South Carolina
South Carolina residents who do not qualify for Medicaid can purchase private health insurance through the federal marketplace at HealthCare.gov. The average benchmark (second-lowest cost Silver) plan in South Carolina costs approximately $529/month for a 40-year-old in 2026.
Premium tax credits (subsidies) are available for households with income between 100% and 400% FPL. Here is what a 40-year-old individual in South Carolina might pay after subsidies:
| Income Level | Annual Income | Expected Contribution | Estimated Monthly Premium |
|---|---|---|---|
| 150% FPL | $23,475 | 4.01% of income | ~$78/mo |
| 200% FPL | $31,300 | 6.52% of income | ~$170/mo |
| 250% FPL | $39,125 | 8.33% of income | ~$272/mo |
| 300% FPL | $46,950 | 9.83% of income | ~$385/mo |
| 400% FPL | $62,600 | 9.83% of income | ~$513/mo |
These are estimates for an individual. Actual premiums depend on your age, household size, tobacco use, and the specific plan you choose. Households with income between 100-250% FPL also qualify for cost-sharing reductions (CSR) on Silver plans, which lower deductibles and copays.
Residents of South Carolina shop for marketplace insurance through HealthCare.gov, the federal exchange. The application process screens for Medicaid eligibility first, so you'll be directed to South Carolina's program if you qualify.
The lack of Medicaid expansion in South Carolina leaves a gap in the safety net. Residents in the coverage gap — too much income for traditional Healthy Connections but too little for marketplace subsidies — rely on community health resources and uncompensated care.
How to Get Coverage in South Carolina
Since South Carolina has not expanded Medicaid, your path to coverage depends on your income level:
- Income above 100% FPL ($15,650+ for an individual): Apply through HealthCare.gov during open enrollment (November 1 - January 15) or after a qualifying life event. You will qualify for premium subsidies.
- Income below 100% FPL: Check if you qualify for traditional Medicaid categories (children, pregnant women, disabled). If not, look into community health centers, hospital financial assistance, and free clinics in your area.
- Children: South Carolina's CHIP program covers children in families with income up to 200-300% FPL regardless of expansion status.
Calculate Your Subsidy in South Carolina
Enter your income, age, and household size to see if you qualify for Medicaid or marketplace subsidies in South Carolina.
Check Your Eligibility →Frequently Asked Questions
What is the income limit for Medicaid in South Carolina?
South Carolina has not expanded Medicaid, so there is no standard income limit for adults. Traditional Medicaid covers specific groups (children, pregnant women, disabled, very low-income parents). Income limits for these groups vary. Children are generally covered up to 200-300% FPL through CHIP.
Has South Carolina expanded Medicaid under the ACA?
No, South Carolina has not expanded Medicaid. This creates a coverage gap for adults earning below 100% FPL who do not qualify for traditional Medicaid categories.
How do I get help paying for health insurance in South Carolina?
Yes. South Carolina residents with household income between 100% and 400% FPL ($15,650 to $62,600 for an individual in 2026) qualify for premium tax credits that reduce the cost of marketplace health insurance. Apply through HealthCare.gov.
What is the South Carolina Medicaid program called?
South Carolina's Medicaid program is known as Healthy Connections. It provides health coverage for eligible low-income residents including children, pregnant women, seniors, and certain other qualifying groups.
How do I keep my health insurance if I lose Medicaid in South Carolina?
If your Healthy Connections coverage ends due to income changes or redetermination, you qualify for a Special Enrollment Period on the marketplace. This gives you 60 days to sign up for a private plan through HealthCare.gov. If your income is between 100-400% FPL, you'll likely qualify for subsidies to help cover the cost.
I don't qualify for Medicaid or subsidies in South Carolina — what can I do?
If you're in the coverage gap (earning below $15,650/year but not qualifying for traditional Medicaid), look into community health centers in South Carolina that offer sliding-scale fees based on income. Many hospitals have charity care programs for uninsured patients. Free clinics and the 211 helpline can connect you with local resources. If your income changes, reapply — even small income increases could qualify you for marketplace subsidies.
Will South Carolina ever expand Medicaid?
Medicaid expansion has been a politically contentious issue in South Carolina. The state legislature has not passed expansion legislation, leaving an estimated coverage gap for adults earning below 100% FPL. Advocacy groups continue to push for expansion, and several neighboring states have recently adopted it. Check with South Carolina's legislative updates for the latest status.
Medicaid Eligibility in Nearby States
- Georgia Medicaid Eligibility — Non-expansion state
- North Carolina Medicaid Eligibility — Expansion state