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Informational guide

Who qualifies for CLTC in South Carolina?

The two parts: Medicaid and level of care

SCDHHS describes CLTC programs as helping people who "want to live at home, need assistance with care and are financially eligible for Medicaid." That gives two separate checks:

1. Level of care. Does the person need the level of care a nursing home provides (or, for some waivers, a hospital)?
2. Medicaid financial eligibility. Does the person qualify for Healthy Connections Medicaid in a group that covers home and community-based waiver services?

Meeting one doesn't settle the other.

Source: CLTC Brochure (May 2023). Checked Oct. 20, 2026.

Who each CLTC program serves

These are SCDHHS's own descriptions:

• Community Choices waiver: "the frail elderly (age 65 and older) as well as persons with physical disabilities (ages 18-64) who meet nursing facility level of care criteria." The CLTC brochure describes it as for people 18 or older who can't perform activities of daily living "such as bathing, dressing and toileting due to illness or disability."
• HIV/AIDS waiver: people with a diagnosis of HIV or AIDS who are in South Carolina (or intend to locate here) and meet the at-risk-of-hospitalization level of care.
• Mechanical Ventilator Dependent (Vent) waiver: frail elderly people and people with physical disabilities, age 21 or older, who require mechanical ventilation and meet nursing facility level of care. The brochure says "dependent upon mechanical ventilation at least six hours daily."
• Medically Complex Children (MCC) waiver: children from birth to 21 with chronic physical or health conditions expected to last at least 12 months, at hospital level of care.

Three other waivers (Community Supports, ID/RD, and HASCI) are operated by BHDD's Office of Intellectual and Developmental Disabilities. Their entry point is the OIDD Single Point of Entry, 1-800-289-7012. See bhdd.sc.gov.

Sources: Community Choices (CC) Waiver; HCBS Waiver Summary Chart (January 2026); CLTC Brochure (May 2023). Checked Oct. 20, 2026.

Financial and Medicaid rules

SCDHHS's eligibility page has a group called "Individuals in Nursing Facilities and/or Receiving Home and Community-Based Waiver Services." It says the same eligibility requirements apply to nursing home care and to waiver services. The difference is that people who need nursing home care but choose to stay home "can receive special services through a waiver to help them remain at home."

For that group, SCDHHS says a person must:

• Be a South Carolina resident.
• Be a U.S. citizen or Lawful Permanent Resident Alien.
• Require nursing facility level of care, either at home or in a facility. "If receiving care in the home, contact Healthy Connections for information about obtaining a Community Long Term Care (CLTC) determination prior to completing your application."
• Reside in a medical institution, receive home and community-based waiver services, or a combination, "for a period of 30 consecutive days."
• Have a Social Security number or verify an application for one.

SCDHHS also says that "generally, an individual must be age 65 or older or blind or disabled," with disability determined using Supplemental Security Income (SSI) guidelines.

Income. SCDHHS says a person "may be eligible if they meet an income limit less than or equal to 300% of the current SSI Federal Benefit Rate (FBR)." For an individual, the page lists a monthly income limit of $2,982, effective January 1, 2026. The figure changes over time, so check the SCDHHS page before relying on it.

Assets and resources. The SCDHHS eligibility page doesn't list a resource limit for this group. The application (Form 3401) asks about bank accounts, vehicles, life insurance, burial funds, and other assets. It also asks whether anything was sold or given away in the past five years. Answer it completely, and expect to be asked for proof.

SCDHHS's advice if you're unsure: "Please apply if you are unsure about eligibility!"

Sources: Program Eligibility and Income Limits; Form 3401, Application for Nursing Home, Residential or In-Home Care (July 2024). Checked Oct. 20, 2026.

What the assessment looks at

• Nursing home level of care. SCDHHS says the South Carolina Nursing Home Level of Care Criteria are used to decide medical eligibility for the Community Choices waiver. Assessors gather information with a standardized instrument. The same criteria and the same instrument are used for nursing facility placement and for waiver enrollment.
• Daily activities. The CLTC brochure describes people who need help with activities of daily living such as bathing, dressing, and toileting because of illness or disability.
• Who does it. The initial assessment is done by a state nurse consultant or a state-licensed social worker. Before enrollment, that person verifies financial eligibility, level of care, and the participant's choice to take part in the waiver.
• Reassessment. Level of care is re-evaluated after enrollment. The waiver summary chart lists annual reviews by contract case managers or the state.

The public pages checked don't describe where the assessment happens, so this page doesn't say. SCDHHS will explain when it contacts the applicant.

Sources: Community Choices Waiver Renewal Application (July 1, 2026), Appendix B-6; HCBS Waiver Summary Chart (January 2026); CLTC Brochure (May 2023). Checked Oct. 20, 2026.

If you don't qualify

• Ask about other Medicaid groups. The SCDHHS eligibility page lists other Healthy Connections groups. For questions, call the Healthy Connections Member Contact Center at (888) 549-0820 (TTY 888-842-3620).
• Appeal a decision. SCDHHS says you can ask for an appeal if Medicaid coverage was changed, ended, or denied, or if a needed service was denied or delayed. Submit the request "within 30 days from the date on your closure or other notice." See SCDHHS Appeals.
• Support for family caregivers. The SC Department on Aging runs a Family Caregiver Support Program with 10 regional Area Agencies on Aging. It points caregivers to GetCareSC.com. SCDOA's toll-free number is 1-800-868-9095.
• Intellectual disability, brain injury, or spinal cord injury. Contact BHDD-OIDD at 1-800-289-7012.

Sources: Program Eligibility and Income Limits; Getting Started; SC Department on Aging, Family Caregiver Support; HCBS Waiver Summary Chart (January 2026). Checked Oct. 20, 2026.

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