Medicaid Estate Recovery in South Carolina
SCDHHS recovers Healthy Connections Medicaid costs for long-term care — nursing facility, home and community-based, and related hospital and prescription services — from the estates of recipients who were 55 or older when they received that care, and from recipients of any age who were inpatients in a nursing facility, intermediate care facility, or other medical institution at death and were required to spend all but a minimal personal-needs amount of their income on the cost of that care. Medicaid may be legally required to file a claim when the estate has assets of more than $25,000.
Administering agency
South Carolina Department of Health and Human Services — Medicaid Estate Recovery
Authority
S.C. Code 43-7-460 (and 43-7-410 et seq.); 42 U.S.C. 1396p(b)
Medicaid Estate Recovery in South Carolina: key facts
- Recovery scope
- Nursing facility services, home and community-based services, and the hospital and prescription drug services provided to people in those settings.
- Who is subject
- Recipients age 55 or older when they received the care, and recipients of any age who were inpatients in a nursing facility, intermediate care facility for persons with intellectual disability, or other medical institution at death and were required, as a condition of receiving that care, to spend all but a minimal personal-needs amount of their income on the cost of medical care.
- Estate threshold
- Where the estate has assets of more than $25,000, Medicaid may be legally required to file a claim against it. The Medicaid claim ranks below higher-priority claims such as funeral expenses, taxes, and attorney fees.
- Recovery is deferred
- SCDHHS states that estate recovery "must be deferred if the beneficiary is survived by a spouse or a child under the age of 21 blind or permanently disabled." Recovery may be made only after the surviving spouse has died and at a time when there is no surviving child under 21 and no blind or permanently and totally disabled child — so a surviving spouse or qualifying child postpones the claim rather than extinguishing it.
- Undue-hardship waiver
- SCDHHS publishes hardship criteria covering the home: a surviving sibling with an equity interest who lived there at least one year before institutionalization; a caregiver child who lived there at least two years before institutionalization; an immediate family member who has lived in the home at least two years, still lives there, owns no other real property, and has family income at or below 185% of the federal poverty guidelines; and a sole income-producing asset. Home-property hardship protects only a homestead of modest value — 50% or less of the average home price in the county as of the date of death.
Governing law: S.C. Code 43-7-460 (and 43-7-410 et seq.); 42 U.S.C. 1396p(b)
Steps to take when someone dies
- Determine whether the deceased received Medicaid long-term care at age 55 or older, or was an inpatient in a nursing facility, intermediate care facility, or other medical institution at death while paying all but a minimal personal-needs amount of their income toward the cost of care.
- Confirm whether estate recovery applies — SCDHHS may be legally required to file a claim where the estate has assets of more than $25,000.
- Contact SCDHHS Medicaid Estate Recovery at (803) 898-2932 to confirm whether a claim applies and to request the amount.
- Address the claim as a debt of the estate, paid after higher-priority claims such as funeral expenses, taxes, and attorney fees.
- Submit an undue-hardship waiver request to SCDHHS after the recipient's death if the family's circumstances meet the conditions in the law.
South Carolina Department of Health and Human Services — Medicaid Estate Recovery
Phone: (803) 898-2932
Visit the agency website →Frequently asked questions
SCDHHS recovers the cost of long-term care — nursing facility services, home and community-based services, and the hospital and prescription drug services provided to people in those settings — from the estate of a recipient who was 55 or older when the care was provided, or who was an inpatient in a nursing facility, intermediate care facility, or other medical institution at death while required to spend all but a minimal personal-needs amount of their income on the cost of that care.
Recovery must be deferred while the recipient is survived by a spouse, a child under age 21, or a child who is blind or permanently disabled — a claim may be made only after the surviving spouse has died and no such child survives, so those survivors postpone the claim rather than cancel it. SCDHHS must waive recovery upon proof of undue hardship, and may exempt assets covered by a qualified long-term care partnership policy.
No. Only the assets of the deceased recipient's estate are considered. A Medicaid estate recovery claim is paid from the estate after higher-priority claims, and is never collected from surviving family members personally.
Sources
Data sourced from Medicaid Estate Recovery in South Carolina primary sources (4 pages reviewed). How we research.
Administering agency
South Carolina Department of Health and Human Services — Medicaid Estate Recovery
Authority
S.C. Code 43-7-460 (and 43-7-410 et seq.); 42 U.S.C. 1396p(b)