Medicaid Estate Recovery in South Carolina

What is recovered

Nursing facility services, home and community-based services, and the hospital and prescription drug services provided to people in those settings.¹

Who is subject to recovery

Recipients age 55 or older when they received the care are subject to recovery.¹

Section 43-7-460 also reaches 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, if that care required them to spend all but a minimal personal-needs amount of their income on medical care.^{2, 1}

What counts as the estate

Only the assets of the deceased recipient's estate are considered. The claim is paid from the estate and is never collected from surviving family members personally.¹

When recovery is deferred or barred

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."¹

Section 43-7-460(B) allows recovery 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 these survivors postpone the claim rather than extinguish it.²

Undue-hardship waiver

SCDHHS must waive recovery upon proof of undue hardship. Its home criteria cover a surviving sibling with an equity interest who lived there at least one year, or a caregiver child who lived there at least two years, before institutionalization.¹

The criteria also cover 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.¹

Exemptions and protected assets

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.¹

Long-term care partnership policies

SCDHHS may exempt assets covered by a qualified long-term care partnership policy.¹

How the state files its claim

Where the estate has assets of more than $25,000, Medicaid may be legally required to file a claim against it.³

Section 62-3-805 places the Medicaid claim in class (a)(4), below higher-priority claims such as funeral expenses, taxes, and attorney fees.⁴

Governing law: S.C. Code 43-7-460 (and 43-7-410 et seq.); 42 U.S.C. 1396p(b)

1. 1.Estate Recovery (South Carolina Department of Health and Human Services)
2. 2.S.C. Code Title 43, Chapter 7 (including 43-7-460)
3. 3.SCDHHS Estate Recovery brochure (August 2022)
4. 4.S.C. Code Title 62, Chapter 3 (including 62-3-805)