South Carolina Medicaid Long Term Care

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Medicaid Assistance Programs For The Elderly

Medicaid 101

Medicaid, a health care program that is jointly funded by the state and the federal government, is for individuals and families who have limited income. Via the South Carolina State Medicaid Plan, also called Health Connections in SC, the elderly and disabled are able to receive nursing home care. Personal care assistance, although fairly limited, is also made available through the state plan. Services and benefits via this program are entitlements, meaning that all eligible applicants are able to receive the assistance / care they require. In addition to the state Medicaid program, the state of South Carolina also has two Home and Community Based Services Waivers. In contrast to the state plan, these waivers are not entitlement programs. This means that the number of people who are able to receive services / benefits via the programs are limited. Once participant caps have been met, there will be waitlists.

1) Community Choices Waiver This waiver provides a variety of supports and benefits to allow individuals who require a nursing home level of care to remain living in the community, rather than require placement in a nursing home. Some services are able to be self-directed, such as personal care assistance, companionship services, and attendant care. For more benefits and eligibility requirements, .

Elderly And Medicaid Waivers In South Carolina

Experience the Kindness of Waivers in the Palmetto State

By Regina Woodard for Assisted Living Directory

Make sure to have a glass of water and fan with you while sitting on the porch when youre in South Carolina. The 23rd most popular state in the US, South Carolina is one of the original thirteen colonies that began what would become the United States. Besides beautiful mountains, forests, and beaches, South Carolina is also home to several lakes that both locals and tourists can enjoy.

Another aspect that locals can enjoy, especially those who are elderly, are some of the many waivers that are able to help elderly residents and their families.

Home and Community Based Services Waiver

The Home and Community Based Services waiver or HCBS, helps to assist recipients of Medicaid to continue to live in the community instead of or avoiding institutionalization. This waiver helps to provide services and supports such as adult day health care and nursing, assistive tech and appliances, incontinence supplies personal care, respite, in-home support, day activity and more.

The HCBS also covers several other waivers, including the Community Choices Waiver, the HIV/AIDS waiver, the Community Supports waiver, the Mechanical Ventilator waiver, and several others.

Palmetto SeniorCare Waiver

Community Long Term Care

CLTC has some overlap with the HBCS, including the community choices waiver, the HIV/AIDS waiver, and the mechanical ventilator waiver.

Resources:

Assisted Living / Memory Care

As of 2021, per Genworths 2020 Cost of Care Survey, the average statewide cost of living in an assisted living facility in South Carolina ranges from $2,200 / month on the low end to $5,475 / month on the high end. However, the statewide average is $3,988 / month. Comparably speaking as to the rest of the United States, South Carolina is one of the states that has the most affordable assisted living. The Greenville, Charleston, and Sumter areas are even more affordable than the statewide average at approximately $2,200 $3,600 / month. Spartanburg and Florence have monthly costs nearly consistent with the statewide average at $4,095 $4,163 / month. Hilton Head Island, by far, has the most expensive monthly cost for assisted living at approximately $5,475.

For those with Alzheimers or a related dementia, many assisted living facilities have special Alzheimers Care units, often called Memory Care units. These types of units cost approximately $997 / month more than traditional assisted living units due to the higher level of care and supervision.

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How The State Takes A Home

Medicaid can put a lien on a recipients home, but not every state will do this. A lien prevents the sale until debts are paid. This means a Medicaid recipient cant transfer ownership of a home before death to prevent it from being used to pay back state Medicaid.

A lien will be filed by the state after the recipient moves out, if they are not expected to ever move back in. The lien gets lifted if the recipient moves home or if the home is sold to pay back Medicaid.

Medicaid cannot put a lien on a home if any of the following still live there: The recipients spouse Recipients child who is under 21 Recipients child who is disabled or blind Recipients sibling with partial ownership

The process of selling a home and collecting debts via MERP will often be contracted to an agency outside Medicaid, like a Health Management Service . The home is put up for sale with a MERP claim on it. Once a buyer is found, the MERP claim must be addressed before the sale can close.

State Variances on How MERP Takes Homes

How a state seeks reimbursement through the Medicaid Estate Recovery Program can vary quite a bit depending on the state. Some states wont use MERP if the home is valued below a certain amount. Texas, for example, does not try to be reimbursed from a recipient whose estate is valued below $10,000.

Some states waive the MERP process if the cost of Medicaid Long Term Care for the deceased recipient was less than a certain amount .

Optional State Supplementation Program

Medicaid Expansion Supported by South Carolina Voters 50+

The Optional State Supplementation program is available to seniors that reside in an assisted living facility and have been determined to have a monetary need. OSS pays for room and board as well as meals, while also providing a monthly stipend that residents may use to purchase whatever other small items they wish. Individuals enrolled in OSS are also automatically enrolled in Healthy Connections, the states Medicaid program.

Who Is Eligible?

The program is for adults aged 65 and older who meet all the criteria for Social Security Insurance except for income. Participants will need to have an income of less than $1,435 per month and have no resources in excess of $2000 to be eligible to participate in OSS.

How to Apply

Those wishing to apply may do so on the states Healthy Connections website, Healthcare.gov or by calling 549-0820 to find their nearest county Department of Health and Human Services office and applying in person.

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Civil Money Penalty Funds Grant

Nick Ruden, South Carolina CMP Coordinator

A portion of CMPs collected from nursing homes are returned to the states in which CMPs are imposed. State CMP funds may be reinvested to support activities that benefit nursing home residents and that protect or improve their quality of care or quality of life. Requests to use CMP funds may be made by various organizations and entities. Applications may be submitted by certified nursing homes, academic or research institutions, state, local or tribal governments, profit or not-for-profit, or other types of organizations. The form below is a fillable application. The form contains instructions, outlines the process and provides an overview of guidelines for the CMP application. Please ensure all information is filled in completely and accurately. To view guidelines and/or apply, please see the link below.

Choosing A Medicaid Health Plan

Healthy Connections Choices the health plan selection website for South Carolina Healthy Connections Choices. South Carolina Healthy Connections Choices is a program that helps eligible Medicaid members enroll in health plans.

1-877-552-4642

Watch video clips and find materials that help you choose a health plan and doctor. Find meetings in your area to learn more about the health plans.

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South Carolina Medicaid Asset Limits 2019

Individuals in South Carolina are allowed to keep $2,000 when they apply to Medicaid for long term care. If they are over this amount, they must spend down on care. It is important to note, that individuals are not allowed to give gifts of any amount for a period of 5 years prior to applying to Medicaid. If an individual’s assets are more than $2,000, they should learn about Medicaid Planning strategies. This asset limit only applies to assets that are considered countable assets. Some examples of countable assets include savings accounts, bank accounts, retirement accounts and a second home. If you have multiple assets and are looking to access Medicaid, it may make sense to speak with a Medicaid Planner or Elder Law attorney in South Carolina.

Couples that both require Medicaid for long term care in South Carolina are allowed to keep $2,000 in assets. If there is one spouse that requires care, and one that does not, the spouse that does not receive care is referred to as the Community Spouse. The Community spouse is allowed to keep up to $123,600 in countable assets which is known as the Community Spouse Resource Allowance.

The maximum amount of home equity allowed when applying to Medicaid is $572,000. Despite the fact the home is not a countable asset, Medicaid, can look for repayment in probate court from the proceeds of a sale after it stops paying for care. It is important to understand if your home may be subject to the Medicaid repayment process.

Long Term Care Program

Months after Medicaid transition, some providers still wait for payment

The Long Term Care Program surveys Nursing Facilities and Skilled Nursing Facilities for compliance with Medicare/Medicaid regulations.

Medicare and Medicaid Certified Nursing Home Comparison – The primary purpose of this tool is to provide detailed information about the performance of every Medicare and Medicaid certified nursing home in the country.

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Assisted Living Service Plans

At the time of admission, residents should be provided with a schedule of fees and services, the refund policy, the resident bill of rights and facility grievance policy, contact information for the local ombudsman office, and the monthly schedule of their personal allowance payment and the amount.

A written resident agreement between the facility and the incoming resident outlining the scope of expected care, personal care services, dietary needs of the resident, discharge procedures and what services cannot be provided should be signed by both parties and kept with the residents records.

What Are The Issues With The Medicaid Program

Today the Medicaid and CHIP Payment and Access Commission recommend Congress make Medicaid estate recovery voluntary. This recommendation reduces potential recoveries and limits reimbursement prospects based on Medicaid-managed hardship care cases providing waivers on aspects other than financial hardship. Ultimately this proposal will increase federal expenditures and reduce the funds available to Medicaid. Already states tend not to seek recovery via estates unless the return is more significant than recovery cost.

In the long run, decimating the ability for Medicaid to recover some repayment from an asset pool of 8 trillion dollars can potentially bankrupt the Medicaid program itself. There is a need to strengthen America’s long-term care social contract. Americans need public-private partnerships to rethink the handling of long-term care in this country. The middle class, in particular, needs a way to pay for long-term care without having to rearrange their finances to qualify for Medicaid by transferring assets to their adult children or entering into Medicaid Qualifying Trusts or trusts to protect homes from Medicaid liens. It is incumbent upon the US Congress to find ways to protect its ever-growing senior population without bankrupting the social safety nets put in place for their protection. If you have questions about Medicaid contact us today.

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More Ways To Pay For Memory Care

In addition to the state programs mentioned above, those looking for resources to finance memory care may consider:

  • Long-Term Care Insurance: Depending on the policy details, long-term care insurance may be used to pay for memory care services. Its best to sign up for a policy early, as coverage will likely be denied if one already has long-term care needs. More information about the intricacies of long-term care insurance can be found at longtermcare.acl.gov.
  • Reverse Mortgages: Reverse mortgages allow some homeowners to take out a loan as an advance from the eventual sale of their primary residence. This can be a good way to fund memory care in the short-term, but the loans will need to be paid back after the sale of the home. The most commonly used type of reverse mortgages for seniors is the Home Equity Conversion Mortgage, which is the only reverse mortgage insured by the federal government.
  • Veterans Benefits: The Department of Veterans Affairs offers several programs that veterans and their spouses may use to cover health care needs, such as memory care. More information about these programs can be found on the VA website.
  • Life Insurance: Some life insurance policies allow policyholders to cash out their policy before a qualifying death. There may be some downsides to accessing a life insurance benefit early, so be sure to read more about the process.
  • Require assistance with all activities of daily living for longer than a 14-day period

Reverse Mortgages In South Carolina

Relevant laws established to protect South Carolina ...

Reverse mortgages are available in South Carolina. A reverse mortgage is a home equity loan where the borrower does not have to make payments.

If you have significant equity in your home and you and your spouse are at least 62 years old, you can get a reverse mortgage to turn your equity into funding long-term health care, pay for an LTC Insurance policy, pay bills and add to your retirement lifestyle.

This type of mortgage can increase monthly income, eliminate mortgage payments, and even fund Long-Term Care Insurance. However, South Carolina has many rules on these products, and you should seek the help of a qualified and licensed mortgage broker.

The home must be the principal residence without any tax liens.

Learn more about reverse mortgages by .

*The federal government sets a new minimum and maximum amounts each year, but states can set their own minimum requirements at any level between the federal limits. This information is based on the best available sources.

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Assisted Living Laws And Regulations In South Carolina

Facilities in South Carolina are licensed by the Bureau of Health Facility Licensing which falls under the purview of the Board of Health and Environmental Control. In order to gain and retain licensure, the state has set forth a number of rules and regulations that facilities that wish to operate in South Carolina must adhere to.

Medicaid Coverage Of Assisted Living Services In North Carolina

Assisted living facilities are generally less expensive and less medically intensive than nursing homes, but are not cheap by any means. Most North Carolina residents living in assisted living facilities pay their own costs. Generally speaking, Medicaid does not cover room and board fees in assisted living facilities. However, if you have little income and few assets, you may qualify for a program that helps pay for assisted living facilities.

If you receive SSI and live in an assisted living facility, you may qualify for a benefit called Special Assistance that will pay for room and board expenses, up to $1,182/month, at adult care homes . People with dementia who live in specialized care units can receive more money each month . You will also recive a $46 per month personal needs allowance.

If you don’t receive SSI, your income must be lower than $1,229 per month and you must have less than $2,000 in countable assets . Those seeking to live in special care units must have income less than $1,561 per month.

A separate program, called Special Assistance In-Home , provides a similar benefit for low-income people who could reside in an assisted living home but want to stay in their own homes. To apply for SA or SA/IH, contact your local county Department of Social Services office.

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Directory Of Assisted Living Facilities In South Carolina

The decision to choose an Assisted Living Facility whether for oneself or a loved one can be daunting and time-consuming. Our directory of facilities located in South Carolina is comprehensive, convenient and makes the process easier. Use the tools below to locate the right amenities, services, pricing and more.

Requirements For Reporting Abuse

Protecting your assets from Medicaid recovery

In an assisted living facility, all staff, regardless of the level of contact with residents, are considered mandated reporters. Additionally, contracted employees such as visiting, nurses, physicians, pharmacists or home health aide staff are designated as mandated reporters.

However, anyone that suspects that a resident is being abused can also file a complaint with the Vulnerable Adult Investigations Unit at or with the office of the Long-Term Care Ombudsman at 734-9900 or 911 if the resident is in immediate danger. Residents of an assisted living facility or their families may also use these numbers to report abuse of themselves or other residents. The abuse may be physical or psychological in nature and can include, but is not limited to:

  • Sexual abuse
  • Intentionally inflicting harm on an individual
  • Failure to provide care when needed
  • Withholding of food. medicines or other necessities
  • Failure to report or treat injuries

Mandated reporters are required to report abuse within 24 hours of observing the abuse. Failure to report may result in a fine of up to $25,000, one year in jail, a misdemeanor charge and loss of professional license if applicable.

Staff, residents, or the families of residents may report any of these conditions to the states Health Facilities Licensing Bureau via the online complaint form, or by calling 545-4370.

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Penalty Information In South Carolina For Medicaid

If a gift of any amount is given in South Carolina during a period of 5 years before applying to Medicaid, a penalty period will be initiated. This penalty period in South Carolina is called a look-back period and it can make an individual not eligible for Medicaid. Medicaid will not pay for care until the penalty period is over. The penalty is calculated by taking the total amount of any gifts given, and dividing it by $ 6,672, which creates a number of months before Medicaid kicks in.

The average cost of Nursing home care in South Carolina is $6,596, so penalties can become very costly for a family that has not planned appropriately for Medicaid.

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