C. Eligibility

• Library: A Practical Guide to Elder and Special Needs Law in South Carolina (SCBar) (2021 Ed.)

C. ELIGIBILITY

1. Overview

To qualify for the Medicaid program, an applicant must meet both eligibility requirements and program requirements. These requirements may be grouped together as follows:

• Qualification 1: Categorical eligibility. An applicant must fit into one of the coverage groups listed in C.2. below.
• Qualification 2: Meets the non-financial eligibility requirements. An applicant must meet certain requirements that are unrelated to financial need.
• Qualification 3: Meets the financial eligibility requirements. An applicant must have limited assets and low income. The extent of allowable assets and income varies among the different eligibility coverage groups. The elder law attorney must review the income and resource requirements contemporaneously with any representation due to frequent changes in the law and changes in how SCDHHS may expand or apply the law.
• Qualification 4: Agrees to comply and does comply with program requirements. An applicant must follow certain procedures to apply for Medicaid, prove eligibility, and report changes in circumstances.

Applicants must pass all qualification tests to receive Medicaid benefits. The Medicaid agency must make eligibility determinations with "reasonable promptness." 42 U.S.C. § 1396a(a)(8). The regulations allow for 90 days for determinations of applicants applying on the basis of disability and 45 days for all other applications. 42 C.F.R. § 435.912(c)(3). However, for a number of years, SCDHHS has been out of compliance with these statutory and regulatory deadlines. Time frames have been improving as of late 2019 and early 2020.

2. Categorical Eligibility

Being indigent, without income or resources, does not make an individual qualified for Medicaid. For example, an able-bodied 64-year-old man who has only $50 to his name does not qualify for Medicaid. While limited assets and income are one of the requirements of the program, a person must also fit into one of the following coverage groups:

• Receiving cash assistance, such as SSI or Optional State Supplementation (OSS);
• Aged (65 or older);
• Blind;
• Disabled;
• A child under age 19;
• A pregnant woman;
• An adult with a dependent child(ren); or
• falls into one of the other categories listed in Section B of this Chapter for the various services related to the Program for which the individual qualifies.

MPPM, Chapter 102.06, available at http://www1.scdhhs.gov/mppm/ (last viewed on Oct. 23, 2020).

3. Non-Financial Eligibility...