LONG TERM CARE OPTIONS UNDER THE SOUTH CAROLINA MEDICAID PROGRAM and RELATED ASSISTANCE PROGRAMS

INSTITUTIONAL/FACILITY-BASED SERVICES

1. Nursing Home Care.

The South Carolina Medicaid Program covers nursing home care in participating facilities, provided that an individual meets prescribed financial and medical eligibility criteria. This medical criteria is referred to as "Level of Care," and assesses an individuals medical condition AND ability to engage in "activities of daily living."
In South Carolina, the Level of Care criteria are fairly strict, and generally require that an individual need direct, "hands-on" assistance.

Because Medicare only provides limited coverage for nursing home care, and because many individuals do not have private long term care insurance or the ability to pay privately for an extended period of time, Medicaid often eventually becomes the payment source for nursing home care for many individuals that would not otherwise seek - or qualify for -- public assistance. Most (but not all) nursing home sin South Carolina participate to some extent in the Medicaid Program

In South Carolina, the nursing home Level of Care assessment is made by Community Long Term Care (CLTC), a Division of the South Carolina Department of Health and Human Services. The remainder of the eligibility determination - including financial qualification - is handled by the Department of Social Services (DSS).

2. Care in an Intermediate Care Facility for the Mentally Retarded (ICF/MR).

The South Carolina Medicaid Program also covers care provided in a participating Intermediate Care Facility for the Mentally Retarded (ICF/MR). Like nursing home coverage, ICF/MR coverage is dependent upon an individual meeting both financial and medical eligibility criteria.

In South Carolina, the ICF/MR Level of Care assessment is made by the Department of Disabilities and Special Needs. The remainder of the eligibility determination - including financial qualification - is handled by the Department of Social Services (DSS).