How to Start a Medicaid Claim in South Carolina

To claim Medicaid in South Carolina, you submit an application to the Department of Health and Human Services (DHHS). You can apply online through the South Carolina DHHS portal, by mail, in person at a local DHHS office, or by phone. The state processes applications within 30 days for most people, though expedited processing (within 7 days) is available if you meet certain conditions like homelessness or imminent eviction.

You do not need to wait for a specific enrollment period — South Carolina Medicaid accepts applications year-round. Once approved, coverage typically begins on the first day of the month after the state verifies your information. If you are applying based on a recent job loss or change in income, tell the DHHS worker when you apply, because this can speed up processing.

Key Takeaways

  • Apply through the South Carolina DHHS online portal, by phone at 1-888-549-0820, by mail, or in person at your county DHHS office.
  • You must provide proof of income, residency, citizenship or immigration status, and Social Security numbers for everyone in your household.
  • South Carolina has different income limits depending on which Medicaid category you fit into — parent, child, pregnant person, elderly, or disabled.
  • The state processes most applications within 30 days; expedited processing takes 7 days if you are homeless or facing eviction.
  • Once approved, coverage starts on the first of the month after verification, and you receive a Medicaid card in the mail.

Income Limits and Who Qualifies

South Carolina Medicaid has different income thresholds depending on your household situation. For a parent or caretaker relative, the income limit is 67% of the federal poverty level. For children under 19, it is 211% of federal poverty level. For pregnant people and newborns, it is 211% of federal poverty level. For people aged 65 and older or those who are blind or disabled, the limit is 100% of federal poverty level.

These percentages translate to specific dollar amounts that change each year. For example, in 2024, 100% of federal poverty level for a single person is approximately $1,600 per month gross income, but you should confirm the current year's limits with DHHS because they update annually. Your household size matters — a family of four has a higher limit than a single person.

South Carolina also counts certain types of income differently. Wages and salary count as income. Social Security, unemployment benefits, and child support also count. However, some income does not count — for instance, the first $90 per month of unearned income is excluded, and certain work-related expenses can reduce your countable income if you are disabled.

Documents You Need to Provide

When you apply, have these documents ready: proof of income (recent pay stubs, tax returns, or a letter from your employer stating you are unemployed), proof of residency (utility bill, lease, or mortgage statement), proof of citizenship or immigration status (birth certificate, passport, or immigration documents), and Social Security numbers for everyone in your household.

If you are applying based on disability, bring medical records or a letter from your doctor describing your condition. If you are a parent applying for your child, bring the child's birth certificate and Social Security card. If you are applying for a pregnant person, bring proof of pregnancy (a letter from a doctor or clinic). The DHHS worker will tell you if they need additional documents after you submit your initial application.

How to Apply Online, by Phone, or In Person

Online: Go to the South Carolina DHHS website and create an account in the online portal. You will answer questions about your household, income, and resources. You can upload documents directly or mail them later. The system will tell you immediately if you are missing required information.

By phone: Call the DHHS hotline at 1-888-549-0820. A worker will ask you the same questions as the online form and can schedule a time for you to submit documents by mail or in person. This route takes longer because the worker must manually enter your information.

In person: Visit your county DHHS office with your documents. A worker will help you fill out the application on the spot and can often scan or copy your documents immediately. Find your local office on the DHHS website by entering your county name. In-person applications often move faster because the worker can verify information right away.

By mail: Download the application from the DHHS website, fill it out, and mail it with copies of your documents to your county DHHS office. Include a cover letter with your phone number and email so the worker can contact you with questions. Mailed applications take longer — typically 30 to 45 days — because the office must receive and process the mail.

What Happens After You Apply

After you submit your application, the DHHS will send you a notice by mail within 30 days (or 7 days if you requested expedited processing). The notice will say whether you are approved, denied, or need to provide more information. If approved, your Medicaid card will arrive in the mail within one to two weeks. Your coverage begins on the first day of the month after the state approves you.

If the state asks for more information, respond within 10 days. If you miss the deadline, your application may be denied, but you can reapply. If you are denied, the notice will explain why and tell you how to request a hearing to appeal the decision. You have 90 days from the denial date to file an appeal.

Once you have Medicaid, you must report changes in your income, household size, or address within 10 days. You can report changes online, by phone, or in person. If you do not report changes, your coverage could be canceled or you could be asked to repay benefits you were not supposed to receive.

Special Situations: Expedited Processing and Emergency Coverage

If you are homeless, facing eviction, or in a medical emergency, you can request expedited processing. Tell the DHHS worker when you apply that you need a decision within 7 days. Provide documentation of your situation — an eviction notice, a letter from a shelter, or a hospital discharge summary. The state will prioritize your application.

In some cases, you may receive emergency Medicaid coverage before your full application is approved. This covers emergency medical services only and lasts for a limited time. Emergency Medicaid is available to people who would otherwise be ineligible because of immigration status or other factors, but only for emergency treatment.

Medicaid Coverage and What It Includes

South Carolina Medicaid covers doctor visits, hospital stays, emergency care, prescription medications, mental health services, and preventive care like vaccinations and screenings. Coverage varies slightly depending on which category you fall into — for example, coverage for adults differs from coverage for children or pregnant people.

When you receive your Medicaid card, it will have a member ID number. Use this number when you go to the doctor or pharmacy. Most doctors and hospitals in South Carolina accept Medicaid, but some do not — call ahead to confirm. If you need to find a doctor who accepts Medicaid, the DHHS website has a provider directory.

Frequently Asked Questions

Can I work and still get Medicaid in South Carolina?

Yes. South Carolina counts your gross income, not your net income, so taxes and deductions do not reduce your countable income. However, if you are working and your income exceeds the limit for your household size, you will not be approved. If you are disabled and working, certain work-related expenses can reduce your countable income.

What if I have a job but no health insurance through my employer?

Your job status does not matter — only your income matters. If your income is below the limit for your household size and category, you can be approved for Medicaid even if your employer offers insurance. The state will not require you to enroll in employer coverage first.

How long does Medicaid last once I am approved?

Coverage lasts 12 months from the date you are approved, unless your circumstances change. After 12 months, you must reapply or renew your coverage. The state will send you a renewal notice before your coverage ends. If you do not respond to the renewal notice, your coverage will be canceled.

What if I was denied Medicaid — can I appeal?

Yes. You have 90 days from the denial date to request a hearing. The notice of denial will explain how to file an appeal. You can appeal by phone, mail, or in person. At the hearing, you can present new information or documents that support your case.

Do I have to pay anything for Medicaid in South Carolina?

No. South Carolina Medicaid is free for people who meet the income and other requirements. You do not pay a monthly premium, and there are no copays for most services. Some services may have small copays, but the state cannot charge copays for emergency care, family planning, or preventive services.