South Carolina Healthy Connections is the state brand for Medicaid in South Carolina, administered by the South Carolina Department of Health and Human Services (SCDHHS). Losing Healthy Connections coverage can happen for many reasons: the state completing a redetermination and finding you no longer eligible, an administrative paperwork issue, a change in household income or composition, or losing the qualifying category that made you eligible (pregnancy ending, child aging out of CHIP, caretaker status changing). In the COVID-era Medicaid unwinding that ran through 2024 and into 2025, more than 105,000 South Carolinians lost Healthy Connections coverage, and 93% of those disenrollments were for procedural reasons rather than ineligibility. That means the first thing you should do is check whether your termination was an error by contacting SCDHHS at 1-888-549-0820 or logging in at apply.scdhhs.gov.
South Carolina is one of 10 states that has not expanded Medicaid under the Affordable Care Act. This non-expansion status creates an important dynamic: adults in South Carolina who lose Healthy Connections coverage and have income below 100% of the Federal Poverty Level (under $15,960 for a single adult in 2026) often fall into the coverage gap, ineligible for Healthy Connections and also ineligible for ACA Marketplace subsidies, which require at least 100% FPL. Understanding where your income falls is the critical first step. This guide covers the 90-day loss-of-Medicaid Special Enrollment Period, how to check for coverage gap issues, and how to use healthcare.gov or the SCDHHS Citizen Portal to get covered quickly. Many South Carolinians who lost Medicaid coverage also find that their children still qualify for Partners for Healthy Children CHIP at up to 208% FPL regardless of the parent's coverage status.
7 Steps to Get Coverage
Common Mistakes That Cost People Thousands
The most costly mistakes South Carolina residents make after losing Healthy Connections Medicaid:
- Waiting past the 90-day SEP window. Losing Medicaid gives you 90 days to enroll in a Marketplace plan. Miss that deadline and you must wait until ACA Open Enrollment in November 2026 for 2027 coverage.
- Not appealing a paperwork-driven termination. Most South Carolina Medicaid terminations during the 2024-2025 unwinding were procedural. If you did not receive or respond to a renewal notice, you have 90 days to appeal the termination and may be reinstated.
- Assuming you cannot get coverage because SC has not expanded Medicaid. If your income is at or above 100% FPL in 2026, you qualify for ACA Marketplace subsidies through healthcare.gov even though SC has not expanded Medicaid.
- Forgetting to separately enroll children in Partners for Healthy Children CHIP. Children under 19 can enroll in SC CHIP year-round at up to 208% FPL even if the parent is in the coverage gap. A parent losing Medicaid does not automatically remove children from CHIP eligibility.
- Reporting last year's income instead of projected 2026 income. ACA Marketplace subsidies use projected annual income for the current year, not last year's tax return. If your income dropped after losing Medicaid (for example, from also losing a job), use your current projected income for a larger subsidy.
- Thinking COBRA is the only option. COBRA only applies if you also had an employer group health plan. Most Healthy Connections-only enrollees do not have COBRA rights. The Marketplace SEP is the primary post-Medicaid enrollment path.
South Carolina Healthy Connections: Who Qualifies After Losing Coverage in 2026
South Carolina Healthy Connections Medicaid has five major eligibility categories for adults. Pregnant women qualify at up to 194% FPL, which is approximately $30,962 for a single adult in 2026. Parents or caretaker relatives who have a dependent child living in the household qualify at up to 62% FPL, roughly $9,895 for a single parent or $20,460 for a family of 4 in 2026. Aged, blind, or disabled adults qualify at income levels linked to the federal SSI standard, generally at or below $1,330 per month (100% FPL) for an individual in 2026 per SCDHHS. Children under 19 qualify through the Partners for Healthy Children program at up to 208% FPL. The critical gap is childless, non-disabled adults between 19 and 64, who fall into the coverage gap because South Carolina has not expanded Medicaid under the ACA. If you previously qualified under one of these categories and your status changed (pregnancy ended, child turned 19, caretaker status ended), you cannot remain on Healthy Connections in most cases.
SCDHHS administers Healthy Connections enrollment through the online Citizen Portal at apply.scdhhs.gov or by calling 1-888-549-0820. Enrollment in Healthy Connections Medicaid is year-round with no waiting period after income eligibility is confirmed. The standard processing time for a new Medicaid application is 45 days (90 days for disability-based applications). South Carolina does have a presumptive eligibility process for pregnant women, allowing same-day or next-day coverage pending full application review. If you were previously enrolled and terminated for procedural reasons, reapplying with the original qualifying documentation (proof of income, household composition, residency) is the fastest path to reinstatement. The medicaid.gov eligibility overview explains federal baseline requirements that apply in all states including South Carolina.
South Carolina Healthy Connections Medicaid Income Limits by Category, 2026| Eligibility Category | 2026 Income Limit (% FPL) | Approximate Annual Income (family of 4) |
|---|
| Pregnant women | 194% FPL | ~$64,020 |
| Parents / caretaker relatives | 62% FPL | ~$20,460 |
| Children under 19 (Partners for Healthy Children CHIP) | 208% FPL | ~$68,640 |
| Aged, blind, or disabled (SSI-linked) | 100% FPL individual (per SCDHHS 2026) | ~$15,960 individual (~$1,330/mo) |
| Non-disabled childless adults 19-64 (NOT expanded) | Not eligible: coverage gap | No Medicaid path in SC |
South Carolina has not expanded Medicaid under the ACA as of 2026. Income limits apply to the 48 contiguous states FPL base. Source: SCDHHS Program Eligibility and Income Limits page, HHS ASPE 2026 Poverty Guidelines.
Source: scdhhs.gov, HHS ASPE 2026 Poverty Guidelines
ACA Marketplace Options in South Carolina After Losing Healthy Connections in 2026
ACA Marketplace plans in South Carolina are offered exclusively through healthcare.gov, the federally facilitated Marketplace, since South Carolina does not operate a state-based exchange. After losing Healthy Connections Medicaid, you have a 90-day Special Enrollment Period to enroll in a Marketplace plan. Coverage begins on the first day of the month following your enrollment completion. The ACA income limits for subsidy eligibility in 2026 start at 100% FPL for South Carolina residents, which is $15,960 for a single adult and $33,000 for a family of 4. This 100% FPL floor applies specifically because South Carolina has not expanded Medicaid. In expansion states the floor is 138% FPL, and below-138% residents get Medicaid. In non-expansion states like South Carolina, residents between 100% and 138% FPL qualify for Marketplace plans with enhanced subsidies including cost-sharing reductions on Silver plans. Residents below 100% FPL are in the coverage gap and do not qualify for either Medicaid or subsidized Marketplace coverage.
South Carolina Marketplace plans in 2026 come in Bronze, Silver, Gold, and Catastrophic metal tiers. Silver plans are the most subsidy-efficient choice for most enrollees because they carry cost-sharing reduction (CSR) options for those between 100% and 250% FPL, meaning lower deductibles and copays on top of lower premiums from the premium tax credit. The 2026 ACA Marketplace out-of-pocket maximum is $10,600 for individual and $21,200 for a family plan (HHS June 2025 NBPP revision). Note that the enhanced premium tax credits that were in effect from 2021 through 2025 under the American Rescue Plan and the Inflation Reduction Act have expired for 2026, so the 400% FPL subsidy cliff is back. If your income is above 400% FPL, you can still purchase a Marketplace plan but at full premium without subsidy. The ACA income limits chart at aca-income-limits shows exactly where your household falls for 2026.
Documents Needed to Enroll After Losing Healthy Connections in South Carolina
Gathering the right documents before you start your application saves time and prevents your SEP application from being rejected. The SCDHHS termination notice is your proof-of-qualifying-life-event for the Marketplace SEP, so keep the letter or access it through the SCDHHS Citizen Portal at apply.scdhhs.gov. Healthcare.gov requires this documentation within 30 days of your SEP application submission to complete verification. The 1095-B form from SCDHHS documents prior Medicaid coverage by month and is used for IRS purposes as well as SEP verification. Proof of current income matters because ACA subsidies use Modified Adjusted Gross Income (MAGI), which includes wages, unemployment benefits, self-employment income, Social Security income, and alimony. If you received unemployment benefits in 2026, include those in your projected annual income estimate on healthcare.gov. Using last year's income rather than projected 2026 income is the most common cause of subsidy calculation errors after a qualifying life event.
- SCDHHS termination notice (letter or Citizen Portal record) dated within the past 90 days
- 1095-B form from SCDHHS (documents months of prior Medicaid coverage for IRS + SEP verification)
- Pay stubs from the past 30 days or most recent unemployment award letter for income verification
- Social Security numbers for every household member applying for coverage
- South Carolina residential address and ZIP code (Marketplace plans vary by county in SC)
- Birth certificates for children (if enrolling children in Marketplace or Partners for Healthy Children CHIP)
- Immigration documents if applicable (lawfully present immigrants qualify for Marketplace plans; undocumented individuals do not qualify for ACA subsidies)
The Coverage Gap in South Carolina: What Happens If Your Income Is Below 100% FPL
South Carolina is one of 10 states that has not expanded Medicaid under the ACA as of 2026. This creates a coverage gap for non-disabled childless adults whose income falls below 100% of the Federal Poverty Level (below $15,960 for an individual in 2026). In expansion states, these adults would qualify for Medicaid at 138% FPL. In South Carolina, they qualify for neither Healthy Connections Medicaid (income too high for the categorical programs, which mostly top out at 62% FPL for parents) nor ACA Marketplace subsidies (income below the 100% FPL floor for subsidies in non-expansion states). The coverage gap in South Carolina has remained unresolved since 2014. Legislative attempts to expand Medicaid have not succeeded as of the date of this writing in 2026.
Residents in the South Carolina coverage gap in 2026 have limited options: federally qualified health centers (FQHCs) provide sliding-scale primary care regardless of insurance status; free and charitable clinics operate across South Carolina; prescription assistance programs from drug manufacturers can cover specific medications; and state and local social service agencies may connect uninsured residents to emergency dental, mental health, or specialty care. The South Carolina Primary Health Care Association maintains a directory of FQHCs across the state at scha.org. If you are in the coverage gap and believe your income or household situation may have changed to make you eligible for Healthy Connections, reapply at apply.scdhhs.gov, since eligibility determinations are based on current circumstances.
Frequently Asked Questions
How long do I have to enroll in a new plan after losing South Carolina Healthy Connections Medicaid?
Losing South Carolina Healthy Connections Medicaid triggers a 90-day Special Enrollment Period (SEP) for ACA Marketplace plans through healthcare.gov. Your 90 days starts from the date your Healthy Connections coverage actually ended, not from when you received the notice. For example, if your coverage ended June 1, 2026, your SEP runs through August 30, 2026. Healthcare.gov will ask for your qualifying life event documentation (your SCDHHS termination notice) within 30 days of your SEP application. You can also reapply to Healthy Connections Medicaid year-round with no deadline if your circumstances still qualify.
Can I get Medicaid again in South Carolina after losing it?
Reapplying to South Carolina Healthy Connections Medicaid is available year-round through apply.scdhhs.gov or by calling SCDHHS at 1-888-549-0820. Whether you can get Medicaid again depends on whether your circumstances still qualify you. Pregnant women qualify at up to 194% FPL, parents with dependent children in the household qualify at up to 62% FPL, and aged, blind, or disabled adults qualify under SSI-linked standards. Most childless, non-disabled adults between 19 and 64 are not eligible in South Carolina because the state has not expanded Medicaid under the ACA. If your prior termination was due to a paperwork issue during the Medicaid unwinding, you have 90 days from the termination date to appeal and request reinstatement.
What is the coverage gap in South Carolina and do I fall into it?
The South Carolina coverage gap affects non-disabled, childless adults between 19 and 64 whose annual income is below 100% FPL (below $15,960 for an individual in 2026). South Carolina has not expanded Medicaid under the ACA, so these adults are not eligible for Healthy Connections Medicaid. They also do not qualify for ACA Marketplace subsidies, which require income of at least 100% FPL in non-expansion states. If you are a parent with a dependent child in the household, you may qualify for Healthy Connections at up to 62% FPL. If you are pregnant, you may qualify at up to 194% FPL. Otherwise, free and charitable clinics and FQHCs (federally qualified health centers) across South Carolina provide sliding-scale care regardless of insurance status.
How do I prove I lost Medicaid to enroll in an ACA Marketplace plan in South Carolina?
To use the loss-of-Medicaid SEP on healthcare.gov, you need the SCDHHS Medicaid termination notice as proof of your qualifying life event. This can be the paper letter from SCDHHS or a record from the SCDHHS Citizen Portal at apply.scdhhs.gov. You must upload or mail this documentation to healthcare.gov within 30 days of your SEP application submission. You will also need your 2026 projected annual household income, Social Security numbers for all household members, and your South Carolina residential ZIP code. The 1095-B form from SCDHHS, which documents your prior months of Medicaid coverage, is also useful for IRS purposes when you file your 2026 tax return.
Do my children lose Medicaid or CHIP when I lose Healthy Connections in South Carolina?
Your children's coverage is separate from your own Medicaid eligibility in South Carolina. Children under 19 can qualify for Partners for Healthy Children CHIP at incomes up to 208% FPL regardless of whether you as a parent qualify for Healthy Connections. CHIP enrollment in South Carolina is year-round with no deadline. Apply for children at apply.scdhhs.gov or by calling SCDHHS at 1-888-549-0820. Partners for Healthy Children covers comprehensive benefits including dental, vision, and preventive care. Even if you fall into the coverage gap as an adult, your children can still have coverage through Partners for Healthy Children.
What ACA Marketplace plans are available in South Carolina in 2026 and how much will they cost?
South Carolina uses the federally facilitated Marketplace at healthcare.gov. Plans are available in Bronze, Silver, Gold, and Catastrophic metal tiers. Premium costs after the 2026 premium tax credit depend on your income and household size. At 100% to 150% FPL, Silver plans typically cost $0 to $50 per month after subsidies. At 150% to 250% FPL, Silver plans typically cost $50 to $150 per month. Silver plans between 100% and 250% FPL also qualify for cost-sharing reductions that lower deductibles and copays. The 2026 ACA out-of-pocket maximum is $10,600 for an individual plan. Note that enhanced premium tax credits from the American Rescue Plan expired January 1, 2026, so premiums are somewhat higher than in 2024-2025 for the same income level.
What if I miss the 90-day SEP window after losing Healthy Connections?
Missing the 90-day loss-of-Medicaid Special Enrollment Period means you cannot enroll in an ACA Marketplace plan until the next Open Enrollment Period, which runs November 1 through January 15 each year (November 1, 2026 through January 15, 2027 for 2027 coverage). Exceptions apply if another qualifying life event occurs, such as getting married, having a baby, moving to a new state, or losing other coverage. Healthy Connections Medicaid itself is year-round, so if your circumstances change and you re-qualify, you can apply at any time. For uninsured care during any gap period, South Carolina has federally qualified health centers and free clinics that provide sliding-scale or no-cost primary care.
Does losing Medicaid in South Carolina trigger COBRA?
Losing Medicaid alone does not trigger COBRA eligibility. COBRA only applies to employer-sponsored group health insurance plans. If you had Healthy Connections Medicaid as your only coverage, you do not have COBRA rights. However, if you simultaneously had employer-sponsored coverage that you are also losing (for example, your employer stops offering coverage at the same time as a Medicaid redetermination), that employer coverage loss would trigger a separate 60-day COBRA election window. For most Healthy Connections-only enrollees, the ACA Marketplace 90-day loss-of-Medicaid SEP is the relevant enrollment path.
