South Carolina's Medicaid program, Healthy Connections, is administered by the SC Department of Health and Human Services (SCDHHS). Whether an immigrant qualifies depends on three factors: immigration status (lawful permanent resident, asylee, refugee, or other), length of time in that status (the federal five-year bar applies to most lawful permanent residents), and the applicant's household category (child, pregnant woman, parent, or adult with disability). South Carolina has not expanded Medicaid under the ACA, which creates an additional barrier for childless adults regardless of immigration status.
This guide covers who qualifies under each immigration category in 2026, the specific income limits for South Carolina households, changes taking effect October 1, 2026 from federal law (H.R.1), how to apply, and what Emergency Medicaid covers for those who do not qualify for full coverage. For general South Carolina Medicaid eligibility, see our guide at coveredusa.org.
Who Qualifies: South Carolina Immigrant Medicaid Eligibility in 2026
South Carolina Healthy Connections covers immigrants in four main scenarios in 2026. First, lawfully residing children (under 19) qualify for full Healthy Connections coverage up to 208% of the 2026 federal poverty level ($33,197 for a child in a household of one) without any waiting period, because South Carolina has elected the CHIPRA 214 option that waives the five-year bar for children. Second, lawfully residing pregnant women qualify up to 194% FPL ($30,962 for a household of one in 2026) with no five-year waiting period under the same CHIPRA 214 option; coverage continues through 60 days postpartum. Third, lawful permanent residents (green card holders) who have held LPR status for at least five years qualify for full coverage if they meet the applicable income limit for their category (parent/caretaker at 62% FPL, aged/blind/disabled at 100% FPL, working disabled up to 250% FPL). Fourth, certain immigrants who are exempt from the five-year bar, including refugees, asylees, Cuban and Haitian entrants, Amerasians, survivors of trafficking, and COFA migrants from Micronesia, Palau, and the Marshall Islands, qualify immediately without waiting.
South Carolina is one of 10 states that has not expanded Medicaid under the ACA (the others are Alabama, Florida, Georgia, Kansas, Mississippi, Tennessee, Texas, Wisconsin, and Wyoming). This means childless adults without a qualifying disability do not qualify for full Healthy Connections coverage even if they are lawful permanent residents who have completed the five-year waiting period. The coverage gap in South Carolina affects approximately 105,000 low-income adults statewide, a disproportionate share of whom are immigrants.
South Carolina Healthy Connections immigrant eligibility by category 2026| Immigrant Category | Five-Year Bar? | Income Limit (2026) | Notes |
|---|
| Lawfully residing children (under 19) | No wait (CHIPRA 214 option) | 208% FPL ($33,197 for hh-1) | South Carolina has elected CHIPRA 214 for children |
| Lawfully residing pregnant women | No wait (CHIPRA 214 option) | 194% FPL ($30,962 for hh-1) | Covers pregnancy + 60 days postpartum |
| Refugees, asylees, Cuban/Haitian entrants | No wait (exempt) | Same thresholds as above by category | Exempt from PRWORA five-year bar; changes Oct 1, 2026 |
| COFA migrants (Micronesia, Palau, Marshall Islands) | No wait (exempt) | Same thresholds as above by category | Treated as qualified immigrants with no bar |
| Lawful permanent residents (LPRs), all categories | Yes, 5-year wait required | Varies: 62% FPL parents; 100% FPL aged/blind/disabled | Start date = date green card was issued |
| DACA, TPS, undocumented immigrants | Not eligible (no qualified status) | Emergency Medicaid only | South Carolina does not fund state-only Medicaid for this group |
FPL = federal poverty level. 2026 FPL for one person (48 states): $15,960. South Carolina uses 2026 FPL for Medicaid eligibility. Note: eligibility rules for certain immigrant categories change October 1, 2026 under H.R.1 (see section below).
Source: SCDHHS Program Eligibility and Income Limits (March 2026); KFF CHIPRA 214 Tracker; Medicaid.gov non-citizen eligibility overview
Healthy Connections Income Limits for Immigrant Children by Household Size 2026
South Carolina's Partners for Healthy Children program within Healthy Connections covers children under age 19 up to 208% of the 2026 federal poverty level. Lawfully residing immigrant children qualify at this same threshold under the CHIPRA 214 option, with no five-year waiting period. The 2026 FPL for a household of one is $15,960 per year (ASPE, January 2026). The household size table above shows the 208% FPL threshold for households of one through eight persons, plus the per-person increment for larger households.
South Carolina also covers pregnant women at 194% FPL (approximately $30,962 annually for a one-person household in 2026). For lawful permanent residents who have completed the five-year bar, parents and caretaker relatives qualify at only 62% FPL ($9,895 for a one-person household in 2026) because South Carolina has not expanded Medicaid. Aged, blind, and disabled LPRs qualify at 100% FPL ($15,960 for one person in 2026).
The Five-Year Bar: How It Works for South Carolina Immigrants
The Personal Responsibility and Work Opportunity Reconciliation Act (PRWORA), enacted in 1996, bars most qualified immigrants who entered the U.S. on or after August 22, 1996 from receiving federal public benefits during the first five years after receiving a qualifying immigration status. For Healthy Connections purposes, the five-year clock starts on the date the green card (Form I-551) is issued, not the date of entry into the United States. A lawful permanent resident who entered the U.S. on a student visa in 2018 and received their green card in 2022 can apply for full Healthy Connections starting in 2027.
Immigrants who are exempt from the five-year bar and who qualify immediately for Healthy Connections include: refugees (including those later adjusted to LPR); individuals granted asylum or withholding of removal; Cuban and Haitian entrants; Amerasian immigrants; Iraqi and Afghan Special Immigrants; survivors of severe trafficking (with T or U visa); victims of domestic violence under VAWA (certain categories); veterans and active-duty military and their families; and COFA migrants from Micronesia, Palau, and the Marshall Islands. Emergency Medicaid covers everyone in South Carolina, including undocumented immigrants, for the acute emergency period.
Critical 2026 Change: H.R.1 Immigrant Eligibility Restrictions
South Carolina Healthy Connections immigrant eligibility is changing under federal law H.R.1 (also known as the One Big Beautiful Bill, signed in 2025), which restricts federal Medicaid and CHIP funding for non-citizens effective October 1, 2026. After that date, federal matching funds are available only for: lawful permanent residents (after the five-year bar where applicable), Cuban and Haitian entrants, and COFA migrants. This means groups that previously qualified without the five-year bar, including refugees, asylees, trafficking survivors with T visas, VAWA applicants, and several other humanitarian categories, lose federal Medicaid funding eligibility beginning October 1, 2026.
South Carolina does not have a state-only Medicaid program to extend coverage to immigrants who lose federal eligibility, unlike states such as California, New York, or Illinois. Immigrants in the affected categories who are currently enrolled in Healthy Connections will receive a notice from SCDHHS before October 1, 2026, and their coverage will end unless their immigration status changes. The CHIPRA 214 option for lawfully residing children and pregnant women is preserved after October 1, 2026, so those two groups are not affected by H.R.1. For the most current information, call SCDHHS at 1-888-549-0820 or SC Appleseed at 803-779-1113.
Emergency Medicaid in South Carolina: Who Qualifies and What It Covers
Emergency Medicaid is available to every person in South Carolina, including undocumented immigrants, DACA recipients, and immigrants with Temporary Protected Status, who would otherwise meet the financial and categorical requirements for Healthy Connections but for their immigration status. Emergency Medicaid is federally required under Section 1903(v) of the Social Security Act and covers treatment for an emergency medical condition: a condition that manifests itself with acute symptoms of sufficient severity that the absence of immediate medical attention could place the patient's life in serious jeopardy.
South Carolina Emergency Medicaid covers: emergency room visits and acute inpatient hospitalization for the emergency period, emergency surgery, labor and delivery for pregnant women (labor is always an emergency under federal rules), and stabilization services. Emergency Medicaid does NOT cover: follow-up outpatient care after stabilization, prescriptions for non-emergency conditions, preventive care, mental health treatment (unless an immediate psychiatric emergency), or dental care (except emergency extractions). To apply for Emergency Medicaid, go to any hospital emergency room accepting Medicaid; the hospital will assist with the application through SCDHHS.
South Carolina Is a Non-Expansion State: The Coverage Gap for Immigrant Adults
South Carolina has not expanded Medicaid under the Affordable Care Act. In the 40 states and DC that have expanded, adults up to 138% FPL ($22,025 for a single person in 2026) qualify for full Medicaid regardless of whether they have children. South Carolina's threshold for parents and caretaker relatives is only 62% FPL ($9,895 for one person in 2026). Childless adults, including immigrants who have completed the five-year bar, cannot qualify for full Healthy Connections coverage regardless of how low their income is.
Adults who earn between 100% and 400% FPL ($15,960 to $63,840 for one person in 2026) can purchase an ACA Marketplace plan through HealthCare.gov during Open Enrollment (November 1 through January 15 for 2026 plan year coverage). However, the enhanced premium tax credits from the American Rescue Plan Act expired January 1, 2026, meaning ACA subsidy amounts returned to the pre-ARPA levels. Immigrants who qualify for ACA Marketplace coverage are those in a lawfully present immigration status, regardless of the five-year bar (the five-year bar applies to Medicaid and CHIP specifically, not Marketplace plans). Undocumented immigrants are not eligible for Marketplace plans.
How to Apply for Healthy Connections as an Immigrant in South Carolina
South Carolina Healthy Connections accepts year-round applications with no enrollment window. The fastest application method is the online portal at apply.scdhhs.gov, where you can upload documents and track your case. SC Thrive (SCThrive.org) is a nonprofit enrollment assistance organization that offers free help completing the Healthy Connections application; call SC Thrive at 800-726-8774 for an appointment. SC Legal Services (888-346-5592) provides free legal assistance to immigrants with complex immigration status questions, including help understanding whether the five-year bar applies to a specific situation.
SCDHHS uses the federal SAVE (Systematic Alien Verification for Entitlements) database to verify immigration status automatically. You do not need to bring your immigration documents to the county office; however, you must have them available if SCDHHS cannot verify your status through SAVE and contacts you for additional documentation. Processing typically takes up to 45 days, though applications for children may be processed more quickly. Retroactive coverage may be available for up to three months before the application date if the applicant was eligible during that period.
How to Appeal a Healthy Connections Denial
South Carolina Healthy Connections denial notices include the specific reason for the denial and the deadline to appeal. For most categories, the appeal must be filed within 30 days of the notice date. To request a fair hearing, submit a written request to SCDHHS (mailing address: SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101) or call 1-888-549-0820. You can also fax the request to 8888201204@fax.scdhhs.gov. During the appeal period, if you were receiving benefits before the adverse action, you may request continuation of benefits until the hearing decision is issued.
For immigration-related denials specifically, SC Appleseed Legal Justice Center (803-779-1113) and the SC Lowcountry Immigration Coalition provide free legal help with appeals. If the SCDHHS fair hearing upholds the denial, you may appeal to the Administrative Law Court (ALC) in Columbia within 30 days of the final agency order.
Frequently Asked Questions
Can undocumented immigrants get Medicaid in South Carolina?
Undocumented immigrants are not eligible for full Healthy Connections coverage in South Carolina. They are eligible only for Emergency Medicaid, which covers acute emergency medical conditions including labor and delivery. Emergency Medicaid is available at any SC hospital emergency room regardless of immigration status. To apply, present at the emergency room and the hospital will assist with the Emergency Medicaid application through SCDHHS.
How long do I have to wait as a green card holder before I can get Medicaid in South Carolina?
Lawful permanent residents (green card holders) must generally wait five years from the date their green card was issued before qualifying for full Healthy Connections coverage. The five-year clock starts when the I-551 (permanent resident card) is issued, not when you entered the United States. Exceptions include refugees, asylees, and other exempt categories who can qualify immediately. If you are an LPR parent with a child who was born in the U.S. (a U.S. citizen), the child qualifies for Healthy Connections without a waiting period.
Can my child qualify for Medicaid in South Carolina even if I am undocumented?
Yes. Children who are U.S. citizens (born in the U.S.) qualify for Healthy Connections regardless of their parents' immigration status. Lawfully residing immigrant children, even those within the five-year period, qualify under South Carolina's CHIPRA 214 option up to 208% FPL ($68,640 for a family of four in 2026). Only the child's own immigration status matters, not the parents'. Undocumented children are not eligible for full coverage but do qualify for Emergency Medicaid.
Does South Carolina cover immigrant pregnant women on Medicaid?
Yes. South Carolina covers lawfully residing pregnant women through Healthy Connections under the CHIPRA 214 option, with no five-year waiting period. The income limit is 194% FPL ($30,962 for one person, or approximately $53,001 for a family of three in 2026). Coverage includes prenatal care, labor and delivery, and 60 days postpartum. Emergency Medicaid covers labor and delivery for undocumented pregnant women regardless of income, as labor is considered an emergency condition under federal law.
I am a refugee. Do I qualify for Healthy Connections in South Carolina?
Yes, refugees are exempt from the five-year waiting bar and qualify immediately for Healthy Connections at the same income thresholds that apply to other residents. This exemption continues even if you later adjust to lawful permanent resident status. However, beginning October 1, 2026, federal law H.R.1 restricts federal Medicaid funding for refugees, which may affect coverage depending on how South Carolina implements the new rules. Contact SCDHHS at 1-888-549-0820 or SC Appleseed at 803-779-1113 for the most current information.
Is South Carolina a Medicaid expansion state?
No. South Carolina has not expanded Medicaid under the ACA as of 2026. Expansion states (40 states plus DC) cover adults up to 138% FPL regardless of whether they have children. South Carolina covers parents and caretaker relatives only up to 62% FPL ($9,895 for one person in 2026) and does not cover most childless adults. This means many low-income immigrants who would qualify in an expansion state do not qualify for full Healthy Connections in South Carolina, even after completing the five-year bar.
What changes to immigrant Medicaid eligibility are happening on October 1, 2026?
Federal law H.R.1 restricts federal Medicaid and CHIP funding to non-citizens effective October 1, 2026. After that date, only lawful permanent residents (after the five-year bar), Cuban and Haitian entrants, and COFA migrants retain federal Medicaid eligibility. Groups that previously had immediate access without the five-year bar, including refugees, asylees, VAWA survivors, and trafficking victims, will lose federally funded Medicaid coverage. South Carolina does not operate a state-only Medicaid program to fill this gap. Immigrants losing coverage will receive notice from SCDHHS. The CHIPRA 214 option covering lawfully residing children and pregnant women is preserved.
What does MAGI mean and what counts as income for South Carolina Healthy Connections?
MAGI stands for Modified Adjusted Gross Income. For Healthy Connections eligibility, income includes wages and salaries, self-employment net income, taxable Social Security benefits, unemployment compensation, alimony, and capital gains. Income that does NOT count includes child support received, SSI payments, certain veterans' benefits, and non-taxable Social Security benefits. For immigrant households with mixed-status members (some documented, some not), only the income of the eligible applicant and their tax household is counted. The IRS and Healthcare.gov both maintain MAGI definitions that Healthy Connections follows.
