South Carolina's Healthy Connections Medicaid program provides full health coverage for pregnant women who meet income and residency requirements, even though South Carolina has not expanded Medicaid under the Affordable Care Act. The pregnancy category operates under its own income threshold of 194% of the federal poverty level, which is far more generous than the standard adult Medicaid limit for parents in South Carolina (roughly 62% FPL) and well above the near-zero threshold for childless adults. In 2026, a pregnant woman living alone qualifies if her monthly income does not exceed $2,580, and that limit rises when the unborn child is counted as a household member.
Healthy Connections covers prenatal care from early pregnancy through delivery, labor and delivery services, and 12 full months of postpartum care for the mother. South Carolina also offers Presumptive Eligibility for Pregnancy, which allows qualified prenatal providers to grant temporary coverage while the full application is being processed, so prenatal care can begin immediately. This guide covers the 2026 income limits by household size, the step-by-step application process using the official Healthy Connections portal at apply.scdhhs.gov, documents you will need to gather, and what to do if your application is denied.
Quick Answer: Who Qualifies for Pregnancy Medicaid in South Carolina (2026)
Yes. Pregnant women in South Carolina qualify for Healthy Connections Medicaid if household income is at or below 194% of the federal poverty level. In 2026 that equals $2,580 per month for a single person. Because the unborn child counts as a household member, a pregnant woman living alone is evaluated as a two-person household, raising her limit to $3,498 per month. No asset test applies.
Healthy Connections Pregnancy Coverage: What Is Included
Healthy Connections provides the full scope of Medicaid-covered services during pregnancy, which under federal rules must include all medically necessary prenatal and obstetric care. Covered services include prenatal office visits from first trimester through delivery, laboratory tests and ultrasounds ordered by the obstetrician or midwife, prescription medications needed during pregnancy, mental health and substance use disorder treatment, dental care (preventive and emergency), vision care, and inpatient hospital services for labor and delivery.
South Carolina extended its postpartum coverage period from 60 days to 12 full months effective April 2022, following a CMS approval under the American Rescue Plan Act. The extension runs through at least March 2027. Mothers who qualify for Healthy Connections during pregnancy will receive continuous full-benefit Medicaid coverage for 12 months after delivery, even if their income rises above the pregnancy threshold during that period. The newborn is automatically enrolled in Healthy Connections for the first year of life.
Healthy Connections Pregnancy Income Limits by Household Size 2026
South Carolina sets the Healthy Connections pregnancy income limit at 194% of the 2026 federal poverty level. The table above shows exact monthly and annual limits for household sizes one through eight, plus the per-person increment for larger households. The unborn child is counted as a household member under MAGI (Modified Adjusted Gross Income) rules, which is the income-counting method South Carolina uses for the pregnancy category. This means a pregnant woman who lives with no other adults is counted as a household of two, moving her to the second row of the table.
Household composition is determined by who lives with the pregnant woman and their tax-filing relationship, following MAGI household rules. Spouses and children living in the home are counted. Roommates who file taxes separately and have no other legal relationship to the applicant are generally not counted. When in doubt, list everyone in the home and let SCDHHS apply the correct MAGI counting rules.
How to Apply for Healthy Connections Pregnancy Medicaid in South Carolina
South Carolina processes Healthy Connections applications through apply.scdhhs.gov, the official online portal of the South Carolina Department of Health and Human Services. Applications can also be submitted by phone at 1-888-549-0820 (Monday through Friday, 8 a.m. to 6 p.m. EST), by mail to SCDHHS, or in person at a local DSS (Department of Social Services) office. The online portal is the fastest option and allows document uploads directly into the application.
Healthy Connections has no enrollment window. Pregnant women can apply any day of the year. Applying as early as possible in the pregnancy maximizes coverage for first-trimester prenatal visits, which include critical screenings for gestational diabetes, anemia, genetic conditions, and sexually transmitted infections. South Carolina also offers Presumptive Eligibility for Pregnancy (PEP): a qualified prenatal provider can authorize temporary Medicaid coverage on the spot while the full application is pending, so care does not have to wait 45 days.
Documents Needed to Apply for Healthy Connections Pregnancy Medicaid
South Carolina uses electronic data matches for many verifications (Social Security Administration, state wage records, IRS), so not every document listed below may need to be submitted manually. SCDHHS will tell you in the application what they could not verify electronically and request only those documents. Having everything ready speeds up the process.
- Proof of identity: South Carolina driver's license, state ID card, U.S. passport, or birth certificate
- Proof of South Carolina residency: utility bill, lease agreement, mortgage statement, or bank statement with current SC address dated within 60 days
- Social Security numbers for all household members, or a document showing an SSN has been applied for
- Proof of pregnancy: a signed letter or form from a physician, nurse practitioner, or certified nurse midwife confirming the pregnancy and expected due date
- Income documentation: last four pay stubs for each employed household member, most recent federal tax return (Form 1040), W-2 or 1099 forms, award letters for Social Security, SSI, or other benefit income
- Immigration documents if applicable: Permanent Resident Card (green card), visa, Employment Authorization Document, or refugee/asylee documentation
Is South Carolina a Medicaid Expansion State?
South Carolina has not expanded Medicaid under the Affordable Care Act. As of June 2026, South Carolina is one of 10 states that have not adopted expansion. The 40 expansion states and Washington DC cover adults up to 138% FPL without a categorical requirement (no need to be pregnant, disabled, or a parent). South Carolina covers non-pregnant adults only under very narrow categories: parents with children up to roughly 62% FPL, people with serious disabilities who meet SSI-level requirements, and seniors needing long-term care.
The coverage gap in South Carolina is real and affects an estimated 65,000 to 100,000 adults. A single adult without children who earns between roughly $0 and $15,960 per year (100% FPL in 2026) falls into the gap: too low an income for marketplace subsidies through HealthCare.gov (which start at 100% FPL) and not qualifying for Medicaid under traditional categories. Pregnant women are a major exception: the 194% FPL pregnancy threshold puts them well above this gap and well above the 138% FPL expansion threshold, so pregnancy triggers coverage that otherwise would not exist in a non-expansion state.
Common Reasons Healthy Connections Pregnancy Applications Are Denied
South Carolina denies Healthy Connections pregnancy applications most often for income and documentation reasons. The most common denial is that household income exceeds 194% FPL, sometimes because the household size was underreported. The second most common cause is failure to provide required documentation within the deadline SCDHHS sets in a pend notice. Immigration status is the third most frequent barrier: undocumented individuals do not qualify for full Healthy Connections coverage, though emergency Medicaid covers labor and delivery in South Carolina regardless of immigration status.
- Income above 194% FPL for the reported household size: verify the household count, ensuring the unborn child is included
- Missing documentation: income proof, proof of pregnancy, or residency documents not submitted by the pend deadline (usually 10 to 30 days)
- Residency not verified: applicant cannot document a current South Carolina address
- Immigration status: individuals without qualified-alien immigration status are not eligible for full benefits (emergency Medicaid covers labor and delivery only)
- Duplicate active Medicaid case in South Carolina or another state: applicant must close the prior case or the new application will be rejected
How to Appeal a Healthy Connections Denial in South Carolina
South Carolina Medicaid applicants who receive a denial or adverse action notice have the right to appeal. The denial notice will include the specific reason for the denial and the deadline to request a hearing. South Carolina allows 30 days from the date of the notice to file a fair-hearing request. During the appeal, applicants who were already receiving benefits can request continuation of benefits while the hearing is pending, which means coverage continues until the hearing decision is issued.
To request a fair hearing, call the SCDHHS Appeals Line at 1-888-549-0820 or submit a written request to SCDHHS, PO Box 8206, Columbia, SC 29202. A legal aid organization or a patient advocate at your prenatal clinic can help you prepare for the hearing. South Carolina Legal Services (sclegal.org) provides free legal assistance for Medicaid appeals to qualifying low-income residents.
Healthy Connections Background: South Carolina's Medicaid Program
Healthy Connections is the official name for South Carolina's Medicaid program, administered by the South Carolina Department of Health and Human Services (SCDHHS). The program serves about 1.5 million South Carolinians including children, pregnant women, parents, seniors, and people with disabilities. For most enrollees, Healthy Connections delivers benefits through managed care organizations (MCOs) such as Molina Healthcare of South Carolina, Healthy Blue, and BlueChoice HealthPlan. Enrollees choose an MCO and receive all their Medicaid services through that plan's provider network.
South Carolina's pregnancy Medicaid category has historically provided one of the higher income thresholds in the non-expansion South, at 194% FPL. This exceeds the federal minimum for pregnancy coverage (133% FPL) by a meaningful margin and is higher than the pregnancy threshold in neighboring non-expansion states Alabama (146% FPL) and Georgia (220% FPL). The postpartum extension to 12 months, approved by CMS in April 2022, significantly improved maternal health continuity for South Carolina mothers who previously lost Medicaid coverage just 60 days after delivery.
Frequently Asked Questions
What is the income limit for pregnancy Medicaid in South Carolina in 2026?
The income limit for Healthy Connections pregnancy Medicaid in South Carolina is 194% of the federal poverty level. In 2026 that equals $2,580 per month ($30,962 per year) for a household of one. Because the unborn child counts as a household member, a pregnant woman who otherwise lives alone is evaluated as a household of two, raising her limit to $3,498 per month ($41,982 per year). For a household of four, the limit is $5,335 per month ($64,020 per year).
Does South Carolina count the unborn baby in household size for Medicaid?
Yes. Under MAGI (Modified Adjusted Gross Income) rules, which South Carolina uses for pregnancy Medicaid, the unborn child is counted as a household member. This raises the applicable income limit by one row in the income table. A pregnant woman living alone is therefore evaluated as a household of two, not one. This can meaningfully increase the income limit and determine eligibility for higher-income applicants.
How long does South Carolina Medicaid cover a mother after giving birth?
South Carolina extends Healthy Connections Medicaid coverage to 12 full months after delivery. This policy became effective April 2022 after CMS approval under the American Rescue Plan Act and runs through at least March 2027. Mothers maintain full-benefit Medicaid coverage for 12 months postpartum even if their income rises above the pregnancy threshold. The newborn is automatically enrolled in Healthy Connections for the first year of life.
What does Healthy Connections cover during pregnancy?
Healthy Connections covers the full scope of medically necessary prenatal and obstetric services, including all prenatal office visits, laboratory tests, ultrasounds, prescription medications, mental health and substance use disorder treatment, dental care (preventive and emergency), vision care, and inpatient hospital services for labor and delivery. There are no copays or deductibles for pregnancy-related services. Covered services continue for 12 months postpartum for the mother.
Is South Carolina a Medicaid expansion state?
No. As of June 2026, South Carolina has not expanded Medicaid under the ACA. South Carolina is one of 10 remaining non-expansion states. Adults without dependent children face very low income thresholds for traditional Medicaid eligibility. However, the pregnancy category at 194% FPL is entirely separate from expansion status and applies regardless of whether the state has expanded. Pregnant women in South Carolina have access to Healthy Connections coverage that non-pregnant low-income adults do not.
Can I get Medicaid if I am undocumented and pregnant in South Carolina?
Full Healthy Connections Medicaid is not available to undocumented individuals. However, emergency Medicaid (federally funded) covers labor and delivery services in South Carolina regardless of immigration status when the mother would otherwise meet the income eligibility criteria. Prenatal care before delivery is not covered under emergency Medicaid for undocumented individuals. Lawful Permanent Residents and other qualified-alien immigrants who meet income requirements can apply for full Healthy Connections coverage.
How do I apply for Healthy Connections pregnancy Medicaid in South Carolina?
Apply online at apply.scdhhs.gov, which is the official SCDHHS portal. You can also apply by phone at 1-888-549-0820 (Monday through Friday, 8 a.m. to 6 p.m. EST) or in person at a local Department of Social Services office. Healthy Connections has no enrollment window; apply as soon as pregnancy is confirmed. South Carolina also offers Presumptive Eligibility for Pregnancy, which allows a qualified prenatal provider to authorize temporary coverage immediately while the full application is reviewed.
What happens if I earn slightly above the income limit during pregnancy?
If your income is close to the 194% FPL limit, recheck the household size calculation. The unborn child must be included, which raises the income limit by one household-size row. If income still exceeds the limit after the correct count, you may qualify for a subsidized plan on the ACA marketplace through HealthCare.gov. In 2026, household income between 100% and 400% FPL may qualify for premium tax credits. Contact a certified application counselor at sc.gov for personalized guidance.
