South Carolina Medicaid Look-Back Period

How the transfer penalty is calculated

The state manual directs SCDHHS to calculate the penalty using the most current average private-pay nursing-facility rate, rather than a rate from the date of transfer. It also says there is no maximum penalty period. The public manual contains older rate examples, but this research did not locate a verified state-published 2026 statewide penalty divisor. An older figure should not be presented as the current 2026 rate (SCDHHS MPPM Chapter 304).

That absence has a concrete planning consequence: the family should ask SCDHHS for the divisor that applies to the application and penalty calculation instead of estimating it from another state’s rate or a historical South Carolina example. A transfer penalty can create a period in which the person is otherwise eligible but Medicaid does not pay the long-term-care cost the family expected.

Transfers and home planning overlap

A proposed deed can raise both transfer-penalty and title questions. South Carolina’s current code provides a transfer-on-death designation for specified titled personal property, not a statutory real-property TOD deed. A proposed real-property TOD measure and a separate enhanced-life-estate measure have been introduced as bills, but those bills are not enacted law. A family should therefore not assume a commonly named deed from another state is available or penalty-free in South Carolina (South Carolina TOD designation law; S. 49 bill text; H. 4264 bill text).

An exception, hardship claim, or return of property can be highly fact specific. Nothing about the five-year review makes a late transfer automatically prohibited; it does mean that its value, timing, documentation, and applicable exception must be analyzed before the family relies on Medicaid payment.