Optional State Supplementation in 2026: A Worked Example

What is OSS, in one paragraph?

Optional State Supplementation is South Carolina's way of making assisted living possible for people with very little income. SCDHHS pays a participating community residential care facility on the resident's behalf. The resident contributes their own income, keeps a small personal needs allowance, and OSS makes up the rest of the facility's payment up to a set maximum. The combined amount is payment in full for care and room and board, so the facility may not charge the family extra for what OSS covers. OSS recipients also receive full Healthy Connections Medicaid for medical care.

What are the 2026 numbers?

SCDHHS Medicaid Bulletin MB# 26-001 set the figures effective January 1, 2026, after the 2.8% Social Security and SSI cost-of-living adjustment:

For comparison, after the July 2023 rate increase the maximum payment was $1,645 and the income limit $1,724. The figures move every January, so confirm them before planning.

How does the money flow? Two examples

Consider a widowed mother in Anderson whose only income is SSI. Her SSI is under the $1,804 limit, so she qualifies on income. She keeps an $85 personal needs allowance each month for toiletries, clothing and small purchases. The rest of her SSI goes to the facility, and OSS pays the facility the balance so that the facility receives the full payment SCDHHS has set. She pays nothing else for her room, meals and care.

Now consider a retired mill worker in Easley with a small Social Security check and a tiny pension, together just under the limit. Because he has income other than SSI, his personal needs allowance is $105. His remaining income goes to the facility, OSS pays the difference, and again the total is payment in full. If his income rises above the limit, for example because of a pension adjustment, he no longer qualifies, which is why income changes must be reported to SCDHHS promptly.

In both cases the facility's private-pay rate is irrelevant. That is exactly why many communities whose private rates sit near South Carolina's $5,350 monthly median choose not to participate.

Which facilities take OSS?

Participation is a choice each CRCF makes by enrolling with SCDHHS, and neither DPH's licensing data nor any public list we could find shows which Upstate CRCFs currently participate. Smaller residential CRCFs are more likely to; large purpose-built communities often are not. The only reliable way to know is to ask each facility, and to ask whether it has an OSS bed open now.

If a parent is paying privately today but may need OSS within a few years, the most important question to ask on a tour is what happens when a private-pay resident's money runs out. A building that does not participate has no obligation to keep that resident.

Common misunderstandings about OSS

Families sometimes assume OSS is a check paid to the resident that can be used anywhere. It is not; it is paid to a participating CRCF and covers that facility's charges. Others assume any assisted living facility must accept it once a resident qualifies; participation is voluntary. A third misunderstanding is that OSS covers nursing homes. It does not; long-term nursing home care is paid by Healthy Connections Medicaid under different rules.

Finally, OSS has a resource test as well as an income test, following Medicaid's rules, so savings above the limit must be spent down on allowed items first. An elder law attorney or the Area Agency on Aging can explain what counts.

How does someone apply?

OSS eligibility is determined by SCDHHS along with the Medicaid that comes with it. The resident applies through Healthy Connections at apply.scdhhs.gov or by calling the Member Contact Center at (888) 549-0820, and the participating facility completes provider forms. The Appalachian Council of Governments Area Agency on Aging (864-242-9733) for Greenville, Anderson and Pickens counties, and Upper Savannah COG for Laurens County, can walk a family through the steps.

OSS is different from the Community Choices waiver, which pays for services for people at nursing facility level of care and, in a CRCF, covers care but not rent. Some residents need one, some the other.