Optional State Supplementation: South Carolina's help with assisted living

What is Optional State Supplementation in South Carolina?

Optional State Supplementation (OSS) is a state-funded program, run by the S.C. Department of Health and Human Services, that pays a participating community residential care facility on behalf of a low-income resident; the resident's own income goes toward the cost and OSS makes up the difference, and the total is payment in full.

OSS is how South Carolina helps people with very little income live in assisted living. Because the combined payment is payment in full, the facility may not bill the resident or family extra for the care and room and board that OSS covers, and rounding differences cannot be taken out of the resident's personal needs allowance. OSS recipients also receive full Healthy Connections Medicaid for their medical care.

What are the 2026 OSS income limit and payment amounts?

Effective January 1, 2026, the maximum OSS payment to a facility is $1,719 a month and the resident's net income limit is $1,804 a month, after the 2.8% Social Security and SSI cost-of-living increase (SCDHHS Medicaid Bulletin MB# 26-001).

Source: SCDHHS Medicaid Bulletin MB# 26-001 (January 8, 2026).

The figures rise with the annual cost-of-living adjustment and with occasional state rate increases; after the July 2023 increase the maximum payment was $1,645 and the income limit $1,724. Confirm current amounts with SCDHHS before relying on them, because the program's figures change every January.

How much spending money does an OSS resident keep?

In 2026 an OSS resident keeps a personal needs allowance of $85 a month if their only recurring income is SSI, or $105 a month if they have other income such as Social Security, and the facility must make sure the resident receives it.

The admission agreement must state the amount of the personal needs allowance and the date the resident receives it (Regulation 60-84, Section 901.A). The allowance pays for clothing, toiletries, haircuts, phone and small personal purchases. Families often supplement it informally with items rather than cash, because cash gifts can count as income for benefit purposes.

Do all Greenville assisted living facilities accept OSS?

No. Only CRCFs that enroll as OSS providers with SCDHHS accept OSS residents, and many larger private-pay communities in the Upstate do not, so families need to ask each facility directly whether it participates and whether it has an OSS bed open.

Smaller residential CRCFs are more likely to participate, because the OSS payment is far below the private-pay median of about $5,350 a month. A resident who moves into a private-pay building and later runs out of money may have to move unless that building participates. Ask about OSS on the first call, not after savings are gone.

How do we apply for OSS in South Carolina?

OSS eligibility is determined by SCDHHS, which also handles the Medicaid that comes with it; the resident applies through the state's Healthy Connections application (apply.scdhhs.gov, or the Member Contact Center at (888) 549-0820), and the participating facility completes provider forms such as the MSC004.

The applicant must meet the income limit and Medicaid's resource rules, and must need the level of care a CRCF provides. The Area Agency on Aging (Appalachian COG for Greenville, Anderson and Pickens; Upper Savannah COG for Laurens) can help a family through the steps. When income changes, the facility and family must report it to SCDHHS so the payment is recalculated.