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

What is Optional State Supplementation?

OSS is a state-funded program, administered by the S.C. Department of Health and Human Services, that pays a participating community residential care facility on behalf of a resident with low income; the resident's own income goes toward the bill, OSS covers the rest up to a set maximum, and that combined amount is payment in full.

Payment in full means the facility may not charge the resident or family extra for the room, board and care that OSS covers, and it may not take rounding differences out of the resident's personal needs allowance. People receiving OSS also get full Healthy Connections Medicaid for their medical care.

What are the 2026 OSS figures?

Starting January 1, 2026, OSS pays a facility up to $1,719 a month and covers residents whose net income is under $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 move every January with the cost-of-living adjustment and occasionally with state rate increases; after the July 2023 increase the maximum payment was $1,645 and the income limit $1,724. Check the current bulletin before making plans around a specific number.

How much does an OSS resident keep for personal spending?

In 2026 the personal needs allowance is $85 a month for a resident whose only regular income is SSI and $105 a month for a resident with other income such as Social Security, and the facility must see that the resident receives it.

The admission agreement must state the allowance and the date it is paid (Regulation 60-84, Section 901.A). It covers clothing, toiletries, haircuts, phone service and small purchases. Relatives who want to help often buy items directly rather than giving cash, since cash can count as income for benefit purposes.

Do Charleston-area assisted living facilities accept OSS?

Only those enrolled as OSS providers with SCDHHS, and many of the larger private-pay communities around Charleston are not, so ask each building directly whether it participates and whether an OSS bed is open.

Participation is more common among small residential homes, because the OSS payment sits far below the statewide private-pay median of about $5,350 a month. The tri-county area has a large cluster of small licensed homes in North Charleston; our North Charleston page lists them. A resident who moves into a non-participating building and later runs out of money may have to move, so raise OSS on the first phone call.

How does a Lowcountry family apply for OSS?

SCDHHS decides eligibility, together with the Medicaid that comes with OSS; the resident applies through Healthy Connections (apply.scdhhs.gov, or the Member Contact Center at (888) 549-0820), and the participating facility completes its provider forms, such as the MSC004.

The applicant must meet the income limit and Medicaid's resource rules and need the level of care a CRCF provides. The Trident Area Agency on Aging (843-554-2275) can walk a family through the steps. Any change in income must be reported to SCDHHS so the payment is recalculated.