S.C. Code Ann. Regs. 114-1520 – Eligibility Determination.

A. A medical evaluation must be supplied as evidence of disability. It is the responsibility of the applicant to provide any required medical evaluation(s) on the agency-supplied forms. Additional medical data may be supplied in any form and will be considered by the Agency. If the evaluation shows that the individual is either totally and permanently disabled or is not disabled, the application for GDA shall be denied by the County Department.
B. In all other cases, eligibility decisions based on medical information shall be made by a Medical Social Worker, with the assistance of a consulting physician when necessary. The medical evaluation, along with a social evaluation completed by the County Department and containing information relating to the family, background, work history, and past and present health of the applicant, as well as rehabilitation efforts, will be evaluated by the Medical Social Worker to determine if the individual is medically eligible, and if so, for how many months.
C. If a disability exists but is expected to last longer than six months, the individual shall be referred to the Social Security Administration (SSA) to apply for the SSI program.
D. Eligibility for GDA shall not be extended beyond six months for any one medical diagnosis. A new and different diagnosis, however, may qualify an individual for a new grant. A new application will be necessary in case of a new and different diagnosis of disability.
E. To be considered eligible for GDA, an individual can have no cash reserve or any other resources except the following:
1. (1) An individual may own or retain a homestead,
2. (2) An individual may have insurance policies with a face value of any amount, but the total cash surrender or loan value shall not exceed fifteen hundred dollars for all policies.
3. (3) An individual may have one licensed vehicle that is used for transportation purposes and is not income producing.
4. (4) An individual may have up to 2 times the maximum monthly payment level for the GDA Program in cash reserves.
F. If an individual sells real or personal property, the money from the sale shall be considered as income for meeting current living expenses. If an individual transfers real or personal property without receiving fair market value therefor, he will not be eligible for GDA until such time as fair market value is received and used for current living expenses.
G. Any income from employment shall render an individual ineligible for GDA. The spouse of the individual may have income from employment. If the spouse is included in the budgetary computation, the spouse’s gross wages shall be considered as available income.
H. For purposes of budgeting, an individual and spouse who are living together shall be treated as a unit, except as follows:
1. (1) If the spouse is receiving SSI or Aid to Families with Dependent Children (AFDC), the spouse is not included in the GDA budget and any income which has been considered by SSA in determining the SSI payment amount or which has been considered in determining the AFDC payment amount shall not be considered available to the GDA applicant or recipient.
2. (2) If the spouse has children of which the GDA applicant or recipient is not the legal parent and the children are not eligible for SSI or AFDC, the spouse’s income shall be allocated to the children according to current AFDC standards. Any income of the children shall be subtracted from the AFDC standard in determining the amount to be allocated from the parent.
3. (3) If both members of the couple apply for and are found eligible for GDA, a budget is computed for the couple to determine if a deficit exists. If so, each person may be certified for a payment equal to one-half the deficit, not to exceed the maximum payment level per individual.
I. Total needs consist of an allowance for basic requirements and of allowances for special needs, if applicable.
1. (1) Basic requirements are items of need considered essential to all people in the assistance budget. Allowances are included for food, clothing, medical chest, incidentals, household needs, laundry, insurance, shelter, and utilities. The basic requirements allowance for an individual is ninety-four dollars and fifty-five cents per month and the basic requirement allowance for an individual and spouse is one hundred forty-three dollars and eighty cents per month.
2. (2) Allowances for the following special needs may be included if verification is provided by an individual’s physician that the special need currently exists.
  1. (a) A standard allowance of six dollars per month for a special diet will be included for each person with tuberculosis or an arrested tubercular case who still requires medication for the illness.
  2. (b) An allowance of up to one hundred thirty dollars per month will be included for nursing care in the home if medical necessity is verified and documented and if the care cannot be provided by responsible relatives in the home.
J. Total income for eligibility purposes means total gross income.
If any person in a GDA budget receives income from the sources specified in 114-11-50 B, such income shall be disregarded in the same manner as in the AFDC program. Income received on a weekly basis shall be multiplied by four and one-third to obtain the monthly amount. Irregular unearned income as defined in 114-11-50(A)(2)(b) shall be computed in the same manner as in the AFDC program.
K. Amount of assistance to be granted shall be determined by subtracting total rounded income from total rounded needs. The award will be the amount of the deficit, but may not exceed the maximum payment level.
L. Maximum payment level for GDA shall be set by the agency each year according to funds available from the State General Appropriation Act.
M. An individual who is determined eligible for a GDA money payment shall be eligible for State Medical Assistance beginning with the first day of the month of certification for GDA payment. There shall be no eligibility for medical services performed before this date for GDA clients.
N. Institutional Living Situations.
1. (1) An individual who needs or desires to live in a public or private institution may be eligible for GDA and medical vendor payments, depending on the nature of the institution and whether the individual is otherwise eligible for GDA.
2. (2) To be eligible for GDA while living in an institution, the individual must be in a public or private Title XIX certified hospital or nursing facility or a licensed residential care facility.
3. (3) An individual shall not be eligible for GDA while a patient in or resident of a public or private medical institution which is not Title XIX certified or which is operated primarily for the care of mentally ill or tubercular patients.
4. (4) The need for nursing care must be certified by the Professional Standards Review Organization (PSRO) before medical vendor payment can be authorized.
5. (5) The institution in which the individual is living must be licensed by the appropriate State licensing authority.
6. (6) If the individual is a patient in a public or private hospital, financial eligibility shall be determined according to the individual’s home situation.
7. (7) An individual who resides in a licensed nursing facility shall be allowed a personal needs allowance, the amount of which is set annually by the agency.
  1. (a) If the individual has income it shall be subtracted from the personal needs allowance in determining the amount of the GDA payment. If the income exceeds the personal needs amount, a budget shall be computed to see if the individual would be eligible in his or her home situation. If so, the individual shall be eligible for GDA-Medical Assistance Only.
  2. (b) Any income the individual has in excess of the personal needs allowance shall be applied to his or her cost of care.
8. (8) A GDA-eligible individual who resides in a licensed residential care facility shall have financial eligibility established according to the Net Income Limitation (NIL) as defined in 114-19-10(C) for the Optional Supplementation Program. The NIL is set by the State General Appropriation Act.
  1. (a) All income available to the individual shall be budgeted against total requirements in determining the GDA payment.
  2. (b) The payment amount will be the exact amount of the deficit.