Charleston Senior AdvisorBy Charleston Senior Advisor Care Team · October 7, 2026
In 2026 OSS pays a participating assisted living facility up to $1,719 a month for a resident whose net income is below $1,804. The resident's income goes to the facility first, OSS makes up the difference, the total is payment in full, and the resident keeps $85 or $105 a month for personal needs.
Why OSS matters around Charleston
Medicaid in South Carolina does not pay assisted living rent. For residents with very little income, the state's answer is Optional State Supplementation, a state-funded payment to a participating community residential care facility. Without it, many low-income older adults would have no path to assisted living at all.
OSS is not accepted everywhere. Only CRCFs enrolled with SCDHHS take it, and in the Charleston area those tend to be smaller residential homes rather than large communities.
The 2026 figures
| 2026 OSS figure | Amount |
|---|---|
| Most OSS will pay the facility each month | $1,719 |
| Resident's net income must be below | $1,804 |
| Personal needs allowance, SSI only | $85 a month |
| Personal needs allowance, other income | $105 a month |
Source: SCDHHS Medicaid Bulletin MB# 26-001, effective January 1, 2026.
These figures change every January with the Social Security cost-of-living adjustment and sometimes with state rate increases.
A worked example
Consider a resident whose only income is $1,200 a month in Social Security. She keeps a personal needs allowance of $105, since her income is not SSI alone. The remaining $1,095 goes to the facility. OSS then pays the difference between the resident's contribution and the total payment, so the facility receives about $1,719 in all, from her income and OSS combined.
| Line | Monthly amount |
|---|---|
| Social Security income | $1,200 |
| Kept as personal needs allowance | $105 |
| Paid by the resident to the facility | $1,095 |
| Paid by OSS (up to the total) | about $624 |
| Total the facility receives, as payment in full | about $1,719 |
This is a simplified illustration; SCDHHS calculates the actual payment from the resident's verified net income. The essential point is that the facility may not bill the resident or family extra for the room, board and care OSS covers.
What OSS does and does not include
OSS comes with full Healthy Connections Medicaid, which pays for doctor visits, prescriptions and other medical care. It does not pay for a private room upgrade a resident chooses, personal purchases, or services beyond what the facility provides under OSS. The personal needs allowance covers clothing, toiletries, haircuts and small items.
When income changes
OSS payments depend on the resident's verified net income, so changes matter. When Social Security rises each January, the resident's share rises too and the OSS portion falls, while the total payment to the facility follows the new maximum. A pension change, a new benefit or the sale of property must be reported to SCDHHS so the payment is recalculated.
Families sometimes worry that a small gift will disqualify a parent. Cash given to a resident can count as income, so it is safer to buy items directly, such as clothing or toiletries, than to hand over money.
Planning ahead for OSS
A resident who pays privately today may need OSS later. The simplest protection is to choose a building that participates in OSS from the start, so a move is not forced when savings run out. Ask the facility whether private-pay residents can convert to OSS in place, and whether OSS residents share rooms.
If a parent already lives in a building that does not take OSS, start the conversation early. A planned move to a participating home, made while there is still time to compare options, is far easier than an emergency move after the money is gone.
Common misunderstandings
OSS is sometimes confused with Medicaid paying for assisted living. Medicaid in South Carolina does not pay assisted living rent; OSS is a separate state payment, though recipients receive full Medicaid for medical care. It is also not a voucher a resident can take anywhere. Only participating CRCFs accept it.
Another misunderstanding is that a family can top up an OSS payment to secure a nicer room. Because the combined payment is payment in full for covered services, families should ask SCDHHS or the ombudsman before agreeing to any extra charge.
How to apply
Apply through SCDHHS's Healthy Connections application at apply.scdhhs.gov or by calling (888) 549-0820. The participating facility completes provider forms. The Trident Area Agency on Aging (843-554-2275) can help a family with the steps, and the long-term care ombudsman can help if a facility bills an OSS resident improperly.
More detail is on our OSS guide, and OSS vs. Community Choices explains the other program.
Frequently asked questions
What is the OSS income limit in 2026?
A resident's net income must be below $1,804 a month in 2026, under SCDHHS Medicaid Bulletin MB# 26-001. The figure changes each January.
Can a facility charge an OSS resident more?
Not for the room, board and care that OSS covers. The resident's contribution plus the OSS payment is payment in full for those services.
Does OSS come with Medicaid?
Yes. People who receive OSS also receive full Healthy Connections Medicaid for their medical care.
Which Charleston-area facilities accept OSS?
Only CRCFs enrolled with SCDHHS. Participation is more common among small residential homes. Ask each facility directly whether it participates and has an OSS bed open.
