What is Medicaid?
Medicaid is South Carolina’s aid program by which the federal and state governments share the cost of providing medical care for people who meet certain eligibility criteria. The Medicaid program is administered by the South Carolina Department of Health & Human Services (SCDHHS). To learn more about eligibility, how to apply and to access forms and applications, visit the SCDHHS website and select the “Getting Medicaid” tab. Then select from the drop down menu.
To apply online from the SC DHHS homepage, visit this Apply for South Carolina Medicaid webpage.
To learn more about how Family Connection can help, call our Family Information Center at 1-800-578-8750.
Medicaid Eligibility Categories
*This is a partial listing. Visit SCDHHS’ Getting Start page for a full listing.
Partners for Healthy Children is for children under age 19 in families with low incomes. Coverage is reviewed and renewed annually.
TEFRA/Katie Beckett is a category of eligibility for Medicaid coverage for children under age 19 who meet the Supplemental Security Income (SSI) childhood disability definition and level of care and can be provided care at home more economically than in a hospital or community home. This eligibility is based on the child’s income and resources, not family income.
Aged, Blind and Disabled (ABD) is an eligibility category for individuals age 65 or older who are blind or disabled and have low income.
Supplemental Security Income (SSI) pays benefits to children and adults who are blind or disabled and have limited income and resources. If determined eligible for SSI, the child or adult will be automatically eligible for Medicaid.
Choosing a Medicaid Health Plan
Healthy Connections Choices –the health plan selection website for South Carolina Healthy Connections Choices. South Carolina Healthy Connections Choices is a program that helps eligible Medicaid members enroll in health plans. Here you can:
• Choose a health plan and doctor.
• Review and update your information.
• Compare health plans.
• Find a doctor.
• Watch video clips and find materials that help you choose a health plan and doctor.
• Find meetings in your area to learn more about the health plans.
Autism Services Changes
There are exciting changes coming to how autism services are covered for Medicaid eligible individuals in South Carolina.
Coverage for Autism related services are being moved to be a part of the State Plan. This means services like Applied Behavior Analysis (ABA) will be covered under the State Plan instead of under the Pervasive Development Disorder (PDD) Waiver. While there is not a set deadline for having these services moved to the State Plan, SCDHHS is working diligently to complete this process as quickly as possible.
South Carolina Department of Health and Human Services (SCDHHS), the agency that runs Medicaid in South Carolina, is working to develop a policy on what services will be covered under the State Plan and what information is needed for the services to be approved.
For those currently receiving services through the PDD Waiver please continue to do so as long as the child is eligible for these services. We do not anticipate these changes will cause a disruption in services for your child.
For children enrolled in Medicaid and on the waiting list for the PDD Waiver, your child may be able to receive Medicaid covered services sooner than expected because of these changes.
For those who are enrolled in Medicaid, have already received services through the PDD Waiver and have moved off of the waiver, your child may be allowed to receive Medicaid covered ABA or similar services again thanks to these changes.
Healthy Connections Medicaid offers a Health Insurance Premium Payment Program (HIPP) that may qualify your family for subsidized insurance premium payments if retain your private insurance. For more information, please contact the HIPP office at: (803) 264-6847 or visit this HIPP webpage.
Please keep in mind that services such as speech, occupational and physical therapy are already covered under the State Plan when appropriate for those enrolled in Medicaid and do not require the child to be enrolled in the PDD Waiver.
If you have questions about what to do while SCDHHS is creating this policy, please contact our Family Connection’s Healthcare Connection Program at 1-800-578-8750.
Other SCDHHS Programs for Families Enrolled in Medicaid
Health Insurance Premium Payment (HIPP) Program
The HIPP Program was created to assist families of Medicaid beneficiaries with the cost of health insurance that covers the client. The goal is to help beneficiaries maintain their private insurance to ensure Medicaid payment as a last resort. Private plans pay first for medical services and Medicaid is secondary. A program brochure, questions and answers , and the referral form are available on the website. The referral form must be printed, completed and submitted to the address on the form.