Healthcare Coverage

Where do I look for help with healthcare?

Various programs may provide assistance depending on the situation. Several state programs may be able to provide services based on area of need. Grant opportunities can help pay for care not included in state programs and not covered by insurance. The programs listed here may provide health care assistance, either by providing health care or through financial assistance.

doctor sits with young patient

State Programs

BabyNet is South Carolina’s early intervention system for infants and toddlers under three years of age with developmental delays or conditions associated with developmental delays. BabyNet services are provided at no cost to the family.

Continuum of Care provides intensive case management to assist children with severe emotional disturbance, their families and agency providers in developing an individualized plan of service for a child eligible through a formal selection process.
p. (803) 734-4500

SC Department of Disabilities and Special Needs (DDSN) serves individuals with intellectual disabilities, autism, head and spinal cord injuries and conditions related to these disabilities. Services are delivered through local county Disabilities and Special Needs (DSN) Boards. DDSN also provides early intervention services to children birth to age six years of age.
p. (803) 898-9600 or 1(888) 376-4636

SC Department of Health and Environmental Control
Select from a variety of health related resources available through DHEC, including services related specifically to Children and Adolescents. Services include information and referrals, care coordination and financial assistance from DHEC.
p. (803) 898-0784

SC Department of Mental Health (DMH) provides a full range of community and inpatient services to people of all ages who are affected by serious mental illness and significant emotional disorders. These services are provided through a network of 17 community mental health centers that serve the state’s 46 counties.
p. (803) 898-8581

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). Healthy Connections is South Carolina’s Medicaid program. It is a medical assistance program that helps pay for some or all medical bills for eligible candidates who cannot afford medical care. Eligibility is usually based on applicants’ income and assets. Healthy Connections is administered by the South Carolina Department of Health and Human Services (SCDHHS). It is not affiliated with Family Connection of South Carolina.

Medicaid Eligibility Categories

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.

Partners for Healthy Children is for children under age 19 in families with low incomes. Coverage is reviewed and renewed annually.

Aged, Blind and Disabled (ABD) is an eligibility category for individuals age 65 or older, blind, or living with a disability.

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.
Phone: 1(800)772-1213

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.

1-877-552-4642

TTY: 1-877-552-4670

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.

Other SCDHHHS 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.

Medicaid Waivers

What is a Medicaid Waiver?
Waivers are used to supplement services provided through the South Carolina Medicaid plan. In South Carolina, there are nine waiver programs through the South Carolina Department of Health and Human Services (SCDHHS). Three state agencies are responsible for operating the waivers. Each waiver provides different services and has different eligibility criteria. Call our Healthcare Connection Coordinators at 1-800-578-8750 for details.

To view a summary of the waivers in South Carolina, visit this Home and Community Based Waiver Summary Chart (PDF).(Note: This document has been provided to Family Connection of SC from SCDHHS. If you need access to this document in a format that is not available, please contact us via email).

Community Long Term Care (CLTC) operates home and community-based waiver programs for people eligible for nursing home care but who prefer to receive their services in the community.

Medically Complex Children’s Waiver (MCC) is a statewide program to serve children from birth to age 18 who meet either Nursing Facility or Intermediate Care Facility-Intellectually Disabled level of care and medical criteria.

South Carolina Department of Disabilities and Special Needs (DDSN) provides home and community-based waiver services. From this DDSN webpage, click on the links for more information on waivers provided by DDSN. Each link also will give you information on how to obtain each waiver.

Private Health Insurance

Private health insurance is coverage through an employer or that’s purchased by an individual from a private health insurance company. With the Affordable Care Act, the Health Insurance Marketplace (also known as the Health Insurance Exchange) is available to purchase insurance. 

Have questions about private insurance or the Health Insurance Marketplace? Please call the Family Information Center at 1-800-578-8750.

Children’s Specialized Hospital –Health Insurance Education
Information on health insurance is provided here to ensure you have the information and resources needed to select the best health plan for your family.

Healthcare.gov
This official site of the Affordable Care Act provides health coverage choices, ways to save and how the law affects you. You can also enroll in health coverage.

South Carolina Health Insurance Pool (SCHIP)
The South Carolina Health Insurance Pool (SCHIP) was created by the South Carolina General Assembly by Act 127 of 1989 to make health insurance coverage available to residents of South Carolina who are either unable to obtain health insurance because of a medical condition or whose premium for health coverage exceeds 150% of the pool rate.

SCHIP is a safety net mechanism for accessing health insurance or Medicare Supplement insurance that is funded by the premiums paid by those enrolled in SCHIP coverage and through assessments against insurance companies and HMOs that write health insurance in South Carolina. It is governed by a board of directors and Chapter 74 of Title 38 of the South Carolina Code of Laws. 

Other Healthcare Assistance

Other Opportunities

Please note these organizations are not endorsed by Family Connection of South Carolina. These are opportunities that we have been made aware of that we make available to families to determine what is a best fit for a family and its circumstances.

IMPACT is a project of national Family Voices and promotes a holistic approach to health and wellness for all families and children including those with special healthcare needs and disabilities. It also promotes health and wellness by developing materials and tools and sharing other resources that help families learn skills to build healthy relationships, healthy families and healthy communities.

NeedyMeds is a national nonprofit information resource dedicated to helping people locate assistance programs to help them afford their medications and other healthcare costs.

Partnership for Prescription Assistance helps qualifying patients without prescription drug coverage get the medicines they need for free or nearly free.

Pfizer RXPathways connects eligible patients to a range of assistance programs that offer insurance support, co-pay help and medicines for free or at a savings. Enter the name of the medicine you’ve been prescribed. You can search one medicine at a time. Then answer a few questions to see which available program(s) may be right for you.

RX Outreach is a nonprofit pharmacy committed to helping people get the medications they need at an affordable price.

United Healthcare Children’s Foundation is a nonprofit charity dedicated to facilitating access to medical-related services that have the potential to significantly enhance either the clinical condition or the quality of life of the child and that are not fully covered by the available commercial health benefit plan. This “support” is in the form of a medical grant to be used for medical services not covered or not completely covered by commercial health benefit plans. Visit the United Healthcare Children’s Foundation website to read more about the grants and how to apply.

Welvista is a unique private-public partnership of non-governmental healthcare intervention that, since 1993, has helped thousands of uninsured residents in South Carolina.

Care Providers

Community Health Centers are community-based, nonprofit organizations that provide comprehensive, high-quality, patient-focused health care services in a culturally appropriate manner. With a focus on primary care, prevention, education and case management, health centers accept most health insurance plans, including Medicare and Medicaid. For those patients without insurance, services are provided on a sliding fee scale based on the patient’s income.

Hands of Hope Pediatric Palliative Care focuses on children, prenatal to age 21, with complex or serious conditions and their families, enhancing quality of life in partnership with the existing care team. Hands of Hope Pediatric Comfort and Palliative Care is provided by the only nationally board certified interdisciplinary team available to serve any child living in or visiting South Carolina.

RiteCare Scottish Rite Childhood Language Program provides provides professional speech and language therapy to children with speech and language disorders.

Shriners Hospitals for Children– Greenville is a pediatric hospital providing comprehensive care to children with orthopedic and neuromusculoskeletal disorders and diseases.