Healthy Connections: The SC Medicaid Program

On a National level, the Medicaid program covers more people than you may realize. While the program is federally regulated, states have the power to add additional benefits and create their own state-wide version of the Medicaid system. In South Carolina, this is called “Healthy Connections.”

Almost 20% of the South Carolina population is enrolled in Healthy Connections. That includes one out of every eight adults, two out of every five children, and two out of every five disabled people. Are you eligible?

What You Should Know about SC Medicaid Includes:

• South Carolina Medicaid Eligibility Requirements
• How to Apply for South Carolina Medicaid
• What does SC Medicaid Cover?
• Healthy Connections Prime
• South Carolina Medicaid and Medicare Assistance

South Carolina Medicaid Eligibility Requirements

Medicaid eligibility is not always black and white. The Healthy Connections program includes several categories of eligibility: Aged and blind or disabled, breast and cervical cancer, disabled children, family planning, former foster care, nursing home residents, medically needy, parents and caretaker relatives, partners for healthy children, pregnant women and infants, qualifying Medicare beneficiaries, and working disabled people. The chart below can help you determine whether or not you qualify:

How to Apply for South Carolina Medicaid

You can apply for South Carolina Medicaid online, in person, or by mail. To apply in person, visit the County Offices of the Department of Health and Human Services. Some hospitals and federally qualified rural health centers can also help you apply.

Using the SC Medicaid Portal

While all options are viable, applying online certainly has unique perks. By using the SC Medicaid Portal, you’ll be able to see all of your free and affordable health coverage options, plus you can save your work and return to it later. This is important because the application requires a lot of paperwork and documentation that you may not have in front of you all at once. Plus, it takes a while to complete the application properly. It may be easier for you to spend a few minutes at a time working on it.

Download the South Carolina Medicaid Application

Click here to download the application that you can either mail in or drop off at your local office. If you have trouble filling out some of the sections, we recommend that you visit your local County Office of the Department of Health and Human Services to complete your application in person, instead.

What does SC Medicaid Cover?

There are five South Carolina Medicaid plans, all of which are very similar. Plans are Absolute Total Care, Healthy Blue by BlueChoice of SC, First Choice by Select Health of South Carolina, WellCare, and Molina Healthcare of SC.

Most SC Medicaid services are free or have a very low copayment (averaging at about $4 for most, $25 for hospital inpatient visits). The South Carolina Medicaid program is quite comprehensive. In general, SC Medicaid covers:

• Doctor Visits
• Hospital services
  • Inpatient/outpatient
  • Emergency room
  • Ambulance
• Home and long-term care
  • Nursing homes
  • Intellectually disabled homes
  • Home-based services
• Labs and x-rays
• Medical equipment
• Non-Emergency Transportation
• Prescriptions
• Specialized services:
  • Alcohol and drug abuse
  • Autism spectrum disorder
  • Audiology
  • Dental
  • Vision (Exams only for adults; glasses included for kids)
  • Family Planning
  • Mental Health/Psychiatric
• Therapy
  • Occupational
  • Physical
  • Speech-Language

Adults can receive a wellness visit (physical) every two years, and kids under the age of 21 can receive one every year (as well as periodically throughout the year for young babies).

SC Healthy Connections Dental Program & Vision Coverage

Adults in the SC Healthy Connections Dental Program can receive preventative services of up to $750 in value per year. This includes annual cleanings and exams, x-rays, extractions, and fillings. Most people will pay a $3.40 copayment. Kids also get six-month fluoride treatments, one sealant every three years, and one space maintainer. These services are provided through Dentaquest, so you can find a provider at the SC Dentaquest website.

Vision coverage is also much more comprehensive for kids than it is for adults. While kids can get coverage for both exams and glasses, adults can only receive medically necessary exams, like for those pertaining to eye diseases like glaucoma.

The SC Medicaid Formulary (Prescription Drugs)

Use the SC Medicaid Formulary (Preferred Drug List) to determine what drugs you can easily receive coverage for from Medicaid. Any drugs outside of the preferred list will need prior approval, otherwise, you may have to pay out of pocket.

South Carolina Medicaid Doctors

To find a doctor or other provider near you who accepts your SC Medicaid plan, use the SC Choices provider search tool. Enter your city, county, and zip code, the plan you have or would like to enroll in, and the type of doctor you are looking for. You can also type in a specific doctor’s name to see if they accept your plan. We would recommend calling ahead and making sure that the doctor you want to schedule an appointment with will accept your plan.

Healthy Connections Prime

If you qualify for both Medicaid and Medicare in South Carolina, you can qualify for Healthy Connections Prime. The Prime option means $0 prescription copays, one plan and one card, no premiums, a long-term care plan and hospital transition plan, and a personalized team to help you with non-emergency medical transportation and care coordination. To sign up, call 877-552-4642 (TTY 877-552-4642).

South Carolina Medicaid and Medicare Assistance

If you qualify for both Medicaid and Medicare, you can also qualify for a Medicare Advantage dual-special needs plan. These plans can save you money and provide additional coverage. To find out more about dual-special needs plans in your area, or to speak with a licensed agent in North Carolina, fill out this form or call us at 844-431-1832.