News
South Carolina Medicaid has changed how some members receive their medical benefits
August 27, 2026
As of January 1, 2026, changes to South Carolina Medicaid have taken effect. Here’s what you need to know. Some Medicaid members started receiving most of their medical benefits through a Healthy Connections managed care plan. This change is sometimes called the Medicaid Managed Care Carve-In. Healthy Connections, the SC Medicaid program, has decided to use managed care organizations (MCOs) to deliver health care while also managing cost, utilization, and quality. Medicaid managed care provides Medicaid health benefits and additional services through contracts between Healthy Connections and MCOs. They receive a fixed amount of money each month to cover each member’s services. This change affects Medicaid members who are 18 years of age or older and who are:
- dually enrolled in Medicare and Medicaid; or
- enrolled in the HIV/AIDS Waiver; or
- enrolled in the Mechanical Ventilator Dependent (Vent) Waiver; or
- enrolled in the Community Choices Waiver; and
- Medicaid members who reside in a nursing facility
- Healthy Connections Medicaid members who reside in a nursing facility will now be enrolled in an MCO for coverage of medical services.
For the first 180 days after joining an MCO, members had a ‘continuity of care’ period. This meant you could keep getting services from your current doctors, and anything already approved would stay the same. During this period, MCOs had to:
- Honor all previous prior authorizations without requiring additional authorization from providers; and
- Pay previously authorized services at 100% of the applicable Medicaid FFS rate, unless a contractually negotiated rate exists, regardless of whether the provider is in-network with the MCO.
As of June 30, 2026, your doctors and other providers must be enrolled with your MCO to keep providing you with services. If you have both Medicare and Medicaid, receive services through one of the waivers mentioned above, or live in a nursing facility, this change may affect how some of your medical care is covered. You should have received a letter from Healthy Connections about this change.
If you are affected by these changes, make sure you:
• Watch your mail for information from Healthy Connections or your health plan
• Know which managed care plan you are enrolled in
• Check that your doctors, specialists, and prescriptions are covered
• Ask questions if something does not look right
For official information and updates, visit scdhhs.gov/carvein.
You may also look for more information on the continuity of care period and other managed care carve-in related changes on SCDHHS’ Carve-in FAQ Page .
Please share this with someone who may need it. Clear information can make navigating Medicaid changes a little easier.