Part 1: Medicaid
States use different payment methods for billing Medicaid services. South Carolina uses both a fee-for-service (FFS) model and a managed care model. DHHS requires certain people to enroll in managed care, where their services are approved by a Managed Care Organization (MCO). These people cannot leave managed care unless there is a change in their status.
When approved for Medicaid, Healthy Connections will mail you a notice telling you which Medicaid category or categories you qualify for. You will also be informed whether you need to pick a Managed Care Option or not and provided with instructions and next steps. They call this Healthy Connection Choices.
Current MCOs in South Carolina are:
- Absolute Total Care
- Blue Choice (Healthy Blue)
- Humana Healthy Horizons
- Molina
- Select Health (First Choice)
The following groups of people must enroll in an MCO:
- SSI Beneficiaries (This includes people who would qualify for SSI but due to other government benefits, are not eligible, such as widows/widowers who receive a survivor’s benefit)
- Children (up to age 19)
- Low-income Families
- Pregnant Women
- Aged or Disabled Beneficiaries
- Working Disabled Beneficiaries
- Former Foster Care Children (ages 18-26)
The following groups of people can decide not to use an MCO and receive their services FFS:
- Children in Foster Care
- SSI beneficiaries under age 19
- Children eligible under TEFRA
- Children with a Disability
- Members of federally recognized Indian Tribes or refugees
- Beneficiaries in nursing homes, residential care facilities, community long-term care facilities, or institutional settings
- Beneficiaries receiving family planning only
- Medicare beneficiaries
- Beneficiaries in home and community-based waiver programs