Medicaid & Healthcare

Introduction

We envision a society where all people, regardless of the type or severity of disability, have equal access to health care services that meet their unique needs and that all services should be readily available, affordable, accessible and accountable.

What We Do

We can assist individuals with disabilities who have been discriminated against or denied health care services through case work, legal representation and self-advocacy training. Staff also work to improve laws, regulations, policies and practices that affect the healthcare of people with disabilities through litigation and advocacy.

Frequently Asked Questions

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 get started go to the SCDHHS website.

Waivers are used to supplement services provided through the South Carolina Medicaid plan. These services are to provide a choice between living in the community versus living in an institution so these services are provided in the home or another community setting. Currently, there are seven different Medicaid Home and Community-Based Waivers in South Carolina: HIV/AIDS Waiver, Community Choices Waiver, Intellectual Disability/Related Disabilities (ID/RD) Waiver, Head and Spinal Cord Injury (HASCI) Waiver, Community Supports Waiver, Ventilator Dependent (Vent) Waiver for Adults, and Medically Complex Children’s Waivers.

The Community Long Term Care (CLTC) Division of the Department of Health and Human Services (DHHS) independently operates four of the waivers: HIV/AIDS, Community Choices, Vent, and the Medically Complex Children’s Waivers.

The other three waivers, HASCI, Community Choices, and ID/RD, are joint projects between DHHS and DDSN. An individual may meet eligibility requirements for several different Waivers. However, an individual may only participate in one (1) specific waiver.

An appeal is asking for a hearing because you do not agree with a decision the South Carolina Department of Health and Human Services (SCDHHS), a Managed Care Organization (MCO), or another party acting on behalf of the agency has made. Appeals are often about denial of eligibility or a specific service request, reductions in services or hours, or another adverse decision.  The hearings that are held are often referred to as “fair hearings.”

To appeal a Medicaid eligibility decision, you should state what and why you are appealing and a attach a copy of the notice of denial you received by one of the following methods. The denial notice should tell you how long you have to file an appeal.

  • Online at www.scdhhs.gov/appeals. You will receive an electronic confirmation via email after submitting an appeal.
    OR
  • Fax to (803) 255-8274 or (888) 835-2086
    OR
  • Mail to SCDHHS PO Box 100101 Columbia, SC 29202
    Attn: Eligibility Appeals
    OR
  • Email to [email protected]

If you are enrolled in a Managed Care Organization (MCO), you should contact your health plan and work through its internal appeal process before filing an appeal with the Division of Appeals and Hearings.

If you are enrolled in waiver services through SCDDSN, you should complete its reconsideration process before filing an appeal with the Division of Appeals and Hearings.

 

Early and Periodic Screening, Diagnosis, and Treatment (EPSDT) is Medicaid’s comprehensive and preventive child health program for individuals under age 21.  EPSDT is a complete benefit package that provides periodic check-ups (screenings) and necessary treatment to children enrolled in Medicaid. EPSDT offers four types of screens: Medical, Vision, Hearing, and Dental. These screens are scheduled at appropriate age intervals to meet current pediatric, adolescent, and dental practices so that children receive services necessary to maintain their health. All Medicaid-eligible children under the age of 21 qualify for EPSDT. For information about who is eligible for Medicaid, contact the SC Department of Health and Human Services at (888) 549-0820 or http://www.scdhhs.gov/

DRSC Client Success Story

A P&A Client who lived in a private apartment complex needed an electronic remote door opener so that she could continue to live safely in her apartment without having to leave the door unlocked. Even though she was eligible for coverage of the device under Medicaid, the South Carolina Department of Health and Human Services (DHHS) refused to cover the device because she lived in a private apartment, rather than a state-sponsored setting.  P&A helped Client file a Fair Hearing request (appeal) and contest the denial, which was successful.  DHHS agreed to cover the device. Subsequently, extensive negotiations were required with the apartment complex management to approve installation, which caused significant delays, but ultimately the device was installed successfully and functionally.  Client was able to continue living in her apartment with a locking door.