Medicaid

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What is Medicaid?

Medicaid is a health insurance program for people with low incomes, disabilities, and other groups. It is funded by state and federal governments. States that accept federal funding must follow federal Medicaid laws, but they also have the flexibility to set up some of their own policies. This means Medicaid programs vary from state to state.

Medicaid is different from Medicare. Medicare is a health insurance program for people 65 and over and some people with disabilities. The federal government manages Medicare. A person can qualify for both Medicaid and Medicare. In this case, Medicaid might help with Medicare costs or cover services Medicare does not fully pay for South Carolina calls its Medicaid program, “Healthy Connections” and is run by the Department of Health and Human Services (DHHS).

What We Do

  • Provide information and referral services on disability-related Medicaid services.
  • Help with self-advocacy assistance so people with disabilities can stand up for their rights to Medicaid services.
  • Provide advocacy and legal assistance in select cases concerning Medicaid services.

When We Can Help

  • Assist people who want to move from institutional settings to the most integrated community settings.
  • Assist people who have had home and community-based services denied or cut, resulting in not being able to receive services in the most integrated community settings.
  • Educate and assist people with disabilities on how to appeal decisions made on Medicaid services.
  • Please note: We do not assist individuals in applying for Medicaid or Social Security Disability or SSI.

Home and Community-Based Services (HCBS) Waivers

Home and Community-Based Services (HCBS) Waivers, also known as Medicaid waivers, provide extra services for people who need a high level of care and want to live at home or in the community instead of an institution. These programs serve a variety of groups, such as people with intellectual or developmental disabilities, physical disabilities, or mental health conditions. To qualify for an HCBS waiver, a person must:

  • Be eligible for Medicaid
  • Require a high level of care, like what is provided in a hospital, nursing home, assisted living facility or an Intermediate Care Facility for individuals with intellectual disabilities

In South Carolina, the Department of Health and Human Services (DHHS) runs eight different HCBS waivers. However, many of these waivers have long waitlists.

If you or a family member may need these waiver services in the future, it’s important to learn about the different waivers and apply as early as possible. Getting on a waitlist now can help you get services when you need them later.

Resources:

Guide to Medicaid and Medicaid Waivers in South Carolina

DRSC Webinar: DRSC University Medicaid 102: Waivers and Waiver Case

Healthy Connections Waiver Program Overview

Healthy Connections Waiver Chart Comparison Chart

Early, Periodic Screening, Diagnosis and Treatment (EPSDT)

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.

Resources:

Learn More

A person with a disability may be eligible for Medicaid if they fall within any of the following groups of people:
Aged, Blind or Disabled (ABD)

  • Disabled Children (“Katie Beckett” or TEFRA)
  • Former Foster Care (Up to Age 26)
  • Individuals in Nursing Facilities and/or Receiving Home and Community-Based Waiver Services
  • Parent/Caretaker Relatives
  • Qualified Medicare Beneficiaries*
  • Working Disabled

*Limited benefits programs

For a complete list of eligibility for Medicaid, please visit the SCDHHS website. TEFRA is a way for children aged 18 and under with disabilities to get full Medicaid coverage. It allows Medicaid to ignore a family’s income when determining a child’s eligibility. It is sometimes called Katie Beckett. To qualify for TEFRA, a child must:

  • Have a family income too high to qualify for Medicaid.
  • Have a medical, mental, or emotional health need as defined by the childhood listing of impairments on the Social Security website.
  • Require a high level of care, also called an institutional level of care, like what is needed to live in special homes for those with intellectual disabilities, nursing facilities, or hospitals.

The main way to apply for Medicaid in South Carolina is on the Healthy Connections website. There are also other organizations that will help you complete your application.

Healthy Connections
Phone: (888) 549-0820

SC Thrive
SC Thrive can assist with your Medicaid application and review your household’s most likely health coverage options, which include Medicaid, the Children’s Health Insurance Program (CHIP), and the new Advanced Premium Tax Credit.
Phone: (800) 726-8774

Family Connection of South Carolina
If you have a child with a disability and need help completing a TEFRA application, you can contact Family Connection South Carolina for assistance.
Phone: 1-800-578-8750

An appeal is asking for a hearing because you you disagree with a decision made by SCDHHS, a Managed Care Organization (MCO), or someone working for them. 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 electronic confirmation via email after submitting an appeal.
  • Fax to (803) 255-8274 or (888) 835-2086
  • Mail to SCDHHS PO Box 100101 Columbia, SC 29202 Attn: Eligibility Appeals
  • 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.

Self Advocacy Tips

  • MCOs, DDSN and DHHS must send their decision on denial or reduction of services in writing. They cannot deny services verbally.
  • It is important to keep all documentation from your MCO, SCDDSN and DHHS regarding denials or cuts to services, as well as a copy of documentation on your appeal.
  • It is also important to review any deadlines for responding to denials or service cuts.
  • It is recommended that you respond immediately to their written denials or other decisions to cut services.

Resources:

Healthy Connections Medicaid must be renewed every year. Here are the steps you’ll need to take to complete the process when you receive your review form.

It is very important that you follow the steps below.  If you do not, you are at risk of losing your Medicaid coverage.  Also, it is very important that you submit the form to Medicaid by the deadline date. Ignoring the deadline can lead to losing coverage

  1. Make sure your contact info is up to date

To make sure you don’t miss important updates about your Medicaid coverage, make sure Healthy Connections Medicaid has your correct address and contact info. You can change or add your address, email or phone number online.

  1. Be on the lookout for your review form

Check your mail for important letters. SCDHHS may be able to renew your Medicaid with the information they have. If so, you will receive a “Continuation of Benefits” notice. You will not receive or need to complete the annual review form. If SCDHHS cannot confirm your eligibility, they will send you an annual review form in the mail. They will also text (if they have your cell phone number) to let you know it is time to complete your form. You can always check your annual eligibility review status and complete your review online.

  1. Complete and return your form (if you get one)

When you receive your form, complete it fully and clearly. Be sure to return it by the due date listed on the form. You can also complete your annual review form online when it’s time to renew. If you do not have all the info, return your signed and completed form. They will follow up if they need anything. Once they receive your form, your Medicaid will continue while they assess you for the next year of coverage. After completing the assessment, you will receive notice of a decision. If you do not return the form by the deadline, they will send a notice to let you know the date when your Medicaid will end.

Submit the form using one of the methods below.

Resources:

SCDHHS Annual Review Information

Alert 

Changes to Medicaid enrollment and reenrollment will change due to the passing of the Big Beautiful Bill that was signed into law on July 4, 2025.  We are monitoring the changes that may impact on you and will include them on this page once we learn more. 

DRSC Resources