Skip Persistant Navigation
Search DHHS:
DHHS Home

Information For:

Inside DHHS

Helpful Links

 
  Home >> Eligiblity Policy and Oversight >> Download Applications

 Application Download Page
 Checklist for Required Documentation
 Income Limits for the Specific Program


The information below is based on the selected need for coverage made on a previous page.

This page will provide you with:

  • An Application
  • A Checklist Of Required Documentation
  • Income Limits
For the Medicaid program or other coverage programs managed by DHHS.

Note: Coverage is provided under many categories with different income limits. More than one income table may be presented . Not all programs providing coverage are Medicaid programs.

Printable Applications
Applications in Adobe PDF Format Form Link Description
FM 400 « Family Planning Application

What else you will need.
If applying for the first time, you must Provide
Proof Of Citizenship .
The application is not valid without the Applicant's Signature.
If you need assistance in completing the application,
or if you have any questions about Family Planning Services,
please call the following toll-free number: 1-888-549-0820.
Then Mail Applications to: ¬
(FM 400) Mail to Central Eligiblity Office



Skip Persistent Navigation
Home | Inside DHHS | Programs and Services | Contact DHHS | Site Map   
This Web site has both active pages and archives.
Please be certain to check the date of each release.
There may have been a bulletin released or a provider manual update
that supercedes the information found on this page.
Privacy Policy   |   SCDHHS Notice of Privacy Practices

SCDHHS Notificacion de Practicas de Privacidad

Authorization to Disclose Health Information

Experiencing Problems with our website?
Please tell us.
Copyright © 2010 All Rights Reserved.

Department of Health and Human Services
P. O. Box 8206
Columbia, SC 29202-8206

The general phone number is (803) 898-2500
Fraud (888) 364-3224
Medicaid Beneficiaries (888) 549-0820

SC DHHS HIPAA Website

To ask questions about the agency, programs, or services,
email info@scdhhs.gov.

If you have comments, questions or suggestions, regarding this website
email webmaster@scdhhs.gov.

SC State Government Site.
SC.GOV