Frequently Asked Questions
If you do not find an answer to your question about South Carolina Healthy Connections (Medicaid), please call (888) 549-0820 to speak to a representative.
- Getting Health Insurance
- Minimum Essential Coverage and Tax Penalties
- Am I Eligible for Medicaid?
- Presumptive Eligibility
- Applying for Healthy Connections Online
- Using Your Healthy Connections Plan
- Citizenship and Residency
- Appeals and Hearings Frequently Asked Questions
Q. What Is South Carolina Healthy Connections (Medicaid)?
A. Medicaid is a health insurance program that pays medical bills for eligible low-income families and individuals whose income is insufficient to meet the cost of necessary medical services. The South Carolina Medicaid program, called Healthy Connections, is administered by the South Carolina Department of Health and Human Services (SCDHHS) and pays medical bills with state and federal tax money.
Q. Are Medicaid and Medicare the same?
A. No. Medicaid and Medicare are two different programs. Medicare is a health insurance program for all people age 65 and over or who have received Social Security disability benefits for a minimum of 24 months.You can find out more about Medicare at their website www.medicare.gov or contact them at 1-800-633-4227.
Q. Can I have both Medicaid and Medicare at the same time?
A. An individual can have both Medicaid and Medicare in some circumstances. If you receive Supplemental Security Income (SSI) from the Social Security Administration, you are automatically eligible for Medicaid and often receive Medicare as well. If you receive both Medicaid and Medicare, Medicaid will usually pay your Medicare premium, co-payments, and deductibles.
Q. What is the Federal Health Insurance Marketplace?
A. The Patient Protection and Affordable Care Act was signed into law in 2010. One provision of the law established a system of health insurance exchanges, commonly referred to as the Health Insurance Marketplace or “the Marketplace.”
Insurance plans in the Marketplace are offered by private companies. South Carolinians may use the Marketplace to compare options and apply for coverage. Depending on your income, you might qualify for lower premiums. (Premium costs are reduced with a tax credit which can be applied directly to your monthly premiums immediately.) In addition, you may qualify for the Marketplace cost-sharing reduction, which lowers out-of-pocket costs like deductibles and copayments.
To be eligible for health coverage through the Marketplace, an applicant must live in the United States; must be a U.S. citizen or national or be lawfully present; and cannot be currently incarcerated.
Visit healthcare.gov or call 1-800-318-2596 for more information.
Q. Does the Affordable Care Act require me to carry health coverage of some kind?
A.Most people must have health coverage or pay a fee. However, some people may qualify for an exemption to this fee. You are considered covered if you have Medicare, Medicaid, CHIP, VA health coverage, retiree coverage, TRICARE, any job-based plan, COBRA, any plan you bought yourself, or some other kinds of health coverage
Q. Should I apply for S.C. Healthy Connections Medicaid or go straight to the Federal Marketplace?
A. You may apply at either website. If you apply for S.C. Healthy Connections (Medicaid), you may be assessed eligible for services in the Federal Marketplace. However, the Marketplace makes this final decision. Conversely, if you initially apply for health coverage through the Marketplace and are assessed eligible for Medicaid, Healthy Connections makes the final decision as to Medicaid eligibility.
If you think you may qualify for Medicaid, please complete an online Medicaid application at apply.scdhhs.gov .
Q. Who is required to have Minimum Essential Coverage (MEC)?
A. All U.S. citizens living in the United States are required to have health coverage or insurance that meets the Affordable Care Act's (ACA) definition of Minimum Essential Coverage (MEC). Otherwise, you may have to pay a tax penalty called the "shared responsibility provision." Citizens required to have MEC also include:
- Children -
- Each child in a family must have MEC or the adult(s) claiming the child as a dependent may have to pay the penalty.
- Senior Citizens -
- Aside from Medicaid, Medicare Parts A and C qualify as MEC.
- Foreign Nationals and Resident Aliens -
- You are required to have MEC if you have been in the U.S. long enough during a calendar year to qualify as a resident alien for tax purposes. If you have to file a tax return, but have not been in the U.S. long enough to be considered a resident alien, you are not required to have MEC.
- U.S. Citizens Living Abroad -
- You are required to have MEC unless you have not been physically present in the United States for at least 330 full days within a 12-month period or if you are considered a bona fide resident of a foreign country for an entire taxable year.
Q. Is my Medicaid coverage considered to be Minimum Essential Coverage?
A. Most South Carolina Healthy Connections Medicaid coverage meets MEC and satisfies the individual shared responsibility provision. A specialty program called Family Planning does not satisfy the provision because it is a limited benefit program that only provides Medicaid coverage for certain services. If you were approved for Family Planning, your approval notice explained the program's limited coverage.
Q. What if I didn't have MEC all year? Will the Affordable Care Act require me to pay a penalty if I have health insurance for only part of the year?
A. If you are uninsured for just part of the year, which is considered to be a "coverage gap," you may have to pay a fee for each month you were uninsured. A gap in coverage that lasts less than three months qualifies as a short coverage gap. Legally you are allowed to have one short coverage gap per year without a penalty fee.
Q. Can I get an exemption?
A. You can claim an exemption if the lowest-priced coverage available to you would cost more than 8% of your household income; if you don't have to file a tax return because your income is too low; or if you qualify for a special "hardship" exemption. For a detailed list of circumstances that qualify for the hardship exemption, or if you would like to apply for an exemption, visit healthcare.gov.
If you are not required to file a federal income tax return because your income is too low, you are automatically exempt from the individual responsibility fee for that year and do not need to take any further action. If you are not required to file a tax return but file one anyway, you will be able to claim the exemption on your tax return.
If you don't file a tax return, you can also apply for the exemption using forms available at healthcare.gov.
Q. How will I know if I qualify for Medicaid?
A. First, you must apply. You may use our online application tool at apply.scdhhs.gov contact Healthy Connections at (888) 549-0820 to request a paper application by mail, or apply in person at your local county office.
Healthy Connections will take certain criteria into account when determining eligibility. If you or someone in your family needs health care, you should apply for Medicaid even if you are not sure of your eligibility. Some income and assets, like home ownership, may not count against you, depending on your situation. You are encouraged to apply if:
- You are pregnant or think you may be pregnant
- You are or have a child or teenager age 18 or under
- You or your child is in foster care or adopted
- You have been diagnosed with breast or cervical cancer
- You are blind
- You have a disability or disabilities
- You need nursing home care
- You are over the age of 65
- You have very low or no income
Q. How long does it take Healthy Connections to determine my Medicaid eligibility?
A. Generally, it takes up to 45 days for Healthy Connections to determine eligibility, though determination times can increase for certain applicant categories.
Q. The federal Marketplace told me I’ve been assessed as Medicaid eligible in South Carolina. What should I do?
A. The federal Marketplace will forward your information to SC Healthy Connections for a final eligibility determination. Healthy Connections will notify you when we have made a determination on your eligibility.
Q. How long will it take for me to receive my Medicaid card?
A. You should receive your Medicaid card within one week of being determined eligible.
Q. What if I am turned down for Medicaid?
A. If you do not qualify for Healthy Connections Medicaid, you may find an affordable option through the federal Marketplace .
Visit healthcare.gov or call 1-800-318-2596 for more information.
Q. I have been turned down for Medicaid and need medical assistance right away. What can I do?
A. Federally Qualified Health Centers (FQHC) and other Community Health Centers (CHC) offer comprehensive medical services, including dental services and prescription drugs, to patients with no health insurance. You often only pay what you can afford, based on your income.
You may search for FQHCs in South Carolina here .
Search for other CHCs via the South Carolina Primary Care Association’s search portal here .
Q. I would like to appeal a denial. What are my next steps?
A. If you received a denial from the federal Marketplace , you must send your appeal to the Marketplace (see below). If you received a denial from SC Healthy Connections, you must send your appeal to SC Healthy Connections. Healthy Connections cannot process an appeal to the Marketplace and vice versa.
Federal Marketplace Appeals: Your notice from the Marketplace will contain appeals instructions, including the number of days you have to file an appeal. For more information, call 1-800-318-2596 or visit healthcare.gov .
Healthy Connections Appeals: Applicants have 30 days from the date of the denial to submit new information, or submit any information that was previously requested, in order to have the case reevaluated. Applicants have the right to appeal the decision at a hearing with SCDHHS, the agency that administers Medicaid in South Carolina. If you are an applicant requesting an appeal, you may represent yourself at the hearing, hire an attorney to help you or have someone speak on your behalf. You must submit a written request for a hearing no later than 30 calendar days from the date on the denial via one of the following methods:
- Appeal online at www.scdhhs.gov/appeals
- Mail the request to:
SCDHHS – Central MailPO Box 100101Columbia, SC 29202-3101Attn: Eligibility Appeals
Fax the request to: 888-835-2086
Or email the request to: email@example.com. For your privacy and security, please note that mailing personal health information is more secure than email.
Q. How much income can I receive and still be eligible for Medicaid?
A. Whether your income level qualifies you or your family for Medicaid depends on the size of your family and the Medicaid program for which you are applying. Income limits are set each year by the federal Department of Health and Human Services . These income limits are based on the Federal Poverty Level (FPL) and vary for different family sizes and programs. Healthy Connections will determine the income limit for you and your family when you apply.
Q. What if I didn’t file taxes last year?
A. Filing taxes is not a requirement for Medicaid eligibility. We look at what income you are receiving at the time you file your application for Medicaid. We do ask questions about your plans for filing taxes next year to help make the decision.
Q. If I have private health insurance, am I eligible for Medicaid?
A. Yes. If your income is low, and you have minor children, you and your children can have private health insurance and still be eligible for Medicaid.
Q. Does my Medicaid from another state work the same now that I live in South Carolina?
A. No. Medicaid is different from state to state.
Q. I would like to see a copy of the applicant’s rights and responsibilities.
A. The Rights and Responsibilities are available here and are also included on the signature page of the Healthy Connections Application.
Q. What is Presumptive Eligibility?
A. The Presumptive Eligibility (PE) process allows hospital workers to screen people for Medicaid eligibility during intake. Healthy Connections (Medicaid) has authorized certain hospitals to determine a patient’s Medicaid eligibility onsite at the hospital to help cover the costs of healthcare. A patient/applicant does not have to provide the hospital with financial, citizenship, or other documents at the time of application.
Medicaid eligibility in this category is temporary and is intended to offer immediate coverage, while the applicant is processed for a full Medicaid application, at which point all financial and other data will be verified. The PE program is used as a last resort payment option; if a patient has any other alternative insurance coverage, the hospital will seek to use the alternative coverage.
Q. Can any hospital or doctor deem me eligible for Medicaid?
A. No. Only a hospital authorized by Healthy Connections can make a Medicaid determination. Determinations must be performed by a hospital employee and the authority to determine eligibility may not be delegated to any non-employee or third party. Authorized hospitals that fall out of compliance with state policies and procedures risk disqualification from the program.
Q. How will the hospital know if I am eligible?
A. During the initial intake process, hospital staff will determine if you meet the financial and categorical requirements to be eligible for Medicaid. PE is applied to the following Medicaid categories:
A pregnant woman can only be authorized for one PE period (two months) per pregnancy. PE coverage is limited to ambulatory prenatal care, like medical exams, and DOES NOT include labor and delivery. Labor and delivery is covered for pregnant women under a different program. Contact Healthy Connections at (888) 549-0820 for more information.
Family planning services are available to individuals whose family income is at or below 194% of the Federal Poverty Level (FPL).
Former Foster Care (Up to Age 26)
Services are available for individuals up to the age of 26 who were formerly in the South Carolina foster care program. Applicants must have been a Medicaid recipient in the State of South Carolina at the time they aged out of foster care. Income is not considered for this coverage group.
Breast and Cervical Cancer Program
The program is designed for uninsured individuals who are found in need of treatment for breast or cervical cancer or pre-cancerous lesions (CIN 2/3 or atypical hyperplasia).
Infants and Children
Coverage is available for children who live in families with income at or below 208% of the FPL.
Parents and Caretaker Relatives
This program provides coverage for parents or other caretaker relatives who meet financial eligibility criteria (62% FPL) and have a dependent child living in the home.
Q. What information will I need to provide to the hospital?
A. At intake, you only need to provide answers to the questions on the application. No further verification is required for a PE determination.
Q. How long will I have Medicaid, once a hospital determines that I am eligible under the PE program?
A. Coverage will extend from the beginning of the month in which you applied to the last day of the following month. If you are deemed eligible for full Medicaid during that time, your PE coverage will end on the day your full coverage begins. You may only receive Presumptive Eligibility coverage once within two calendar years.
Q. How do I apply online?
A. Visit apply.scdhhs.gov to start the online application process.
Q. How long does it take to apply online?
A. Application times vary significantly by applicant. If you cannot complete your Healthy Connections online application in one sitting, the application tool is designed to allow you to bookmark your work and return to it at a later time.
Q. Will applying online expedite my eligibility determination?
A. Applying online will save time since you won’t be mailing the application. However, Healthy Connections doesn’t expedite online applications over traditional application methods—once received, all applications are treated and processed equally. Generally, it takes up to 45 days for Healthy Connections to determine eligibility, though determination times can increase for certain applicant categories.
Q. How will I know if my online application went through?
A. You will be routed to a confirmation screen when your application is successfully submitted. In addition, you will receive a confirmation email at the email address you provided in the application.
Q. I am completing the Medicaid online application. Why am I being asked to confirm things like a previous address or a car I have purchased?
A. During the application process, we may ask for you to provide information that will confirm your identity such as a previous address or a car that you purchased. Answering these questions will help us confirm who you are and ensure that we correctly process your application.
Q. I completed the Medicaid online application, but it says my identity could not be verified. What should I do?
A.Because we were unable to verify your identity online, you will need to provide a photocopy of one of the following documents either in person or via mail to a Medicaid office before we can process your application. (Please do not mail in your original documents—send photocopies.)
- Driver’s license issued by state or territory
- School identification card
- Voter registration card
- U.S. military card or draft record
- Identification card issued by the federal, state, or local government, including a U.S. passport
- Military dependent’s identification card
- Native American Tribal document
- U.S. Coast Guard Merchant Mariner card
If you are unable to provide one of the documents listed above, you may provide photocopies of two of the following documents in person or via mail to a Medicaid office
- Birth Certificate
- Social Security card
- Marriage certificate
- Divorce decree
- Employer identification card
- High school or college diploma (including high school equivalency diplomas)
- Property deed or title
Q. I would like to apply with a paper form. How will I know which form to use? Where do I send it?
A. Applicants should submit the Healthy Connections Application (Form 3400). After initial review, Healthy Connections staff will determine what additional forms are needed and will provide them to you. If you know the Coverage Group for which you are applying (example: Aged, Blind, or Disabled) you may refer here for additional forms.
Mail the completed Healthy Connections Application to: SCDHHS
PO Box 100101
Columbia SC 29202-3101
Q. What medical services does Medicaid cover?
A. Within certain limits, Medicaid will pay for services that are medically necessary. Examples of services that may be covered include doctor visits, medications, hospital visits, and many other medical services.
If you have any questions about what is covered, click here to view a chart that shows each health plan and what they cover. You can also contact Healthy Connections toll-free at 1-888-549-0820.
Q. How long will my Medicaid benefits remain active?
A. Eligibility for most Healthy Connections programs lasts for 1 year. After 1 year, South Carolina Health and Human Services will review your case annually.
Q. I was enrolled in S.C. Healthy Connections “Choices” and now am told I must choose between health plans. What should I do?
A. The Healthy Connections “Choices” website offers comprehensive information on its health plans. Members may utilize a Quick Start Guide, search for doctors, compare plans, and more. Please visit S.C. Healthy Connections Choices for more information.
Q. I just had a baby. Will the hospital report this to Healthy Connections?
A. Hospitals often do not report. We urge every new mother to call Healthy Connections at 1-888-549-0820 and report a baby’s birth within a few days of delivery. The baby is automatically covered by Medicaid for the first 60 days after birth and your Medicaid card will cover the baby during this period. However, coverage will expire for the baby after 60 days unless you enroll the baby separately for extended coverage.
Q. Do I need to tell South Carolina Healthy Connections when I move or change jobs?
A. Yes. If you have any changes to your income, resources, living arrangements, address or anything else that might affect your eligibility (for example, a child moved out or spouse went to work) you must report these changes to Healthy Connections right away at 1-888-549-0820
Q. What happens when a client's benefit package changes because of a change in eligibility?
A. The household will get a new coverage letter, showing adjusted benefit information.
Q. What if my Medicaid card is lost or stolen?
A. Report a lost or stolen card to Healthy Connections immediately at 1-888-549-0820.
Please allow 7-10 days to receive a replacement card. If you need to visit your healthcare provider sooner than that, your provider can verify your Medicaid status.
Q. I have a complaint about my health care coverage. What can I do?
A. We recommend that you call your health plan first. If your issue remains unresolved, you can file a complaint by calling Healthy Connections Choices at 1-877-552-4642. Filing a complaint will not affect your benefits in any way. We will discuss the problem with you and see how we can help you resolve it.
To obtain full Medicaid benefits in South Carolina, you must be a South Carolina resident and either a U.S. citizen or a legally residing non-citizen. Non-citizens may qualify for coverage for emergencies and labor and delivery services if income requirements are met.
Q. Does Medicaid report non-citizens to the U.S. Citizenship and Immigration Service?
A. No. South Carolina Healthy Connections Medicaid does not report citizenship information.
Q. Can children of non-citizens get Medicaid?
A. If the children are U.S. citizens, they can receive Medicaid if they meet the eligibility requirements. If non-citizens apply for Medicaid for a U.S.-born child, the child’s social security number must be provided or the applicant must show proof that they have applied for a number for the child.
Q. Do non-citizens who are applying for Medicaid for their U.S.-born children have to prove citizenship status?
A. No. If the person applying is not a U.S citizen and is applying for Medicaid for U.S.-born children, they are not required to provide proof of their citizenship status
Q. Are interpreters available?
A. Yes. Healthy Connections can provide an interpreter for a person who has difficulty speaking or understanding English or who is hearing impaired. Applicants may also apply through their own interpreter, such as a bilingual friend or relative.