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 (Healthy Connections And Federal Marketplace)
What Is South Carolina Healthy Connections (Medicaid)?
Medicaid is a medical assistance 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.
Are Medicaid and Medicare the same?
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.
Can I have both Medicaid and Medicare at the same time?
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.
What is the Federal Health Insurance Marketplace?
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.
Does the Affordable Care Act require me to carry health coverage of some kind?
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
Should I apply for S.C. Healthy Connections Medicaid or go straight to the Federal Marketplace?
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. Apply in person at your local county office, or contact our main customer service line at (888) 549-0820. If you do not apply online, you can return your application and supporting documents electronically to email@example.com, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or at your local county office.
- Am I Eligible for Medicaid?
How will I know if I qualify for Medicaid?
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. You can return your application and supporting documents electronically to firstname.lastname@example.org, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or 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
How long does it take Healthy Connections to determine my Medicaid eligibility?
Generally, it takes up to 45 days for Healthy Connections to determine eligibility, though determination times can increase for certain applicant categories.
The federal Marketplace told me I’ve been assessed as Medicaid eligible in South Carolina. What should I do?
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.
How long will it take for me to receive my Medicaid card?
You should receive your Medicaid card within one week of being determined eligible.
What if I am turned down for Medicaid?
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.
I have been turned down for Medicaid and need medical assistance right away. What can I do?
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.
I would like to appeal a denial. What are my next steps?
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.
If You Received a Denial South Carolina Healthy Connections (Medicaid)?
If you have questions about the Medicaid policies and other factors used to reach this decision, please feel welcome to contact the Healthy Connections Medicaid Member Contact Center at (888) 549-0820 (TTY (888) 842-3620). If you receive Community Long Term Care (CLTC) services, please contact your CLTC representative for assistance. You have 30 days from the date of this notice to submit new information or submit any information that we previously requested.
If You Would Like to Request a Fair Hearing
You have the right to appeal this decision at a hearing, called a “fair hearing,” with the South Carolina Department of Health and Human Services (SCDHHS), the agency that administers Medicaid in South Carolina. You may represent yourself at the hearing, hire an attorney to help you, or have someone speak on your behalf. In your fair hearing request, you should specifically state which issue(s) you wish to appeal and attach a copy of the notification received from SCDHHS regarding the specific matter on appeal. If you submit a fair hearing request within 10 days of the date of this action, you may be eligible to continue to receive Medicaid benefits until a decision is made regarding the issue you seek to appeal. If you decide to continue receiving benefits during the fair hearing process, you may be asked to repay any charges to your Medicaid account if the decision is not in your favor.
You must submit a request for a fair hearing no later than 30 calendar days from the date of this eligibility decision via one of the following methods:
- Online - www.scdhhs.gov/appeals
- Fax - (803) 255-8251
- Email - email@example.com
- Phone - (888) 549-0820 / TTY (888) 842-3620
- Mail - SCDHHS Division of Appeals and Hearings, PO Box 8206, Columbia, SC, 29202
- A request for a fair hearing by mail is considered filed if postmarked by the thirtieth (30th) calendar day following receipt of this notification.
- In Person - Hand deliver your written appeal request to a Healthy Connections Medicaid (SCDHHS) county office or visit the county office to tell us verbally that would wish to appeal. You can find a full list of addresses online or by calling (888) 549-0820.
You may request an expedited hearing if you feel that the standard fair hearing timeframe could jeopardize an individual’s life, health or ability to attain, maintain or regain maximum function. Contact SCDHHS to make the request, state that you are requesting an expedited fair hearing and explain why. To avoid delays in the process, please submit any supporting documentation with the request for expedited review or immediately thereafter. While supporting documentation is not required, the Division of Appeals and Hearings will determine if expedited treatment will be granted, based on the information made available at the time we consider the request.
If SCDHHS denies the request to expedite, the appeal will follow the standard 90-day timeframe.
How much income can I receive and still be eligible for Medicaid?
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.
What if I didn’t file taxes last year?
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.
If I have private health insurance, am I eligible for Medicaid?
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.
Does my Medicaid from another state work the same now that I live in South Carolina?
No. Medicaid is different from state to state.
I would like to see a copy of the applicant’s rights and responsibilities.
The Rights and Responsibilities are available online and are also included on the signature page of the Healthy Connections Application.
- Presumptive Eligibility
What is Presumptive Eligibility?
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.
Can any hospital or doctor deem me eligible for Medicaid?
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.
How will the hospital know if I am eligible?
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:
- Pregnant Women
- 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
- 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.
What information will I need to provide to the hospital?
At intake, you only need to provide answers to the questions on the application. No further verification is required for a PE determination.
How long will I have Medicaid, once a hospital determines that I am eligible under the PE program?
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.
- Pregnant Women
- Applying for Healthy Connections Online
How do I apply online?
How long does it take to apply online?
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.
Will applying online expedite my eligibility determination?
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.
How will I know if my online application went through?
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.
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?
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.
I completed the Medicaid online application, but it says my identity could not be verified. What should I do?
Because we were unable to verify your identity online, you will need to provide a photocopy of one of the following documents either electronically to firstname.lastname@example.org, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101 or in person to your local county 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 electronically to email@example.com, by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101 or in person to your local county 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
HEALTHY CONNECTIONS APPLICATIONS AND FORMS
I would like to apply with a paper form. How will I know which form to use? Where do I send it?
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 Central Mail
P.O. Box 100101
Columbia, SC 29202-3101
- Using Your Healthy Connections Plan
What medical services does Medicaid cover?
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, view this chart that shows each health plan and what they cover. You can also contact Healthy Connections toll-free at 1-888-549-0820.
How long will my Medicaid benefits remain active?
Eligibility for most Healthy Connections programs lasts for 1 year. After 1 year, South Carolina Health and Human Services will review your case annually.
I was enrolled in S.C. Healthy Connections “Choices” and now am told I must choose between health plans. What should I do?
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.
I just had a baby. Will the hospital report this to Healthy Connections?
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.
Do I need to tell South Carolina Healthy Connections when I move or change jobs?
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.
What happens when a client's benefit package changes because of a change in eligibility?
The household will get a new coverage letter, showing adjusted benefit information.
What if my Medicaid card is lost or stolen?
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.
I have a complaint about my health care coverage. What can I do?
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.
- Citizenship and Residency
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.
Does Medicaid report non-citizens to the U.S. Citizenship and Immigration Service?
No. South Carolina Healthy Connections Medicaid does not report citizenship information.
Can children of non-citizens get Medicaid?
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.
Do non-citizens who are applying for Medicaid for their U.S.-born children have to prove citizenship status?
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
Are interpreters available?
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.