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Healthy Connections Medicaid team members and managed care plans will never ask for money, gift cards or something else of monetary value via text, email or a phone call. If someone contacts you asking for something of monetary value to get or keep Medicaid coverage, please report it by contacting the Medicaid fraud hotline at (888) 364-3224 Monday through Friday from 8:30 a.m. to 5 p.m. or by sending an email to FraudRes@scdhhs.gov.

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About Special Needs Plans (SNPs)

What is a Special Needs Plan?

A Special Needs Plan (SNP) is a type of Medicare Advantage (MA) health plan. It is designed to provide coordinated care for special needs individuals. A special needs individual could be any one of the following:

  • Living in a nursing home or other long-term care facility
  • Eligible for both Medicare and Medicaid (dual eligible)
  • Living with a severe or disabling chronic condition, as defined by the Centers for Medicare and Medicaid Services (CMS)

SNP may be offered as different types of MA coordinated care plans, including health maintenance organization (HMO) plans, HMO Point-of-Service (HMO-POS) plans, or preferred provider organization (PPO) plans, either local (LPPO) or regional (RPPO). There are three different types of SNPs:

  • Chronic Condition SNP (C-SNP)
  • Dual Eligible SNP (D-SNP)
  • Institutional SNP (I-SNP)
Medicaid Eligibility Categories

The Medicaid eligibility categories encompass all categories of Medicaid eligibility including:

  • Full Medicaid (only)
  • Qualified Medicare Beneficiary without other Medicaid (QMB Only)
  • QMB Plus
  • Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB Only)
  • SLMB Plus
  • Qualifying Individual (QI)
  • Qualified Disabled and Working Individual (QDWI)

States may vary in determining their eligibility categories; therefore, there may be state-specific differences in the eligibility levels in comparison to those listed here.

D-SNPs and Healthy Connections Medicaid

Dual Eligible Special Needs Plans (D-SNPs) are for people who qualify for both Medicare (title XVIII) and Medicaid (title XIX). Medicare is a federal health program. Medicaid is medical assistance program that is run by the federal government and a designated state agency. In South Carolina, SCDHHS is the state agency that runs the Healthy Connections Medicaid program. Depending on a person's eligibility and where they live, Medicaid helps pay for some Medicare costs.

Note: The list above includes groups identified by CMS as potentially eligible for the D-SNP program. SCDHHS' State Medicaid Agency Contract (SMAC) determines which groups are currently eligible.

Resources

The Center for Medicare and Medicaid Services (CMS) oversees and regulates authority for Special Needs Plans (SNP). For more information about SNPs, visit the CMS Resource Center.

Details about all SNP types can be found in the Medicare Managed Care Manual; Chapter 16B.

Choosing the coverage that is right for you" information:

People who are dually eligible and have health coverage from both Medicare and Healthy Connections Medicaid may have several health coverage options. The Coverage Model Comparison tool helps explain the differences between these programs.

Note: Not everyone has the same health needs or meets the same eligibility requirements. Program eligibility may vary.

How to enroll" information:

Enrollment in Medicare and Healthy Connections Medicaid is handled by separate agencies.

Getting Medicare" information:

For questions about D-SNP or other Medicare enrollment information, members can contact Medicare directly by:

  • Visiting www.medicare.gov
  • Calling 1-800-MEDICARE (1-800-633-4227)

"Getting Healthy Connections Medicaid" information:

If members have questions about Healthy Connections Medicaid enrollment, members should contact the South Carolina Department of Health and Human Services (SCDHHS). SCDHHS can be reached by phone, fax, or by visiting local county offices. Information on how to contact SCDHHS regarding enrollment and more can be found in the Members section of the website.

What Types of Dual Special Needs Plans (D-SNPs) are offered?

South Carolina Healthy Connections Medicaid partners with Medicare health plans to offer two types of D-SNPs:

A Highly Integrated Dual Eligible Special Needs Plan (HIDE D-SNP)

is a Medicare Advantage (MA) organization that provides coverage, consistent with SCDHHS' policy, of long-term services and supports (LTSS) or behavioral health services that meets one of the following arrangements: (1) the agreement is between the MA organization and SCDHHS; or (2) the agreement is between the MA organization's parent organization (or another entity that is owned and controlled by its parent organization) and SCDHHS; and (3) has received CMS' designation as a HIDE D-SNP.

South Carolina Healthy Connections Medicaid partners with Medicare health plans to offer two types of D-SNPs:

Coordination Only (CO D-SNP)

is a type of MA plan designed specifically for individuals who are eligible for both Medicare and Healthy Connections Medicaid. The CO D-SNP is required to provide care coordination with a Healthy Connections Medicaid member's chosen MCO and/or Healthy Connections Medicaid where applicable.

HIDE D-SNP

Members who choose a Medicare HIDE D-SNP may have additional enrollment requirements that will apply.

In South Carolina, if a Healthy Connections Medicaid member enrolls in a D-SNP to manage their Medicare, he or she will be enrolled into a Medicaid MCO that aligns where available. This means that the same parent organization will provide Medicare and Medicaid management services to the member. This is 'Exclusively Aligned Enrollment' (EAE) offered by a Highly Integrated Dual Special Needs Plan (HIDE D-SNP).

Healthy Connections Medicaid members who have questions about their Medicare coverage or enrollment should visit Medicare.gov or call 1-800 Medicare (1-800-633-4227).

Questions regarding special needs programs can be answered by visiting Health-Plans/Special Needs Plans. For questions specific to SCDHHS' administration of this program, please email us at SCDSNPS@scdhhs.gov.

Members who participate in a HIDE D-SNP may be enrolled in one of the following:

  • First Choice VIP Care
    https://www.firstchoicevipcare.com/ 
    Member Services: 1 (888) 996-0499 (TTY 711), 
    Available Hours: 
    April 1 to Sept. 30, Monday through Friday, 8 a.m. to 8 p.m. EST.
    Oct. 1 to March 31, Seven days a week, 8 a.m. to 8 p.m. EST.
  • Humana Dual Integrated
    https://www.humana.com/medicaid/southcarolina/dsnp 
    Member Services: (866) 432-0001 (TTY 711)
    Available Hours: 
    April 1 to Sept. 30, Monday through Friday, 8 a.m. to 8 p.m. EST.
    Oct. 1 to March 31, Seven days a week, 8 a.m. to 8 p.m. EST.
  • Molina Medicare Complete Care Plus
    https://www.molinahealthcare.com/members/sc/en-us/mem/medicare/medicare 
    Member Services: (855) 735-5831 
    Available Hours: 
    April 1 to Sept. 30, Monday through Friday, 8 a.m. to 8 p.m. EST.
    Oct. 1 to March 31, Seven days a week, 8 a.m. to 8 p.m. EST.
  • Wellcare Absolute Total Care Dual Align
    go.wellcare.com/ATC 
    Member Services: (833) 998-5063 (TTY: 711)
    Available Hours: 
    April 1 to Sept. 30, Monday through Friday, 8 a.m. to 8 p.m. EST.
    Oct. 1 to March 31, Seven days a week, 8 a.m. to 8 p.m. EST.

Coordination Only (CO D-SNP)

CO D-SNPs may not offer a Medicaid MCO but will work with the member's existing Healthy Connections Medicaid MCO to support benefit delivery and care. Healthy Connections Medicaid partners with CO D-SNPs to support care coordination.

Members enrolled in a CO D-SNP may be enrolled in one of the following:

  • Aetna Better Health Medicare Full Dual and Aetna Medicare Full Dual Care
    https://www.aetna.com/medicare 
    Member Services: (866) 409-1221 (TTY users call 711) 
    Available Hours: Seven days a week, 8 a.m. to 8 p.m. EST.
  • HumanaChoice Special Needs Plan - Dual Eligible (SNP-DE)
    https://www.humana.com/medicaid/southcarolina/dsnp 
    Member Services: (866) 432-0001 (TTY 711
    Available Hours: 
    April 1 to Sept. 30, Monday through Friday, 8 a.m. to 8 p.m. EST.
    Oct. 1 to March 31, Seven days a week, 8 a.m. to 8 p.m. EST.
  • United HealthCare (UHC) Dual Complete SC-S001 and UHC Dual Complete SC-S2
    https://www.uhc.com/communityplan/dual-special-needs-plans/benefits 
    Member Services: (866) 480-1086
    Available Hours:
    Seven days a week, 8 a.m. to 8 p.m. EST.