The South Carolina Department of Health and Human Services (SCDHHS) resumed its standard Medicaid eligibility annual reviews process April 1, 2023. This federally required process is in place to ensure those enrolled in Medicaid programs continue to meet established eligibility criteria. The restart of this process was required by the Consolidated Appropriations Act, 2023, which was passed by Congress and signed into law by President Joe Biden Dec. 29, 2022.
The dashboard below includes data related to the restart of South Carolina’s federally required Medicaid annual eligibility review process and Healthy Connections Medicaid full-benefit enrollment trend data. Data is updated either monthly or weekly as indicated below.
All Medicaid members will receive an annual review form or “continuation of benefits” notice by mail. If a member’s eligibility can be renewed via information that is already available to SCDHHS, the Medicaid member will receive a continuation of benefits notice and will not receive an annual review form. This is known as an “ex parte” renewal. If a member can’t be renewed on an ex parte basis, they are given 90 days to return their review form. If the form is not returned, the member will receive a reminder and then a formal closure notice. Members are granted a 90-day grace period following their benefits ending. If an annual review form is received during this grace period, the member will be reinstated with retroactive coverage until their eligibility is determined by the agency.
Dashboard
Annual Eligibility Review Data
| Medicaid Annual Reviews | Number | Data Definitions |
| Total Medicaid members reviewed for eligibility** | 1,160,960*** | Total number of Healthy Connections Medicaid members whose annual eligibility review has been initiated since the federally required reviews restarted April 1, 2023. This includes full and limited benefit members (ex. individuals who are enrolled in the state's family planning limited benefit program). |
| Total Medicaid members reviewed for eligibility and renewed* | 584,588 | Total number of Healthy Connections Medicaid members who have been reviewed and whose coverage has been renewed. |
| Total Medicaid members reviewed for eligibility and renewed on ex parte basis* | 296,760 | Total number of Healthy Connections Medicaid members who have been reviewed and automatically renewed based on data SCDHHS was able to access on its own, also known as ex parte renewals. |
| Total Medicaid members disenrolled through annual reviews* | 289,538 | Total number of Healthy Connections Medicaid members who have been disenrolled through the restart of the federally required annual eligibility review process since April 1, 2023. |
| Total Medicaid members reviewed and disenrolled* | 112,556 | Total number of Healthy Connections Medicaid members who have been reviewed and disenrolled from coverage since federally required reviews restarted April 1, 2023. |
| Total Medicaid members disenrolled for failure to return their review form* | 176,748 | Total number of Healthy Connections Medicaid members who have been reviewed and disenrolled because they did not return their review form. |
| Total Medicaid members disenrolled for procedural reasons other than failure to return their review form* | 234 | Total number of Healthy Connections Medicaid members who have been reviewed and disenrolled because they did not fill out their review form accurately or completely. |
| Percentage of annual review forms successfully delivered via mail** | 93.04% | The percentage of annual review forms that were successfully delivered via mail. This indicates active addresses that are on file, it does not guarantee receipt. Annual review forms are sent by household and a review form may include more than one Medicaid member. |
| Percentage of annual review text messages successfully delivered** | 86% | The percentage of text messages sent by SCDHHS’ partner organization to remind Healthy Connections Medicaid members of their annual review that were delivered successfully. Annual review forms are sent by household and a review form may include more than one Medicaid member. |
| Percentage of reviews returned within 90 days** | 34.27% | The percentage of annual eligibility review forms that have been sent and were returned within 90 days. |
| Percentage of reviews returned within 90 days or the 90-day grace period** | 40.96% | The percentage of annual eligibility review forms that have been sent and were returned either within 90 days or the 90-day grace period. |
Data in this table is updated either weekly or monthly as indicated. It is important to note that these figures represent point-in-time data. Healthy Connections Medicaid members have a 90-day grace period after their coverage has expired where services can still be paid by Medicaid if they return their review form. This means these figures will continue to fluctuate as Medicaid members who failed to return their annual review form on time return their form and have their cases temporarily re-opened during this grace period; and, as annual review determinations are processed for members who have submitted their annual review forms.
*Updated weekly, last updated April 24, 2024
**Updated monthly, last updated April 11, 2024
***Includes full and limited benefit members (e.g. individuals who are enrolled in the state's Family Planning Limited Benefit Program).
SCDHHS also submits monthly annual eligibility review reports to the Centers for Medicare and Medicaid Services. These reports are available here:
- 2023 Reports
Please direct questions about this data to communications@scdhhs.gov.