Effective Jan. 1, 2026, the South Carolina Department of Health and Human Services (SCDHHS) added some Healthy Connections Medicaid members to the managed care service delivery model. This included Medicaid members who are 18 years of age or older:
- Medicaid members who are dually enrolled in Medicare and Medicaid;
- Medicaid members enrolled in the HIV/AIDS Waiver;
- Medicaid members enrolled in the Mechanical Ventilator Dependent (Vent) Waiver;
- Medicaid members enrolled in the Community Choices Waiver; and
- Medicaid members who reside in a nursing facility
- Healthy Connections Medicaid members who reside in a nursing facility will now be enrolled in a Medicaid managed care organization (MCO) for coverage of medical services.
Medical services include the following:
- Inpatient and outpatient hospital services
- Clinic services (including rural health clinic and federally qualified health clinics services)
- Early and Periodic Screening, Diagnosis and Treatment services (for members under the age of 21)
- Physician services (including medical care provided by other practitioners such as nurse practitioners, physician assistants and others)
- Podiatry services
- Chiropractic services
- Home health care services (including incontinence supplies)
- Rehabilitative therapy services (physical, occupational, speech/language therapies)
- Pharmacy services
- Durable medical equipment (including incontinence supplies)
- Behavioral health services
Effective for dates of service on and after Jan. 1, 2026, all waiver and nursing facility services will be authorized and paid through the fee-for-service (FFS) delivery model.
Waiver services will continue to be authorized through the FFS delivery model. However, for dates of service on and after Jan. 1, 2026, claims for medical services for members who are enrolled in one of the waiver programs listed above should be submitted to the MCO in which the member is now enrolled. This chart outlines CC, HIV and Vent waiver services and medical services.
The MCOs are responsible for a 90-day continuity of care period for newly enrolled MCO members. It is important that providers continue to deliver authorized services. During this continuity of care period, MCOs are required to:
- Honor all previous prior authorizations without requiring additional authorization from providers; and
- Pay previously authorized services at 100% of the applicable Medicaid FFS rate, unless a contractually negotiated rate exists, regardless of whether the provider is in-network with the MCO.
Once the continuity of care period is over, providers must be enrolled with the MCO in which the Healthy Connections Medicaid member is enrolled.
Points of contact and information on prior authorization and enrollment/credentialing for each South Carolina MCO is available on SCDHHS’ website and below.
MCO | Prior Authorization and Provider Help Line |
Absolute Total Care | (866) 433-6041 |
Healthy Blue by Blue Choice of SC | (866) 757-8286 |
Molina Healthcare of South Carolina | (855) 237-6178 |
First Choice by Select Health | (888) 559-1010 |
Humana Healthy Horizons of SC | (866) 432-0001 |
A comparison grid of waiver covered services, broken down by each home and community-based services (HCBS) waiver is available for reference on SCDHHS’ website .
Further guidance on the continuity of care period and other managed care carve-in related changes is located on SCDHHS’ Carve-in FAQ Page .