South Carolina is one of the states currently participating in the Centers for Medicare and Medicaid Services (CMS) initiative to design new coordinated care approaches for individuals dually eligible for Medicare and Medicaid. Please view key data and links to more information about Healthy Connections Prime below. For additional information visit the Provider FAQs page or view the Member FAQs.
Healthy Connections Prime Program Updates
Healthy Connections Prime's program updates showcase program activity and statistics for members, providers, and other stakeholders.
June 2019: Learn about person-centered program design and family caregivers, with a focus on four program design domains: assessment and care planning, benefit design, training, and quality improvement.
August 2017: Learn more about the program, access to care, member profile and the program's goal for Better Care, Better Value and Better Health.
The enrollment dashboard files below provide a summary of the program's enrollment information aggregated at a program-wide level, a county level and a plan level. The first section of each report includes a glossary of key terms. The monthly reports can be accessed below.
Healthy Connection Prime Eligible Beneficiaries
South Carolina’s Healthy Connections Prime demographic is composed of Medicare & Medicaid (dually eligible) beneficiaries 65 years and older. Beneficiaries in this demographic can enroll in Healthy Connections Prime if they meet the additional inclusion criteria by being:
- Full benefit Medicaid enrollees.
- Entitled to Medicare Parts A, B and D.
- Currently residing in a community setting in one of the participating counties.
- Meeting the above criteria, also enrolled in Community Choices Waiver, HIV/AIDS Waiver and Mechanical Ventilator Dependent Waiver.
Note: Members who join Healthy Connections Prime and later transition into a Long-Term Care Facility, elect Hospice, or develop the need for ESRD services may remain enrolled in the Healthy Connections Prime program. See the Provider Tool Kit or Member Tool Kit to understand better how this process works with Healthy Connections Prime.
County Participation Map
As of January 1, 2022, Healthy Connections Prime is available in every county in the state. Eligible members residing in South Carolina will be automatically assigned (passively enrolled) into a Medicare-Medicaid Plan versus needing to actively opt-in to the program.
View the individual plan participation by county.
- July 1, 2020 - Executed a contract amendment to extend the demonstration by three years to December 31, 2023.
- July 1, 2018 - Executed a contract amendment to extend the demonstration by two years to December 31, 2020.
- July 1, 2016 - Wave 2 passive enrollment begins (Southern Midlands to Lowcountry). Includes members who receive Home and Community Based Services.
- April 1, 2016 - Wave 1 passive enrollment begins (Upstate to Northern Midlands). Passive enrollment means individuals are auto-assigned to a plan. Does not include members who receive Home and Community Based Services.
- February 1, 2015 - The earliest effective date for active enrollment. Active enrollment means individuals sign up on their own to be members of the program.
- October 25, 2013 - SCDHHS signs Memorandum of Understanding with CMS
Capitation Rate Report
For information about how Healthy Connections Prime comprises Capitation Rates and rate-setting methodology, please view the report provided below.
- CY2023 Rate Report
- CY2022 Rate Report
- CY2021 Rate Report
- CY2020 Rate Report
- CY2019 Rate Report
- CY2018 Rate Report
- CY2017 Rate Report
- CY2016 Rate Report
- Wellcare Prime by Absolute Total Care, operated by Centene Corporation
- First Choice VIP Care PLUS, operated by Select Health of South Carolina
- Molina Dual Options, operated by Molina Healthcare of South Carolina
More Information About the State Demonstration
The State Demonstrations to Integrate Care for Dual Eligible Individuals, also known as the Capitated Model, is part of a CMS project called the Financial Alignment Initiative.
The ten states currently participating in the Capitated Model demonstration include:
Visit the CMS site and learn more about CMS’ initiative. As South Carolina is participating in the Capitated Model, please focus on content regarding that model for the most relevant information.
To learn about the status of each state’s participation in the financial alignment demonstration, visit the Kaiser Family Foundation’s website.
To review the South Carolina Three-Way Demonstration contract and other regulatory information, visit the CMS website.