I have a child diagnosed with Autism Spectrum Disorder (ASD) and I heard there are new services from Medicaid. Can you tell me more about this?
Any beneficiary 0-21, diagnosed with ASD and who meets medical necessity, is eligible for ASD treatment services.
How do I know if my child meets medical necessity for ASD services?
In order to meet medical necessity for ASD services, beneficiaries age 0-21 need to have a diagnosis of ASD based on a comprehensive testing report from a psychologist, licensed psychoeducational specialist (LPES) or developmental pediatrician that indicates that ASD treatment services are necessary for their behavioral health care. Psychologists, LPES or developmental pediatrician providers can be found using the SCDHHS website provider search, and searching for the provider type “Medical Professional.” Once in the search engine, psychologists or LPES providers can be found. You may also download the Comprehensive Psychological Assessment Provider Directory (PDF) for a listing of providers who can complete a comprehensive psychological assessment for an ASD diagnosis.
How do I apply for ASD treatment services?
Medicaid ASD services are based on medical necessity. In order to apply for Healthy Connections Medicaid ASD treatment services, the following information is required: beneficiary must be between 0-21 years old, Healthy Connections Medicaid member identification (ID) number and a comprehensive assessment report with established diagnosis of ASD.
Please contact an ASD provider directly to assist in requesting an authorization for ASD program services.
How do I find a provider?
Visit the find an autism provider page or use the SCDHHS provider search tool to find a Medicaid provider. Medicaid covers applied behavior analysis (ABA) as well as other evidence-based treatments. Nationwide, and in South Carolina, there is a need for increased capacity of ASD providers. It is not uncommon for providers to have a waiting list for services.
What are the steps once I find a provider for ASD treatment services?
ASD treatment providers are responsible for obtaining prior authorization for any assessment or ASD treatment services. Once authorization is given, the provider can begin seeing the beneficiary up to the maximum allowable hours that are approved for each beneficiary.
If my child was already approved for services under the ASD Interim Services process, will I have to resubmit any paperwork?
If your child already has an authorization via the ASD Interim Services process, you will not need to resubmit paperwork; your child will continue to be eligible to receive up to the authorized amount on your letter.
If my child is in a managed care organization (MCO), will they be eligible for ASD treatment services?
Yes. Contact your MCO about receiving services for your beneficiary ages 0-21.
Who do I call if I have questions regarding my MCO benefits?
If you have questions please contact your MCO at the member service phone number below:
- Absolute Total Care: 866-433-6041
- Healthy Blue (formerly BlueChoice Healthplan): 866-781-5094
- Molina Healthcare of South Carolina: 855-882-3901
- Humana Healthy Horizons: 866-432-0001
- Select Health: 888-276-2020
How do I know if I am in managed care or fee-for-service?
Contact the Member Service Center at 888-549-0820.
Will I have to signup annually with an MCO?
You will remain in the same managed care plan unless you choose otherwise. Upon completion of the MCO’s annual review process, you will have a 90-day window to change health plans. You will receive an annual anniversary letter to inform you that you may make a change in your health plan enrollment.
How is it determined which MCOs I can enroll with?
Your choice is dependent upon plans that are available within your county of residence at the time the choice is made. All plans are not available in every county within the state. You may choose a plan that is not available within your county of residence, but you must identify a reason for choosing such a plan.
Can I change the MCO I am enrolled in?
All enrollees have an annual 90-day choice period during which a change may be made to their health plan. Beneficiaries required to participate in managed care may choose to transfer to another MCO during the 90-day period.
What phone number should I call to change health plans?
The beneficiary should contact South Carolina Healthy Connections Choices (SCHCC) at 877-552-4642.
Will all of my children be enrolled within the same MCO?
Each person in your family can have a different health plan, but it may be easier to have the same plan for everyone.
Who do I contact if my child is not in an MCO?
Please contact SCDHHS at firstname.lastname@example.org or (803) 898-2565.
What happens after my child turns 21?
ASD services are covered through the age of 21. However, your child may be eligible for other services covered under the Medicaid State Plan.
If my ABA therapy provider accepted me as a Medicaid beneficiary, can they bill me for ABA services?
Medicaid members can be asked to pay for services not covered by Medicaid and services for which you have already reached the allowable limit. Please be aware of the Health Insurance Premium Payment (HIPP) program which can help offset any additional costs that may occur.
How do I apply for South Carolina Healthy Connections Medicaid?
To apply for Healthy Connections, you will need to complete and submit an application.
SC Thrive is available to assist you with the online Healthy Connections application and can provide an assessment of your household's most likely health coverage options. Please contact their help line at (800) 726-8774 or visit them online at scthrive.org if you have questions or need assistance. You may also apply in person at your local county office or contact our main customer service line at (888) 549-0820. In addition, you may apply in person at federally qualified rural health centers and at some hospitals.