Are you a Healthy Connections Medicaid member who has recently moved? We've got a new and easy way for you to update your address! Visit apply.scdhhs.gov to find our change of address portal. We always need your current information so we can send you any updates about your Medicaid coverage.
Now you can submit requested info, report a change in income, return an annual review or submit other documents online using SCDHHS' Document Upload tool. SCDHHS will use the info you give to match your uploaded documents with your Medicaid application, if you have one. We will also use the contact info you provide to reach out to you if we have any questions about the documents
General Application and Supporting Forms
- Healthy Connections Application
- Additional Information for Select Medicaid Programs
- Additional Information for Nursing Home and In-Home Care
- Additional Person in Household
- American Indian or Alaska Native Family Member
- Breast & Cervical Cancer Application Addendum
- Tuberculosis (TB) Referral
- Request for Retroactive Medicaid Coverage
Specialty Applications and Supporting Forms
- TEFRA Application
- TEFRA Letter to Parent
- TEFRA Application Checklist
- Family Planning Application
- Single Person Household
- Application for Nursing Home, Residential or In-Home Care
- Income Trust Agreement
- Management of the Income Trust
- Income Trust Checklist
- Income Trust Schedule A
- Resource and Asset Statement for Community or Separated Spouse
Disability Determination Forms
- Adult Disability Report
- Adult Disability Application Checklist
- Substantial Gainful Activity Questionnaire
- Child Under Age 19 Disability Report
- Childhood Disability Application Checklist
- Adult Continuing Disability Review
- Child Under Age 19 Continuing Disability Review
- Authorization to Disclose Health Information (Request for Medical Records)
Miscellaneous Forms
- Authorization for Release of Information and Appointment of Authorized Representative for Medicaid Applications/ Reviews and Appeals
- Revocation of Authorization to Disclose Health Information
- Request for Fair Hearing for Medicaid Applicant and Beneficiary
- Confidential Complaint - Reporting Fraud
- Request for Change of Medicaid Information
- Addendum for Medicare Savings Programs
- Medical Support Referral
- Revocation of Authorization to Disclose Health Information
Revocation of Authorization to Disclose Health Information Form
- For use by the Department of Public Health (DPH)