Health Insurance for Low-Income
The South Carolina Medical Assistance Program, also known as Medicaid, is a Federal and State funded program providing medical and health-related services for eligible South Carolina residents. The Executive Office of Health and Human Services (EOHHS) administers the Medicaid program to provide health insurance for low-income families with children, pregnant women, senior citizens, people with disabilities or special needs, and other residents struggling to access affordable healthcare.
South Carolina Medicaid Plan Options
Healthy Connections is the South Carolina Medicaid program and is provided through a Managed Care Organization. The following carriers have partnered with South Carolina to provide Medicaid coverage to residents:
- Absolute Total Care
- BlueChoice HealthPlan Medicaid
- First Choice by Select Health of South Carolina
- WellCare
- Molina Healthcare of SC
The following individuals are eligible for South Carolina Medicaid:
- Aged, blind, or disabled
- Children 0 - 18 with a household income less than 208% of the Federal Poverty Limit (FPL)
- Parents with a dependent and a household income less than 89% of the FPL
- Pregnant women with a household income less than 194% of the FPL
Additional Services Provided Through Healthy Connections
In addition, the following services are available through Healthy Connections:
Family Planning Service - South Carolina Medicaid covers family planning services including consultation and treatment. This may include initial physical examinations and health history, annual and follow-up visits, laboratory services, prescribing and supplying contraceptive supplies and devices, counseling services, and prescribing medications for specific treatment.
Youth Aged out of Foster Care - The South Carolina Medicaid program provides healthcare coverage for individuals that age out of foster care on their 18th birthday. Coverage continues until age 26 regardless of income.
Women's Cancer Screening Programming - covers uninsured or underinsured women at specific income levels who need screenings for breast or cervical cancer. The program also provides diagnostic services and follow-up when an abnormality is found.
Long-term services and support (LTSS) - is available for adults with disabilities that need both medical care and non-medical living support to assist with normal daily tasks. Medicaid LTSS for adults with disabilities covers care provided at home and in community settings as well as in health facilities like hospitals and nursing homes.
Home and Community-Based Services - Waiver Programs South Carolina Medicaid Long-Term Services and Supports provides opportunities for children, older adults, or the disabled to continue participating in their community activities. Services range depending on the situation, but the goal is to improve the qualify of life of the entire family.
The Program of All-inclusive Care for the Elderly (PACE) - is a care model for acute and long-term care individuals age 55 and older that meet state specific criteria for nursing home care placement. The goal of PACE is to maximize the participant’s autonomy and ability to reside in their community, while receiving quality care at a lower cost relative to the Medicare, Medicaid, and traditional private pay programs.
Medicare Costing Savings programs
The purpose of Medicare Costing Savings programs is to assist individuals in paying their Medicare premiums and by making payments to medical providers for coinsurance and deductibles for Medicare services.
The Qualified Medicare Beneficiary (QMB) program pays for Medicare Part B premiums, coinsurance, and deductibles for those eligible and enrolled in Medicare Part A.
The Specified Low Medicare Beneficiary (SLMB) program provides payment of Medicare Part B premiums only for individuals who would be eligible for the QMB program except for excess income.
The Qualified Individual (QI-1) program provides payment of Medicare Part B premiums only for individuals who would be eligible for the SLMB program except for excess income.
The Qualified Disabled Working Individual (QDWI) program provides payment of Medicare Part A premiums only for individuals meeting income limits.
Additional South Carolina Medicaid FAQs
- What is Medicaid?
Medicaid is a state funded insurance that that provides coverage to low income families, pregnant women, newborns, and children that may not be able to afford to purchase their own care.
- Who is eligible for Medicaid?
The following individuals are qualified for South Carolina Medicaid:
- Children 0-18 years with a household income less than 200% of the Federal Poverty Line (FPL - Current Income Limit);
- Pregnant women with a household income less than 185% of the FPL;
- Parents with dependents and a household income 50% of the FPL.
- How do I find out if I am eligible for Medicaid?
To find out if you are eligible for Medicaid, you must fill out an application for Medicaid or CHIP. You may fill out an application at any time of the year. See more on Medicaid.
- Will Medicaid cover my children?
Your household income level will determine if your child or children can be covered by Medicaid.
- What is CHIP?
CHIP is a program that supports children in families that cannot afford private health insurance, but whose household income is too high to qualify for Medicaid.
- Does Medicaid satisfy the health insurance requirement?
Yes, Medicaid will satisfy the Affordable Care Act (Obamacare) health insurance requirement for the covered individuals.
- What information and documents should I have when I'm signing up for Medicaid?
Depending on the Medicaid program being applied for, you will need the following: Identity, Social Security, proof you live in South Carolina, proof of income, proof of medical costs, and bank account information.
- How does Obamacare work with Medicaid?
Because of South Carolina's Medicaid eligibility requirements, Obamacare does not impact people who qualify for Medicaid and vice versa. As such, tax credits are only available for people who are not eligible for other plans.
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