Medicaid Q&A

Two men on a computer looking for Medicaid information

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HealthLinks sat down with Joshua D. Baker, the director of the South Carolina Department of Health and Human Services (SCDHHS), to discuss Medicaid and how it works for the residents of South Carolina. He answered questions about how to enroll, who is eligible for the program and what the benefits really are.

Q. In South Carolina, who can get Medicaid benefits?

A. Medicaid in South Carolina benefits the disabled, elderly, pregnant women, children and low-income families. If an individual or family needs health care, they should apply for Medicaid even if they are not sure if they are eligible.

Q. How much income can you earn and still receive Medicaid benefits in South Carolina?

A. When an individual or household applies to South Carolina Healthy Connections Medicaid for health coverage, the program considers many things to determine eligibility, including their personal situation. A person may be eligible if he or she is:

  • Pregnant or think she may be pregnant;
  • Is or has a child or teenager age 18 or under;
  • Is in foster care or adopted;
  • Has been diagnosed with breast or cervical cancer;
  • Is blind;
  • Has a disability or disabilities;
  • Needs nursing home care;
  • Is over the age of 65.

In South Carolina, individuals who receive Supplemental Security Income (SSI) from the Social Security Administration are automatically eligible for Medicaid.

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The amount of income a person or household earns impacts eligibility for Medicaid. For some of the Medicaid eligible categories, there is also a limit on the value of what a person owns. For those applying for longterm care Medicaid coverage, eligibility may be affected if the individual has given assets away. If an individual or family needs health care, they should apply for Medicaid even if they are not sure if they are eligible.

Q. In South Carolina, can you receive Medicaid benefits if you also have private health insurance?

A. Yes. Individuals or families can receive Medicaid even if they have private health insurance. Generally, Medicaid will cover all out-of-pocket expenses for beneficiaries with private health insurance coverage.

In some cases, South Carolina Healthy Connections Medicaid can assist beneficiaries in maintaining their private health insurance through the Health Insurance Premium Payment program (HIPP). Enrollment in HIPP is based on a cost-effectiveness determination. HIPP beneficiaries may qualify for coverage of their health insurance premiums for themselves and their eligible dependents. For more information about HIPP and to apply, visit www.scdhhs.gov/hipp.

Q. Are there health insurance programs run by the state of South Carolina for low-income residents who don’t qualify for the Medicaid program? If so, what are these programs and how can people apply for them?

A. If you do not qualify for Healthy Connections Medicaid, you may find an affordable option through the federal marketplace. Visit healthcare.gov or call 800-318-2596 for more information.

You can also contact SC Thrive at 800-726-8774 or visit them online at scthrive.org for an assessment of your household’s most likely health coverage options.

Q. How do you apply for Medicaid benefits?

A. There are multiple ways to apply for South Carolina Healthy Connections Medicaid. Applicants can pick up and complete an application in person at a local county office. To find your local county office, visit the SCDHHS website and click “Getting Medicaid” and then click on “Where to Go for Help.” Applications may also be submitted online (secure website at apply.scdhhs.gov), by mail or by telephone. Individuals can obtain a paper application by calling the Member Contact Center at 888-549-0820, requesting a copy at a local county office or downloading it from scdhhs.gov.

SC Thrive is available to assist with completion of a Healthy Connection Medicaid application or can take a person’s application by telephone. An individual can contact SC Thrive at 800- 726-8774 or visit their website at scthrive.org.

Q. Can a person have Medicare and Medicaid benefits at the same time?

A. An individual can have both Medicaid and Medicare in some circumstances. If a beneficiary receives both Medicaid and Medicare, Medicaid will usually pay the Medicare premium, co-payments and deductibles.

Q. How is the Medicaid program different from state to state?

A. Each state Medicaid program is unique and has its own set of eligibility requirements and covered services.

Q. What information do you need to provide to apply for Medicaid benefits?

A. Before an individual applies for Medicaid, he or she will need to know the following for all the people in their household:

  • Date of birth;
  • Social Security number;
  • Income from jobs or training;
  • Benefits received now (or received in the past), such as Social Security, Supplemental Security Income (SSI), veteran’s benefits or child support;
  • Payments for adult or child care health coverage or medical benefits you currently have.

For the disability based programs, Medicaid would need:

  • The amount of money in your checking account, savings accounts or other resources you own. For those applying for long-term care, Medicaid may need information about your monthly rent, mortgage payment and utility bills.

Q. Do you have to re-apply for Medicaid benefits every year?

A. Eligibility for most Healthy Connections programs lasts for one year. After one year, the South Carolina Department of Health and Human Services will review your case annually.

Q. What services does the Medicaid program pay for?

A. Within certain limits, Medicaid will pay for services that are medically necessary. Examples of services that may be covered include doctor visits, medications, hospital visits and many other medical services.

If an individual has any questions about what is covered and is currently enrolled in a managed care plan, he or she can visit www.scchoices.com to view a comparison chart that shows each health plan and what they cover or can contact the managed care plan he or she is enrolled in. People can also contact the Healthy Connections Member Contact Center at 888-549-0820.

Q. Are Medicaid beneficiaries required to notify the state about changes in income?

A. Yes. If a beneficiary has had any changes to income, resources, living arrangements, address or anything else that might affect eligibility (for example, a child moved out or spouse went to work), he or she must report these changes to Healthy Connections Medicaid right away at 888-549-0820.

Q. Can people who are not citizens of the United States receive Medicaid benefits?

A. To obtain full Medicaid benefits in South Carolina, an individual must be a South Carolina resident and either a U.S. citizen or a legally residing non-citizen. Non-citizens may qualify for coverage for emergencies and labor and delivery services if income requirements are met.

Q. How many people are in the Medicaid program in South Carolina? How many of those are children?

A. The South Carolina Healthy Connections Medicaid program serves over 1 million people, of which more than 650,000 are children.

Q. Do private companies offer Medicaid plans to South Carolina residents? How does that work?

A. Once an individual is enrolled in health coverage through Healthy Connections Medicaid, he or she might be required to select a health plan (some eligibility groups cannot enroll in a plan). A health plan is a group of doctors (or clinics) that may also include hospitals and other medical staff. Health plans offer the same benefits as regular Medicaid but also offer extra services that may help you and your family get better care. Some plans offer vision and dental care, and all plans help with managing diseases like diabetes and high blood pressure. They also have a nurse help line you can call any time with health care questions.

If a beneficiary is eligible to participate in a health plan, he or she will receive an enrollment packet in the mail from South Carolina Healthy Connections Choices. This packet contains a letter, health plan comparison chart for the county in which they reside, information on how to choose a plan and a return envelope. For assistance in making a health plan choice, individuals should call 877-552-4642 (toll-free) Monday through Friday, 8 a.m. to 6 p.m., visit the South Carolina Healthy Connections Choices website at www.scchoices.com or ask their doctor for assistance.

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