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Becoming Eligible for Medicaid

The first step in getting Medicaid is to apply to the South Carolina Department of Health and Human Services (SCDHHS). They will determine if you qualify for Healthy Connections Medicaid.

Step 1 – Am I eligible for Medicaid?

Healthy Blue understands just how important quality health care is for families, and we are contracted by the South Carolina Department of Health and Human Services (SCDHHS) to provide our Healthy Blue Medicaid benefits and services to eligible South Carolinians.

South Carolina’s Medicaid program is called Healthy Connections Medicaid. It is administered by SCDHHS to provide health services for adults, children and families who meet certain non-financial, financial and other specific conditions. If you or your family are determined eligible for Healthy Connections Medicaid, services include physical exams, prescription drugs, as well as medical, laboratory, and transportation services — and much more!

 

How do I know if I’m eligible for Medicaid?

You may be eligible for Healthy Connections Medicaid if any of the following are true for you or someone in your household:

  • You’re pregnant or think you may be pregnant
  • You are or have a child or teenager age 18 or under
  • You or your child is in foster care or adopted
  • You have been diagnosed with breast or cervical cancer
  • You’re blind
  • You have a disability or disabilities
  • You need nursing home care
  • You’re over the age of 65
  • You have very low or no income

Apply for Healthy Connections Medicaid even if you don’t think you qualify. Depending on your situation, some income and assets (like home ownership) may not count against you.

To learn more about Healthy Connections Medicaid:

  • Call Healthy Connections at 1-888-549-0820  (TTY 1-888-842-3620) Monday through Friday from 8 a.m. to 6 p.m. Eastern time (except South Carolina state holidays).
  • Go to the Healthy Connections Medicaid website and view their Frequently Asked Questions page.
  • Call SC Thrive at 1-800-726-8774 Monday through Friday from 8:30 a.m. to 5 p.m. Eastern time.
  • Go to the SC Thrive Site Locator to see a list of SC Thrive locations in your area.
  • Go to the SC Thrive Quick Check webpage to check your eligibility.
What information do I need to apply for Medicaid?

For everyone in your household, you’ll need the following to apply for Healthy Connections Medicaid:

  • Full name(s)
  • Date(s) of birth
  • Social Security number(s)
  • 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
  • Amount of money in your checking account, savings account or other resources you own
  • Monthly rent, mortgage payment and utility bills
    *Healthy Connections Medicaid does not consider these items to be deductions.  Payments or other amounts of money you pay for other health insurance you have
  • Payments or other amounts of money you pay for other health insurance you have
How do I apply for Medicaid?

First, make sure you’re eligible. To see if you qualify for Healthy Connections Medicaid, you must first submit an eligibility application to the South Carolina Department of Health and Human Services (SCDHHS). They will determine if you are eligible. You may apply as follows:

  • Over the Phone — contact any of the following for application information.
    • Healthy Connections Medicaid Resource Center at 1-888-549-0820 (TTY 1-888-842-3620) Monday through Friday from 8 a.m. to 6 p.m. Eastern time (Except South Carolina state holidays)
    • SC Thrive Contact Center at 1-800-726-8774 Monday through Friday from 8:30 a.m. to 5 p.m. Eastern time
  • In Person — go to your local:
  • Online –
    • Visit apply.scdhhs.gov to start the online application process.
    • Download a Healthy Connections Medicaid application

      Find the application you need by going to the coverage group table. If you don’t know which application to choose, call Healthy Connections at 1-888-549-0820 (TTY 1-888-842-3620) Monday through Friday from 8 a.m. to 6 p.m. Eastern time (Except South Carolina state holidays).
  • By mail — Send your completed Healthy Connections Medicaid applications to:
    SCDHHS
    P.O. Box 100101
    Columbia SC 29202-3101
How do I know if I’ve been approved for Medicaid?

It can take up to 45 days for Healthy Connections Medicaid to determine eligibility. Sometimes it can take longer depending on the type of Medicaid program you’re applying for.

You’ll get a letter (called a determination letter) telling you whether or not you’re approved or denied for Healthy Connections Medicaid benefits. Or, you may be asked to send more information to support your Healthy Connections Medicaid application.

What happens after I’m told I qualify for Medicaid?

If you are approved for Medicaid, South Carolina Healthy Connections Choices will send you an enrollment packet.

The packet will include:

  • How to choose your health plan and doctor — important tips and details about getting health care services.
  • Health plan and doctor selection form — use this form to choose a health plan and doctor, or primary care provider (PCP), for each person in your family who qualifies for Healthy Connections Medicaid. You need to choose a health plan within 60 days of receiving your Healthy Connections Medicaid enrollment packet, or one will be assigned for you. You can also choose a PCP at this time — or one will be assigned for you as well.
  • Health plan comparison chart — all health plans cover the same basic services. The chart compares the extra benefits offered by each South Carolina Medicaid health plan.
  • Well-child guide — tells you when to get your child’s FREE medical and dental checkups.
  • Pregnant women and new moms flyer (If applicable) — explains the importance of choosing a health plan and doctor, or PCP for your new baby.
  • Return envelope — use this postage-paid envelope to send back your completed health plan and doctor selection form.

You will also receive a South Carolina Healthy Connections Medicaid member ID card. Keep it with you at all times, and don’t let anyone else use it. However, you still need to complete the enrollment packet and choose a health plan.

For Enrollment packet information:

  • Go to the South Carolina Healthy Connections Choices website — www.scchoices.com
  • Contact the South Carolina Healthy Connections Choices Customer Service Center
    • 1-877-552-4642 (TTY 1-877-552-4670)
    • Fax 1-877-552-4672 Monday through Friday from 8 a.m. to 6 p.m. Eastern time (except South Carolina State holidays)

Find out how to choose Healthy Blue and your PCP.

How do I choose a health plan after I find out I qualify for Medicaid?

Once you find out you’re eligible for Healthy Connections Medicaid, you’ll get an enrollment packet from Healthy Connections Choices. You’ll have at least 60 days from the date you receive your Healthy Connections Choices enrollment packet to choose a health plan. Healthy Connections Choices  will assign you to a plan if you don’t choose one.

Learn more about how to choose Healthy Blue.

Do you already have Medicaid and you just had a baby?

Congratulations on the birth of your new baby! Please notify Healthy Connections Medicaid immediately following the birth of your newborn. Healthy Connections Choices will automatically enroll your baby in the same health plan as you on the month of your child’s birth. In addition, you will receive a Newborn Confirmation Notice via mail. So if you are a Healthy Blue member, your newborn will be covered by the same health plan as you.

Choosing a health plan for your newborn if you don’t have Medicaid:

If you’re not enrolled in Healthy Connections Medicaid at the time of your delivery, you’ll need to choose a health plan for your baby. Once your baby is deemed Medicaid eligible, you will receive an enrollment packet and will have at least 60 days to select a health plan. If you do not choose a health plan, Healthy Connections Choices will assign your baby to a health plan.

If you choose Healthy Blue for your newborn, you may be able to get extra benefits like FREE car seats and no copays for urgent care and preventive visits for adults age 21 and older.

To choose Healthy Blue, please call South Carolina Healthy Connections Choices Customer Service Center and tell them you want to enroll in Healthy Blue. You can call them at:

  • 1-877-552-4642 (TTY 1-877-552-4670) Monday through Friday from 8 a.m. to 6 p.m. Eastern time (except South Carolina state holidays)

How to transfer your newborn to Healthy Blue if you are a member of another health plan or if your baby has been assigned to another health plan:

If you are covered by a different health plan, and would like to choose Healthy Blue for your newborn, contact Healthy Connections Choices within 90 days of your newborn’s enrollment effective date to request a health plan transfer:

  • South Carolina Healthy Connections Choices Customer Service Center : 1-877-552-4642 (TTY 1-877-552-4670) Monday through Friday from 8 a.m. to 6 p.m. Eastern time (except for South Carolina state holidays)
  • Fax: 1-877-552-4672

How to transfer your newborn from their current health plan to Healthy Blue:

Ask for a health plan transfer within 90 days of your newborn’s enrollment effective date. If you don’t request a transfer within that time, your newborn will be locked into their current health plan for one year. You’ll need to complete and submit a Disenrollment Change Request (DCR) form to request a transfer after the first 90 days.

To get a DCR form and to transfer your newborn to Healthy Blue, call or fax the South Carolina Healthy Connections Choices Customer Service Center:

  • Call: 1-877-552-4642 (TTY 1-877-552-4670) Monday through Friday from 8 a.m. to 6 p.m. Eastern time (except South Carolina state holidays)
  • Fax: 1-877-552-4672

Choose a Doctor or Primary Care Provider (PCP)/doctor for your Newborn:

If you’re our member, please call us as soon as you know you’re pregnant or once your baby is born to choose your baby’s primary care provider (PCP)/doctor.

  • Call the Healthy Blue Member Customer Care Center at 1-866-781-5094 (TTY 1-866-773-9634) Monday through Friday from 8 a.m. to 6 p.m. Eastern time.

We’ll assign your newborn a PCP/doctor if you don’t choose one yourself.