Medicaid Rules for South Carolina

Medicaid rules for South Carolina govern the administration of the state and federally funded insurance that pays for the medical needs of low-income individuals. South Carolina, like other states, operates its own Medicaid program. The federal government allows South Carolina to develop the rules and service for its program. South Carolina's Medicaid program goes under the name of Healthy Connections Program.

Eligibility

• South Carolina Medicaid regulations provide coverage for pregnant women, low-income families, the totally and permanently disable and those under age 19 or 65 and older. A relative serving as caretaker for a child under age 18 may also be eligible for Medicaid. In addition, the individual must meet the state's requirements for income and asset and other conditions such as U.S. citizenship and residency in the state.

  Apply for the program at the county offices for the Department of Health and Human Services or most hospital or federally authorized rural health facilities. Once determined eligible, beneficiaries must report changes in address to their eligibility worker. People must also report changes in income, assets or household to the eligibility worker.

Income Requirements

• In some cases, more than one income criterion may apply. As of November 2010, the state has a $2,022 income limit for individuals and $2,739 for spouses. Disabled, blind or those age 65 or over may earn $903 for singles and $1,215 for a family of two. Low-income families have a gross income limit that ranges from $835 for individuals to $2,853 for a family of eight. The category of working disable has a $ 2,257 for one up to $7,711 for a family of eight.

Providers

• Beneficiaries may choose any physician, pharmacy, hospital or health-care service provider as long as the provider accepts Medicaid. Individuals may also go through certain approved managed care organizations, or MCOs. An MCO requires physicians, hospitals, clinics, drug stores and other service providers to sign service agreements with the MCO. Medicaid recipients must select a primary doctor who has the responsibility coordinating all care needs for the insured.

  Individuals may also choose a medical home network. Located in specific areas of the state, an MHN comprises local doctors who work with individuals to manage their health-care needs. In addition, people may decide on the pharmacy.

Services

• The states pays for adult physicals every five years. The program also pays for child checkups, under a program called Early and Periodic Screening, Diagnosis and Treatment, at various age intervals between birth and age 21. Wellness checkups include physicals, nutrition, certain shots, vision, dental and hearing. Medicaid pays for a dental exam for a child every six months. The program covers adults only for emergency dental treatment. Children can receive one vision exam and one pair of eye glasses each year. Adults may receive a vision exam each year. Medicaid allows one pair of lenses after cataract surgery.