Frequently Asked Questions

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South Carolina Healthy Connections Choices is a program that helps eligible Medicaid members enroll in health plans.

When members enroll (or join), they can choose both a health plan and a doctor (or clinic). South Carolina Healthy Connections Choices helps members choose the health plan and doctor that is best for them and their families.

A Medicaid eligibility worker will determine whether or not you are eligible for South Carolina Healthy Connections based on the information you gave in your Medicaid application. In order to get benefits, you must meet certain financial and non-financial requirements and belong to one of the following groups: pregnant; age 65 or older; blind or totally and permanently disabled; under the age of 19; or a parent or caretaker relative living with a child under age 18 (low-income families).

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 you have any questions about what is covered, click here to view a chart that shows each health plan and what they cover. You can also contact your Medicaid eligibility worker or call the South Carolina Healthy Connections Resource Center toll-free at 1-888-549-0820.

You must complete an application and mail it or drop it off at your local Medicaid office.

You can get an application from the South Carolina Department of Health and Human Services website at www.scdhhs.gov, or you can pick one up in person at any Department of Health and Human Services county office. You can also apply at any federally qualified rural health center and at most hospitals.

If you have questions or need help completing your application, call the South Carolina Healthy Connections Resource Center toll-free at 1-888-549-0820.

South Carolina Health and Human Services will let you know your Medicaid status in writing within 45 days after you have submitted your application.

If your case involves a disability determination, you will be told within 90 days after you have submitted your application.

Eligibility for most South Carolina Healthy Connections programs lasts for 1 year. After 1 year, South Carolina Health and Human Services will review your case annually.

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.

Joining a health plan is a good idea for many reasons. When you choose a health plan, you can choose your own doctor (or clinic). That doctor will be your primary care physician (PCP). Your PCP will be your main doctor—they will provide most of your medical and health care and help you stay healthy. You can also go to a specialist when you need to. A specialist is a doctor who treats only certain parts of the body or illnesses, like a cardiologist (heart doctor) or an allergist (for allergies).Your health plan can even help coordinate your care when you need to see more than 1 doctor or specialist. This helps eliminate extra visits and duplicate tests.

Look at the Health Plan Comparison Chart. This chart shows you which plans you can choose from and what benefits and services they provide.

You can also view the chart that came in your Welcome Packet.

If you have questions or need help, call our Customer Service Center at 1-877-552-4642.

Choosing a health plan and a doctor for each member of your family in the program is as easy as 1-2-3. Here’s how:

Step 1: Think about your family’s health needs.
To start, think about and write down:

  • The doctors you want to see.
    • Do you have a doctor you and your family already like? Or is having a doctor close to where you live or work more important?
    • You can search for a doctor by name, distance, or specialty (such as pediatrics) by clicking here.
  • Which hospitals, clinics, and pharmacies you want to use.
    • Do you want them to be close to your home, your job, or your kids’ school?
  • Other services or benefits that you need.
    • Do you or your family members have special health conditions? If so, choose a health plan that lets you keep getting treatment. Special health conditions include asthma, diabetes, pregnancy care, mental health services, and physical therapy.
Step 2: Find out what each health plan offers.
  • Click here to compare the services each health plan offers and to find out which plans work with the doctors, hospitals, clinics, and pharmacies you want to use.
  • Choose a plan that lets you go to the doctors and clinics you want, and gives you the services you need.
  • Each person in your family can have a different health plan, but it’s easier to have the same plan for everyone.
Step 3: Tell us your choices.
Choosing is easy!
  • The fastest and easiest way to choose the health plan and doctor you want is online.
    • At the top of the page, click “Enroll Now.”
    • Enter your Member ID and PIN (you can find both numbers on the first page of the letter that came in your Welcome Packet).
    • Click on “Continue.” Follow the easy instructions to choose your health plan and doctor.
  • You can also call our Customer Service Center at 1-877-552-4642. We can help you in the language you speak.
  • Or fill out the Health Plan and Doctor Selection form. Mail it back in the envelope provided or fax it to 1-877-552-4672.

The Health Plan Comparison Chart shows the services that each plan offers. Use it to compare the plans in your area. Then choose the one that best meets you and your family’s needs.

  • The top row shows the name of each health plan.
  • The left-hand column shows a list of the types of benefits and services.
  • A shows that the plan offers that service.
  • A means the plan does not offer that service.
  • To see details about each plan, click on the “See Details” link under the health plan name.
  • To compare each plan's services, click on the “See Details” link next to the name of each service. Since each plan may offer slightly different options for the same service, it’s a good idea to compare the details of the services that are important to you.
  • To see details for all of the plans and all of the services, click on the “See All” button.

Yes. You must select a health plan and primary care physician (PCP) for each member of your family who is in the program. Use the “How to Choose a Health Plan and Doctor” guide to help you find the health plans and PCPs that meet you and your family’s needs. Click here to see the guide.

No. You can choose a plan first or a doctor first. It’s up to you. If you pick a doctor first, we’ll tell you which health plans work with that doctor. Then you can choose one of those plans. If you pick a plan first, you can then select a doctor who works with that plan.

Yes. You can change your health plan once within the first 90 days of when you enrolled. To change health plans, click here. To log in, use your Member ID and PIN. Click “Continue,” and follow the easy instructions to change your health plan and doctor. Or call our Customer Service Center at 1-877-552-4642.

If you don’t change plans in 90 days, then you must stay in the health plan for at least 1 year, unless you can show a good reason to change.

You may have health care coverage from another insurance company and still be eligible for South Carolina Healthy Connections. It is important to tell your local Medicaid eligibility worker if your other insurance coverage changes.

A primary care physician (PCP) is your main doctor. This doctor will provide most of your medical and health care, and will help you stay healthy. Your PCP can refer you to specialists if you need them.

Click here to search for a doctor. It lists all the primary care physicians (PCPs) participating in the South Carolina Healthy Connections program. It also shows the languages each doctor speaks. Check to make sure that the doctor you want as your PCP works with your health plan.If you need help choosing a PCP, call your health plan or call the Customer Service Center at 1-877-552-4642.

Yes, you can stay with your doctor if your doctor:

  • Works with one of the health plans that is part of the South Carolina Healthy Connections program
  • Serves your region
Many doctors work with the program. Ask your doctor if they are a part of the program. If not, search for your doctor by clicking here.

Maybe. First, check the spelling of your doctor’s name to make sure you typed the correct name in the search field on the “Find a Doctor” page on this website. If their name isn’t listed, then call your doctor to ask if they work with the South Carolina Healthy Connections program. If they say yes, call the Customer Service Center at 1-877-552-4642 to choose this doctor.

Yes. You can change your primary care doctor at any time by calling your health plan. You can find the number on your health plan ID card (if you received one) or you can look it up by clicking here.

To get medical care, call your PCP (doctor). You can find your PCP’s phone number on the front of your health plan ID card (if you received one) or you can look up by clicking here.

Your PCP will help you get all of the health services you and your family need. Even if you’re healthy, you should set up an appointment with your doctor. If you have never seen this doctor before, you should see them as soon as possible.

When you go to your doctor appointment, remember to bring your Medicaid card and health plan ID card (if you received one).

Dental coverage is available for children under the age of 21.

Members over the age of 21 may be eligible for dental services only if the services are needed in preparation for or during the course of treatment for one or more of the following conditions: organ transplants; chemotherapy for cancer treatments; radiation of the head and/or neck for cancer treatments; total joint replacement; heart valve replacement; or treatment of trauma related injuries administered in a hospital or outpatient facility. Oral surgery services are also available for adult members in the event of an emergency.

Some of the health plans offer adult dental programs. Look at the Health Plan Comparison Chart to find the plans in your area that offer this benefit.

It depends. Some members may have to pay a small co-payment for some services. If the doctor or clinic accepts you as a Medicaid patient, you can only be asked to pay for:

  • Allowed co-payments
  • Services that are not covered
  • Services for which you have already used more than the allowed limit
Always ask if the services your doctor says you need are covered by your health plan.If you have any questions about co-payments, please ask your Medicaid eligibility worker or call the South Carolina Healthy Connections Resource Center toll-free at 1-888-549-0820.

Your South Carolina Healthy Connections benefits begin on the date noted in your Welcome Letter. Once your South Carolina Healthy Connections application is approved, your will get this letter in the mail.

You will receive a Medicaid ID card from South Carolina Healthy Connections when you are approved for Medicaid. If you choose one of the following health plans, you will also get an ID card from them: Absolute Total Care, BlueChoice HealthPlan Medicaid, First Choice by Select Health of South Carolina, Advicare, Molina Healthcare of SC, and WellCare.

Your Member ID and PIN are special identification numbers that show you’re a member of the South Carolina Healthy Connections program. You can find your Member ID and PIN in your letter from South Carolina Healthy Connections. Click here to see what it looks like.

You need your Member ID and PIN numbers to log in to your account online. You also need your Member ID number when you call our Customer Service Center.

If you don’t have your Member ID and PIN, go to the “My Account” page. Click on the “Forgot Pin” link.

If you still cannot log in, call the Customer Service Center at 1-877-552-4642.

All health plan selection materials for the South Carolina Healthy Connections program are available in English and Spanish.

If you need help in another language, call the Customer Service Center at 1-877-552-4642. We can help you in the language you speak.

Contact your local Medicaid eligibility worker for information on how to reapply for South Carolina Healthy Connections benefits.

Call your health plan. The number is on your health plan ID card (if you received one) or you can look it up by clicking here.

If you can’t get the help you need at the member services office, call our Customer Service Center at 1-877-552-4642. If you have hearing loss, call TTY at 1-877-552-4670.

Try entering your Member ID and PIN again, checking the numbers carefully. If the website still shows the wrong person, call the Customer Service Center at 1-877-552-4642.

Yes. If you have any changes to your income, resources, living arrangements, address or anything else that might affect your case (for example, child moved out or spouse went to work) you must report these changes to your local Medicaid eligibility office right away.

You can file a complaint by calling our Customer Service Center at 1-877-552-4642. . If you have hearing loss, call TTY at 1-877-552-4670. Filing a complaint will not affect your health care benefits in any way.

We’ll discuss the problem with you and see how we can help you resolve it. If your complaint is about your health plan, such as having a medical service delayed or denied, we’ll help you call your health plan and get your issue resolved.

To find answers to your questions online, click the links below based on what you want to know:

Or call our Customer Service Center toll-free at 1-877-552-4642.

If you are a new Medicaid member, you will get a Welcome Packet in the mail. As soon as you get it, you can enroll. Other eligible Medicaid members in the household can enroll in a health plan at any time.

For initial enrollment, you have at least 30 days from the day we mail the enrollment packet to choose a health plan. If you don’t choose a plan, we may assign a plan for you. It’s better if you make the choice.

Once you are in the South Carolina Healthy Connections program, you will receive all of your current Medicaid benefits plus any extra benefits provided by your health plan.

If you are not able to find what you need on our website, call our Customer Service Center at 1-877-552-4642 or TTY at 1-877-552-4670. It is open Monday through Friday, from 8 a.m. to 6 p.m. We can help you in the language you speak.