South Carolina Medicaid Program-General Information

Program Description

  • Established by Title XIX of the Social Security Act
  • Provides quality health care to low income, disabled, and elderly individuals by utilizing state and federal funds to reimburse providers for approved medical services.
  • South Carolina Department of Health and Human Services (SCDHHS) is the single state agency designated to administer the SC Medicaid program.
  • SCDHHS administers the traditional fee-for-service Medicaid program and offers two (2) Medicaid Managed Care Programs.

Medicaid Managed Care Organization (MCO) Program

  • Consists of contracted MCOs that provide approved medical services through a developed network of providers
  • SCDHHS pays a capitated rate per member per month, according to age, gender, and category of eligibility to MCOs.
  • Payments for core services provided to MCO members are the responsibility of MCOs, not the fee-for-service Medicaid program.

Primary Care Case Management/Medical Homes Networks (PCCM or PCCM/MHN)

  • The MHN Program is a PCCM program.
  • An MHN is composed of a Care Coordination Services Organization (CSO) and the primary care providers (PCPs) enrolled in the network.
  • The CSO supports the member physicians by providing care coordination, disease management, and data management. 
  • The PCPs manage the health care of their patient members directly or authorizing another provider to treat the member.
  • The MHN receives a per-member-per month (PMPM) care coordination fee.
  • Reimbursement for medical services provided is made on a fee-for-service basis

Both MHNs and MCOs may elect to provide their members enhanced services beyond what is offered under traditional fee-for-service Medicaid.

SC Federal Qualified Health Centers participate in the traditional fee-for-service Medicaid program and the Medicaid Managed Care programs. Please contact the center in your area about the specific Medicaid Managed Care programs that are accepted.

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