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