Program Description

• Establish 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 Programs

Medicaid Managed Care Organization (MCO) Program

• Consist 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.