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.
- 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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