South Carolina Primary Health Care Association - Programs & Services - FQHC Revenue Cycle - 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.
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.