Medicaid is South Carolina's grant-in-aid program by which the Federal and State governments share the cost of providing medical care for needy persons who have low income. South Carolina began participation in the Medicaid Program in 1968.
Individuals who meet financial and categorical requirements may qualify for Medicaid. States are required to cover certain groups (mandatory groups) and states are given the option of covering other groups (optional groups).
Historically, Medicaid eligibility rules have been closely linked to those of the cash assistance programs such as the Family Independence Program (FIP), previously known as Aid to Families with Dependent Children, or the Supplemental Security Income (SSI) program. However, in recent years, Congress has given states more flexibility in establishing policies for the different coverage groups. At the same time, Congress has added more mandatory coverage groups and placed more requirements on some of the services provided. See the Medicaid Program - Services topic for detailed information about the types of services provided.
Because the State and Federal governments share the cost of the Medicaid Program, States are given some flexibility in providing coverage to its needy citizens. For this reason, the rules for Medicaid coverage vary from state to state.
The South Carolina Medicaid Program sponsors the payment of long-term care for those individuals who reside in licensed and certified nursing facilities. Medicaid also pays for special services for those individuals who participate in Home and Community Based Waiver services. The same eligibility requirements apply for both programs. The difference is that the individuals who need nursing home care, but who choose to stay at home rather than going to an institution, can receive special services through a waiver to help them remain in the home. See the Medicaid Program - Optional Group Coverage topic for additional information.
The Medicaid for the Working Disabled Program provides Medicaid to working disabled individuals whose net family income is less than 250% of the Federal Poverty Level and who would be eligible to receive SSI benefits except for their earned income.
The Department of Health and Human Services (DHHS) determines eligibility for all Medicaid programs except Supplemental Security Income (SSI). Individuals who apply for Supplemental Security Income (SSI) through the Social Security Administration, and who are determined eligible, are generally eligible for Medicaid.
Applicants must meet financial and non-financial eligibility standards. To be categorically eligible for Medicaid an individual must be either under age 19 or over age 65, or blind or disabled according to SSI criteria, or pregnant. Low-income families with dependent children may also be eligible.
Applications for coverage groups other than SSI may be filed in person or by mail. Applications may be filed at out-stationed locations such as the county health departments, federally qualified rural health centers, most hospitals, and the county Department of Social Services. Applications may be mailed to:
South Carolina Department Of Health and Human Services
Division of Central Eligibility Processing
Post Office Box 100101
Columbia, South Carolina 29202-3101
Once a determination of eligibility is made, an applicant is notified in writing of approval or denial.
The most recent version of a summary chart of the South Carolina Medicaid major coverage groups showing the eligible population, income and resource limits, and benefits is available online at:
Medicaid Program - Services
Medicaid Program - Mandatory Group Coverage
Medicaid Program - Optional Group Coverage
Medicaid Program - Non-Financial Eligibility
Medicaid Program - Financial Eligibility
Medicaid Program - Payments for Services
Medicaid Program - Spousal Impoverishment Provisions
Medicaid Program - Partners for Healthy Children
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