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Medicaid Program - Care Plan Options - South Carolina

The South Carolina Medicaid program offers different ways beneficiaries can receive health care services. The choices include both managed care and fee for service.

Regular Medicaid

You can go to any provider that takes Medicaid. It is up to you to find one that accepts Medicaid.

HOP – Healthy Options Program

This is a Medicaid Managed Care program. This program is for Medicaid beneficiaries ages 18 and under. Your doctor will see your child when he/she is sick or needs a check-up. Your doctor will also arrange for care if your child needs to be admitted to a hospital or needs to see a specialist. You are responsible for arranging Medicaid services such as pharmacy.

PEP – Physicians Enhanced Program

This is a Medicaid Managed Care program. With this program you choose a primary care doctor to provide or arrange the health care that you need. You still have a choice of any pharmacy that accepts Medicaid.

HMO – Health Maintenance Organization

This is a Medicaid Managed Care Program. An HMO is a company that contracts with clinics, doctors, hospitals, pharmacies and other providers. You choose a primary care doctor who is a member of the HMO. Your primary care doctor must provide or arrange the health care that you need.

Medicaid Managed Care Enrollment

To enroll in a Medicaid Managed Care plan, or if you have any questions about the plan that you have chosen, you may call the toll-free Help Line at 1-888-549-0820.

Additional Information

More information about health care services is available by calling the Help Line at 1-888-549-0820. Help Line hours are Monday through Thursday from 8:00 a.m. to 6:00 p.m., and on Friday from 8:00 a.m. to 5:00 p.m.

Source

http://www.dhhs.state.sc.us/InsideDHHS/Bureaus/BureauofBeneficiaryandSystemsSupport/other1024732003.htm

http://www.dhhs.state.sc.us/InsideDHHS/Bureaus/BureauofBeneficiaryandSystemsSupport/service11121132003.htm

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