Streamlining Medicaid Delivery through Managed Care
SCDHHS is undertaking a multi-year effort to streamline the Healthy Connections Medicaid delivery system and create a more integrated, coordinated and accountable system of care for South Carolinians. Through a phased approach to streamlining Medicaid service delivery, the Department is working to reduce fragmentation across delivery systems, strengthen care coordination and improve the experience of members and providers while maintaining access to high-quality services and critical member protections.
- Phase I (Completed)
Effective Jan. 1, 2026, the South Carolina Department of Health and Human Services (SCDHHS) added some Healthy Connections Medicaid members to the managed care service delivery model. This included Medicaid members who are 18 years of age or older:
- Medicaid members who are dually enrolled in Medicare and Medicaid;
- Medicaid members enrolled in the HIV/AIDS Waiver;
- Medicaid members enrolled in the Mechanical Ventilator Dependent (Vent) Waiver;
- Medicaid members enrolled in the Community Choices Waiver; and
- Medicaid members who reside in a nursing facility
- Healthy Connections Medicaid members who reside in a nursing facility will now be enrolled in a Medicaid managed care organization (MCO) for coverage of medical services.
- Phase II (In-Progress)
During Phase II, SCDHHS will transition coverage of HCBS waiver services, nursing facility services, and hospice services into the managed care delivery model for the population included in Phase I. This shift strengthens the integration of long-term services and supports with members’ medical, behavioral health, and pharmacy benefits, allowing MCOs to coordinate care more holistically and effectively.
View or download the Phase II Concept Paper to learn more about waiver consolidation, population and provider impact, and the timeline.