SCAM ALERT

Healthy Connections Medicaid team members and managed care plans will never ask for money, gift cards or something else of monetary value via text, email or a phone call. If someone contacts you asking for something of monetary value to get or keep Medicaid coverage, please report it by contacting the Medicaid fraud hotline at (888) 364-3224 Monday through Friday from 8:30 a.m. to 5 p.m. or by sending an email to FraudRes@scdhhs.gov.

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Providers and D-SNPs

The South Carolina Department of Health and Human Services acknowledges and partners with multiple Dual Special Needs Programs (D-SNPS) designed to enhance coordination of benefits for individuals who are receiving Medicare and Healthy Connections Medicaid services.

The D-SNP serves as primary Medicare coverage for members followed by Healthy Connections Medicaid. D-SNPs are responsible for maintaining knowledge of SC State Plan for Medical Assistance but not responsible for providing Medicaid related services. 

Partnered D-SNPS

Click on the links below to learn more about each specific D-SNP.

In South Carolina, if a Healthy Connections Medicaid member enrolls in a D-SNP to manage their Medicare, he or she will be enrolled into a Medicaid MCO that aligns where available. This means that the same parent organization will provide Medicare and Medicaid management services to the member. This is 'Exclusively Aligned Enrollment' (EAE) offered by a Highly Integrated Dual Special Needs Plan (HIDE D-SNP).

Providers who have questions about Medicare plan including claims or provider contracting should contact the specific health plan, visit Medicare.gov or call 1-800 Medicare (1-800-633-4227).

Questions regarding special needs programs can be answered by visiting Health-Plans/Special Needs Plans. For questions specific to SCDHHS' administration of this program, please email us at SCDSNPS@scdhhs.gov.

Members who participate in a HIDE D-SNP may be enrolled in one of the following:

  • First Choice VIP Care
    Provider Services: 1-(888)-978-01511  (TTY 711), 
    Available Hours: 
    April 1 to Sept. 30, Monday through Friday, 8 a.m. to 8 p.m. EST.
    Oct. 1 to March 31, Seven days a week, 8 a.m. to 8 p.m. EST.
  • Humana Dual Integrated
    Provider Services: (866) 432-0001 (TTY 711)
    Available Hours: 
    April 1 to Sept. 30, Monday through Friday, 8 a.m. to 8 p.m. EST.
    Oct. 1 to March 31, Seven days a week, 8 a.m. to 8 p.m. EST.
  • Molina Medicare Complete Care Plus
    Provider Services: (855) 237-6178 
    Available Hours: 
    April 1 to Sept. 30, Monday through Friday, 8 a.m. to 8 p.m. EST.
    Oct. 1 to March 31, Seven days a week, 8 a.m. to 8 p.m. EST.
  • Wellcare Absolute Total Care Dual Align
    go.wellcare.com/ATC 
    Provider Services: (855) 538-0454 (TTY: 711)
    Available Hours: 
    April 1 to Sept. 30, Monday through Friday, 8 a.m. to 8 p.m. EST.
    Oct. 1 to March 31, Seven days a week, 8 a.m. to 8 p.m. EST.

Coordination Only (CO D-SNP)

CO D-SNPs may not offer a Medicaid MCO but will work with the member's existing Healthy Connections Medicaid MCO to support benefit delivery and care. Healthy Connections Medicaid partners with CO D-SNPs to support care coordination.

Members enrolled in a CO D-SNP may be enrolled in one of the following:

Requirements and Payment Procedures

SNPs must follow existing Medicare Advantage (MA). This includes regulations at 42 CFR 422, as updated by federal guidance. These rules apply to Medicare-covered services and prescription drug benefits. All SNPs must offer Part D prescription drug coverage. This ensures special needs individuals can access the medications needed to manage their special health care needs. SNPs should assume that, if no modification is contained in guidance, existing Part C and D rules apply.

Payment procedures for SNPs follow the same process that the Center for Medicare and Medicaid Services (CMS) use to make payments to non-SNP MA plans. SNPs must submit bids like other MA plans and are paid based on the plan's enrollment and risk adjustment payment methodology. All SNPs must follow current CMS guidance on cost-sharing requirements.