Your Role in the Enrollment Process

South Carolina Healthy Connections Choices
Your Patients
Make the Most
of Their
Medicaid Benefits
SC Healthy Connections Choices
Overview of South Carolina Healthy Connections
and South Carolina Healthy Connections Choices
Benefits of Joining a Health Plan
South Carolina Healthy Connections Choices Goals
Review the Health Plan Enrollment Process
Your Role in the Enrollment Process
Overview of SC Healthy Connections Choices
South Carolina Healthy
Connections (SCHC)
South Carolina Healthy
Connections Choices (SCHCC)
South Carolina Healthy Connections
is South Carolina’s Medicaid
SCHCC is the part of SCHC that
helps Medicaid members in choosing
a managed care health plan.
Currently there are just under one
million members in SCHC (2/2013).
In SC Healthy Connections there are
three Medicaid Eligibility Categories
Assignable (Managed Care Only)
Regular Medicaid (Fee-for-Service)
Non-Assignable (can choose to be in
Managed Care or regular Medicaid)
SCHCC serves Medicaid members in
the Assignable and Non-Assignable
Eligibility Categories.
835k Medicaid members are eligible for
Managed Care participation (7/2013)
637k of those are enrolled in a Health
Benefits of Health Plans
Some of the benefits of being in a health plan are:
 Members have a medical home that provides accessible, comprehensive, familycentered care led by a primary care physician who knows them and their medical
 The same core services as regular Medicaid plus they have access to additional and
enhanced services.
 Greater access to preventive and primary care services.
 An ally to help them navigate the complex medical system providing better
coordination of care, including finding the appropriate specialist when one is needed.
 Improved understanding of how to access services and the appropriate use of the
emergency room.
 Access to a “live voice” 24 hours a day, 7 days a week.
As a results members have:
Other Benefits
 Better health care and health
 Reduced use of the emergency room
for non-emergencies
 Greater investment in their own health
 Lower overall costs by reducing acute
medical care and disease-related
SC Healthy Connections Health Plans
Current Health Plans
• Carolina Medical Homes
• Palmetto Physician Connections
• South Carolina Solutions
Absolute Total Care
BlueChoice Medicaid Health Plan
First Choice by Select Health
United Healthcare Community Plan
Health Plans after the Transition from MHNs to MCOs is Complete
Absolute Total Care
Advicare (formerly PPC)
BlueChoice Medicaid Health Plan
First Choice by Select Health
South Carolina Solutions
WellCare(Effective 9/1/2013)
800-327-3183, ext. 25151
SC Healthy Connections Choices Goals
We want to help members:
Goals of SCHCC
 Understand benefits of health
plans and various plan options
 Increased voluntary enrollment
rate (minimize auto assignment)
 Choose a health plan that their
doctor of choice accepts
 Decreased churn from one
health plan to another
 Enroll in a health plan by making
the process easy
 Greater satisfaction with health
care services
 Take an active role in their health
care by
 Improved access to and use of
preventive and primary care
• Choosing their own Primary Care
Provider (Medical Home)
 Improved overall health
• Getting preventive and primary
health care
 Improved efficiency and
effectiveness of the program
• Taking children to well-child visits
Health Plan Enrollment Process
Initial Enrollment Period (at least 30 days)
An enrollment packet is mailed to all
Assignable Medicaid members who are
required to select a Managed Care
Health Plan.
An outreach packet is mailed to all NonAssignable Medicaid members who can
choose to select a Managed Care Health
Plan or regular Medicaid.
We send out reminders to encourage
members to make their choice.
If members do not choose a plan by
the end of the Initial Enrollment
Period they will be automatically
assigned to a plan.
If the member does not choose a
health plan they remain in regular
Members in regular Medicaid, can
switch to a health plan at any time.
Health Plan Enrollment Process
Once enrolled, members stay in their health plan for 12 months unless
one of the following happens:
They become ineligible for Medicaid and/or Managed Care enrollment.
They requests transfer within the first 90 days
They make a written For Cause Transfer Request after the Choice Period
Annual Right to Change
Managed Care Health Plan members will receive an enrollment packet 30 to 60
days prior to their anniversary date for their Annual Right to Change.
At this time, they can remain in their current health plan or they can transfer to a
different health plan. On the day after their Anniversary Date, they are transitioned
to a 90 Day Annual Right to Change Period.
Health Plan Enrollment Process
Enrollment Process: Newborns
If the mother has Medicaid, her baby is automatically eligible.
In the MCO structure the baby is enrolled in the same health plan as her/his
The baby enters the 90 Day Choice Period and her/his health plan can be
changed one time within the first 90 days after birth.
Primary Care Providers
Members can change their PCP at any time by contacting the Member
Services Department of their Health Plan.
Enrolling in a Health Plan
There are three ways a member can enroll in a health plan:
Available in English and Spanish
Takes 5-10 minutes
Easy, step-by-step instructions
We also have a webinar explaining how to use the website for online
Mail or fax the completed health plan selection form to SCHC
 Mailing Address
SC Healthy Connections Choices
PO Box 8691
Columbia, SC 29202-9255
 Fax: 1-877-552-4672
Call our Customer Service Center at 1-877-552-4642
Your Role in the Enrollment Process
Talk with your patients about the benefits of enrolling in a health
plan, especially:
 Newly eligible members
 Non-Assignable Medicaid members who have chosen regular
 Mothers of newborns
Encourage Members to enroll in a plan
 Process is easy
 Online step-by-step instructions
Tell Members which plans you participate with
 Use the “Prescription for Better Health Care” sheet
 Put up SCHCC posters in your waiting room and other high traffic
Your Role in the Enrollment Process
Your Role in the Enrollment Process
Your Role in the Enrollment Process
Your Role in the Enrollment Process
Maximizing Your Participation in Medicaid Managed Care
• Consider participating with all the health plans available in your county
as it makes your practice more flexible for patients.
• When a Medicaid member calls for an appointment ask for their Medicaid
ID # (MAID) and check the Medicaid WebTool to verify that they are in a
health plan your practice participates with AND that you are their Primary
Care Provider (PCP).
• If you are a Pediatric practice, make sure to take the SCHCC “Prescription
for Better Health” sheet to the hospital when doing newborn visits.
• Consider providing opportunity for your patients to contact us while at
your office via our website,
• Make use of the Medicaid Managed Care Educational Classes that the
Provider Services Center makes available to your staff. You can find
classes on the Provider Services website,
SCHCC Provider Outreach Team
Tom Dalik
Phone: 843-754-8322
Email: [email protected]
Michelle LeMoine
Phone: (803) 834-9956
Email: [email protected]
Allendale, Bamberg, Beaufort, Berkeley,
Calhoun, Charleston, Chesterfield,
Clarendon, Colleton, Darlington, Dillon,
Dorchester, Florence, Georgetown,
Hampton, Horry, Jasper, Lee, Marion,
Marlboro, Orangeburg, Sumter, and
Williamsburg Counties
Abbeville, Aiken, Anderson, Barnwell,
Cherokee, Chester, Edgefield, Fairfield,
Greenville, Greenwood, Kershaw, Lancaster,
Laurens, Lexington, McCormick, Newberry,
Oconee, Pickens, Richland, Saluda,
Spartanburg, Union, and York Counties

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