Applications and Forms


Think you make too much money to get help with your children’s health insurance coverage?
Check anyway . . . You will be glad you did.
Getting free children’s health insurance may be the easiest job of the day.

First time applying? Medicaid expired? You will need:

1. The application can be completed online by visiting You may also print SC DHHS Form 3400 Application for Healthy Connections (Medicaid), complete and submit by mail or to your county office. This is not a fillable form. You must print it and fill it out. (Ahora, no hay aplicacion en espanol, pero podemos ayudarle completirla en ingles.)
2. This form is not required. If you would like the opportunity to appoint a Palmetto Project staff member or volunteer to assist you during the application, renewal and/or appeal process, you can complete the Authorization for Release of Information and Appointment of Authorized Representative for Medicaid Applications/Reviews/and Appeals SC DHHS Form 1282 (optional).

Time to renew?

The new Annual Review Form is now available. If you have moved, the Annual Review Form (and any other communication from SC Healthy Connections Medicaid cannot be forwarded to your new address because it contains Protected Health Information (PHI).

It’s very important that you notify SC Healthy Connections at 1-888-549-0820 of any change in address. Make sure you provide your complete address, including any apartment or lot number, to ensure your mail gets to you. If you need another form, you can download and print the form here. It is 15 pages long. You can also go to your county office. SC Healthy Connections will not mail an additional form to you.

If you do not submit your Annual Review Form 30 days before your SC Healthy Connections Medicaid coverage expires, you will need to begin the application process again, by submitting this form.

Confused? Our trained staff and volunteers can help!
Call or click today and feel better tomorrow.

Toll-free (888) 998-4646.

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