Jan 052017

SC Healthy Connections Medicaid is truly comprehensive health insurance for our state’s children. It covers traditional health services, such as well-child check-ups, immunizations, x-rays, prescriptions, emergency room visits, and specialty care.

But did you know that it also include dental and vision coverage for children at no additional cost? Exams, cleanings, sealants, x-rays, and more are covered for free for your children who have SC Healthy Connections Medicaid. To find a provider near you, you can call Healthy Connections at 888-549-0820 or you can use this handy tool!

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Jul 162015

Unable to ForwardCompleting SC Healthy Connections Medicaid annual review process could be a little tricky this year. Families may have difficulty accessing the new forms, which may mean missed deadlines and the possibility for coverage gaps. But there is help available over the phone and in person from certified enrollment assisters through the Palmetto Project’s Children’s Health SC team.

The SC Department of Health and Human Services (DHHS), the state agency that runs the federally- and state-funded health care program for South Carolina’s low-income and disabled children and families, has not been conducting annual reviews for more than a year. The agency asked for and received a waiver from the Centers for Medicare and Medicaid Services (CMS) to extend the eligibility periods for those in several Medicaid coverage categories affected by changes in the Affordable Care Act. These coverage categories — Parent/Caretaker Relative, Pregnant Women, and Partners for Healthy Children — are those affected by a new income calculation referred to as MAGI (Modified Adjusted Gross Income). This gave both the agency and enrollment assisters, like Palmetto Project’s certified insurance navigators, time to adjust to the new health insurance marketplace, new application forms, new ways of calculating income for eligibility, and so many more advances brought on by the Affordable Care Act. The upshot is that many families with children covered by Medicaid have not been required to complete the yearly process of determining if their child would still be covered by Medicaid; rather, the child’s eligibility has continued. That is, until February.

The new Annual Review Form has many changes that consumer advocates have been asking for. The form is similar to the application on HealthCare.gov. It includes information from Medicaid’s records, such as family members’ names and dates of birth. It requires only that the family make corrections to any erroneous information, add or remove household members, and provide income verification that may not be verifiable through other data hub sources, such as alimony. This is a positive change from prior annual review processes that essentially had required families to provide all of the information that already existed in the Medicaid system.

Beginning earlier this year, families started receiving correspondence from SC Healthy Connections Medicaid with the new Annual Review Form, complete with pre-filled information about the family from the Medicaid database. At least, they should have received the form. But after more than a year of continuous eligibility, many families have moved.  And even if they had submitted a change of address notice to the US Postal Service, the Annual Review Form cannot be forwarded because it contains Protected Health Information (PHI). The only way a family who has moved will receive the Annual Review Form is if their address is current in the the SC Healthy Connections Medicaid database. And that will only happen if the family notifies either SC Healthy Connections Medicaid or their Medicaid Managed Care Organization (MCO).

SC Healthy Connections Medicaid member ID cards do not list an expiration date so families typically don’t know when their coverage expires. They usually find out when they are at the doctor with a sick child and the front desk person says, “Sorry, your child can’t be seen today because your insurance is not valid.” Even if there is a coverage gap, Medicaid can be approved retroactive for 90 days from the date of eligibility, but it does require that the family provide income documentation for the retroactive period. And there’s no requirement that medical providers must go back and bill Medicaid to reimburse you for expenses you have paid out of your own pocket or to cover any outstanding bills.

Families can get blank forms by visiting their county’s SC DHHS office. The agency is not mailing new forms to members. The Palmetto Project has added the Annual Review Form to its catalog of applications and forms available at ChildrensHealthSC.org. Families can download the fillable form, print it, and submit it by mail or deliver it to their county’s SC DHHS office. If need help completing the form, want to talk about changes in your family situation that you think could affect your eligibility, or have already submitted an application but haven’t been able to get the status of your eligibility, we can help. Certified insurance navigators are available throughout the state to help by phone and in-person. You can call 1-888-998-4646 to speak to someone and make an appointment.

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Mar 112015

Many social services use family income as part of their eligibility determination. Generally, for social services, agencies and organizations use the Federal Poverty Level or FPL, as a guideline. The FPL usually increases every year (but not always). Each agency can decide when and if they will adopt the new year’s released FPL.

SC Healthy Connections Medicaid and Healthcare.gov use different year’s FPL to evaluate eligibility. Luckily, most of us don’t have to memorize these tables. Rather, the application software used to submit applications directly to SC Healthy Connections Medicaid (apply.scdhhs.gov) and the Health Insurance Marketplace (HealthCare.gov) allow families to simply enter their taxable income information and the system will determine your potential eligibility for both Medicaid and the Marketplace.

You can click here to see an income chart that includes information for the three SC Healthy Connections Medicaid programs that affect most families with children under 19 in our state. The chart also includes three columns with information that pertains only to health insurance plans sold in the Federally-Facilitated Marketplace at HealthCare.gov.

The quickest way to apply for health coverage is using the online application, but both websites also operate toll-free call centers that allow you to complete an application by phone — SC Healthy Connections Medicaid: 1-888-549-0820 or HealthCare.gov: 1-800-318-2596.

Additionally, Palmetto Project has a staff of certified enrollment specialists aroudn the state to provide free, confidential, local in-person assistance to help you apply for the state’s free and low-cost health coverage for children and their families, and also for health coverage offered under the Affordable Care Act. To schedule an appointment for in-person assistance, you can click here or call 1-888-998-4646.

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Aug 072014

We know that your children are your first priority. And their health and happiness are always at the top of your “To Do” list. That’s why you’re looking for all options to get your children covered, whether it’s SC Healthy Connections Medicaid or private insuGetting a physical examrance or coverage through HealthCare.gov. But once you’ve secured coverage for your children,
what about you?

There are many new options for coverage for parents too. Eligibility for both Medicaid and policies on the Health Insurance Marketplace at HealthCare.gov are determined by your taxable income, family size, and citizenship status. With these changes in eligibility determination, more parents are now eligible for health insurance coverage either through Medicaid and the Health Insurance Marketplace at HealthCare.gov.

Beginning August 1, 2014, SC Healthy Connections Medicaid has implemented a new plan for adults with taxable income under 194% FPL (see income chart here for details) called Healthy Connections Checkup. Checkup includes family planning coverage, a physical every two years, and recommended health screenings. These may include mammogram, colonoscopy, cholesterol, blood pressure, etc., based on your age and family history. (Healthy Connections Checkup does not meet the Federal standard for Minimal Essential Coverage (MEC), so becoming eligible for Healthy Connections Checkup does not exempt you from the Federal mandate for individual coverage.)

You can apply for Healthy Connections Checkup online here. Our staff, partners, and volunteers can also provide in-person assistance in completing and submitting the application. Call us at 1-888-998-4646 to find help near you.

So even if you have looked at SC Healthy Connections Medicaid before, it’s time to look again.

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Mar 202014

Thanks to the Affordable Care Act and SC’s commitment to covering children, there are some big changes to SC Healthy Connections, the name for SC’s Medicaid program.

Beginning in 2014, only taxable income is counted to determine eligibility for several categories of Medicaid that affect children and their parents and caregivers. That means that child support is no longer counted as income when determining Medicaid eligibility. “We’re pretty excited about what this means for low-income families and children, especially single parents,” said Palmetto Project’s director of programs, Shelli Quenga. “For many single parents, child support can be a significant portion of the family’s income,” she said, “but under these new rules, it will not keep a child or parent from qualifying for low cost or free health coverage.”

For more information about how this new rule could affect your family, call Palmetto Project at 1-888-998-4646. In Spartanburg County, contact Khadijah Dawkins at  864-978-8464. In Georgetown, Orangeburg, Sumter, and Williamsburg Counties, call Cokeitha Gaddist at 843-870-9508.

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