Medicaid agency: South Carolina Department of Health and Human Services (SCDHHS) / Healthy Connections
South Carolina Medicaid is administered by the Department of Health and Human Services (SCDHHS), a single-purpose Title XIX agency untouched by the state's recent agency reorganizations. State legislation enacted in 2025 merged three behavioral-health and disability agencies into a single new cabinet agency, the Department of Behavioral Health and Developmental Disabilities (BHDD), which now administers the state's I/DD waiver programs through its Office of Intellectual and Developmental Disabilities. Five managed care organizations (Absolute Total Care, First Choice by Select Health, Healthy Blue, Humana Healthy Horizons, and Molina Healthcare of South Carolina) deliver Healthy Connections Choices, the state's Medicaid managed care program, under a shared contract template running July 1, 2024 through June 30, 2027; Healthy Connections Choices operates under Section 1932(a) State Plan authority rather than a comprehensive Section 1915(b) waiver. South Carolina runs CHIP as a Medicaid expansion (M-CHIP), not a separate plan; children in households up to 208% of the federal poverty level qualify through Medicaid itself. South Carolina has not adopted ACA Medicaid expansion; its own state-branded work-requirements effort, Palmetto Pathways to Independence, remains pending at CMS via a 2025 application covering parent and caretaker-relative adults at 67-100% of the federal poverty level, an 80-hour-per-month engagement requirement, and an 11,400-person enrollment cap, and the state has not joined the multistate lawsuit challenging the CMS rule that narrowed the medically-frail work-requirement exemption.
CMS's most recent managed care enrollment data, report year 2024, lists five comprehensive MCOs for South Carolina, all operating statewide under Healthy Connections Choices: Absolute Total Care (Centene), First Choice by Select Health (AmeriHealth Caritas), Healthy Blue by Blue Choice (BlueCross and BlueShield of South Carolina), Humana Healthy Horizons, and Molina Healthcare of South Carolina, with combined enrollment of 812,589. SC Solutions, a primary care case management entity, separately serves 995 members. Three small PACE programs (two Prisma Health Senior Care sites and the Orangeburg Senior Helping Center) serve a combined 539 members across parts of the Midlands and Upstate regions. CMS's dataset does not include a dental vendor row for South Carolina, and no non-emergency medical transportation broker has appeared in the dataset since 2021.
Long-term services and supports run largely outside the five MCOs. Home- and community-based waiver services, including the SC Community Choices waiver for older adults and people with physical disabilities, remain fee-for-service, administered by SCDHHS's Community Long Term Care division and, for waivers serving people with intellectual and developmental disabilities, by BHDD's Office of Intellectual and Developmental Disabilities. Effective January 1, 2026, SCDHHS moved several previously fee-for-service populations (dual eligibles, beneficiaries in the HIV/AIDS, Mechanical Ventilator Dependent, and Community Choices waivers, and nursing-facility residents) into MCO acute and behavioral health coverage, while their waiver home- and community-based services stay fee-for-service. Healthy Connections Prime, South Carolina's capitated dual-eligible demonstration, ended January 1, 2026 with the national sunset of CMS's Financial Alignment Initiative; members moved to Dual Eligible Special Needs Plans.
Partially integrated into managed care
Behavioral health and substance use disorder services are carved into the standard MCO benefit alongside physical health, pharmacy, and other core services, not layered on through a separate behavioral health vendor. BHDD's Office of Mental Health and Office of Substance Use Services (the former Department of Mental Health and Department of Alcohol and Other Drug Abuse Services) provide program oversight and state-operated services, not managed-care claims administration.
Carved in
Dental is carved out of the five MCOs and administered separately by DentaQuest for Healthy Connections Medicaid members.
Pharmacy runs under a single, state-directed Preferred Drug List that applies across both fee-for-service and all five MCOs, effective July 1, 2024, replacing a prior structure in which each MCO set its own formulary.
ModivCare (formerly branded LogistiCare) remains the operating incumbent non-emergency medical transportation broker while a competitive re-procurement continues without a final award; the current, third solicitation remains open after an earlier solicitation was cancelled following a bidder protest.
Clemson University hosts South Carolina's Core Medicaid Management Information System, a mainframe platform SCDHHS is working to replace through its MES Modernization Roadmap. BlueCross and BlueShield of South Carolina operates the Medicaid provider and claims portal as fiscal agent.
116 agency updates tracked for South Carolina. Available with Pro.
See them with ProIn the only scheduled South Carolina gubernatorial debate before the election, Democrat Jermaine Johnson and Republican Alan Wilson split on Medicaid expansion, gambling, and data centers while agreeing abortion restrictions should not go further. Johnson called expanding Medicaid eligibility to all adults up to 138% of the federal poverty level a necessity, citing his mother's diabetes-related leg amputation and high amputation rates in a north Columbia ZIP code. South Carolina is one of 10 states that has not expanded Medicaid under the Affordable Care Act. Wilson did not join Johnson's call for expansion, continuing the state's divide over coverage for low-income adults ahead of the election.
Novant Health is selling 36 South Carolina urgent care centers to Prisma Health as it shifts strategy toward virtual care, the Post and Courier reported Oct. 4. The centers were mostly acquired in Novant's November 2024 purchase of UCI Medical Affiliates from Blue Cross and Blue Shield of South Carolina, which included 52 urgent care sites and 20 physical therapy practices. Physical therapy locations are not part of this deal and their future is unclear. The sale closes Nov. 1, more than doubling Prisma's urgent care footprint and transferring about 500 employees, as Novant expands 24/7 virtual care and specialty services instead.
In a commentary published ahead of Ostomy Awareness Day, Theresa Johnson, CEO of South Carolina-based Stomagienics, argues that CMS's plan to apply competitive bidding to ostomy supplies will harm patients. She writes that beginning January 1, 2028, CMS will award contracts to just six suppliers nationwide, which she argues will reduce access to the specific, properly-fitting products beneficiaries need, since ostomy products are not interchangeable commodities. Johnson cites United Ostomy Associations of America estimates that 13,200 South Carolinians live with an ostomy, including 8,580 Medicare beneficiaries, and warns that a dozen South Carolina supply companies could be forced to reduce or eliminate ostomy offerings. She contends that lowering product costs through bidding risks raising overall care costs through leakage, skin damage, infections, and hospitalizations, and urges Congress to weigh real-world patient outcomes rather than price alone.
HHS OIG found that South Carolina failed to report approximately $108.6 million of the federal share of Medicaid and CHIP collections subject to the temporary increased FMAP authorized during the COVID-19 public health emergency. The finding stems from an audit examining whether the state properly identified and returned collections tied to the enhanced federal match rate. The report affects South Carolina's Medicaid agency, which will likely need to refund the unreported federal share to CMS and correct its reporting processes. The audit underscores broader compliance risk for states that received the temporary FMAP bump and must accurately reconcile collections against the higher match rate.
CMS announced $167 million in federal funding to South Carolina for rural health care infrastructure, health technology upgrades, and prevention programs. The funding will support construction of rural care sites and modernization of health IT systems. The announcement did not specify eligibility or implementation timelines. This matters for South Carolina Medicaid providers and health plans operating in rural service areas, as infrastructure investments may affect network capacity and care delivery models.
16 active waivers tracked for South Carolina. Available with Pro.
See them with Pro1 active solicitations tracked for South Carolina. Available with Pro.
See them with Pro24 managed care contracts tracked for South Carolina. Available with Pro.
See them with Pro21 bills tracked for South Carolina. Available with Pro.
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