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Prime Weekly Update | November 1, 2013

Today, South Carolina Healthy Connections Medicaid named five health plans that will partner with the state and provide coordinated and integrated care for individuals who are eligible for both Medicare and Medicaid.  This innovative program, Healthy Connections Prime, realigns incentives so Medicare and Medicaid services can work in a single system managed by a single entity that is accountable for the quality and cost of these services.  The following Coordinated and Integrated Care Organizations (CICOs) have met the state’s qualification for participation:

  • Absolute Total Care, Inc.
  • Advicare, Corp.
  • Molina Healthcare of South Carolina, Inc.
  • Select Health of South Carolina, Inc.
  • WellCare Health Plans, Inc.

After careful and thoughtful review, Humana has decided not to continue to pursue the application to participate in South Carolina's demonstration initiative.  Although Humana will not pursue the demonstration, they will continue to enhance care coordination for individuals dually eligible for Medicare and Medicaid in South Carolina.

The readiness review will further evaluate the capacity of each CICO and its ability to meet all requirements, including having an adequate network that addresses the full range of beneficiary needs, and the capacity to uphold all beneficiary safeguards and protections.  Prior to implementation, this unique partnership will be formalized in a three-way contract between each CICO, CMS and the state. 

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Medicare-Medicaid FAQs (Frequently Asked Questions) | PDF

Contact CMS for any questions or concerns regarding the meetings, guidance, or the MMP application. Emails can be directed to MMCOcapsmodel@cms.hhs.gov

Contact the Healthy Connections Prime Team for more information, questions, and/or comments related to Prime by email at prime@scdhhs.gov.

For additional assistance, please contact the Prime Program Manager, Teeshla Curtis by email at curtist@scdhhs.govor by telephone at (803) 898-0070.

Visit the Healthy Connections Prime Website at https://www.scdhhs.gov/prime.

Visit the CMS-MMCO Website at https://www.cms.gov/Medicare-Medicaid-Coordination/Medicare-and-Medicaid-Coordination/Medicare-Medicaid-Coordination-Office/index.html

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