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Program Data

As part of the State Demonstrations to Integrate Care for Dual Eligible Individuals, South Carolina is one of thirteen states, the Centers for Medicare and Medicaid Services (CMS) selected to design new coordinated care approaches for individuals dually eligible for Medicare and Medicaid. 

Below is some key data about the Healthy Connections Prime, along with links to further information. For frequently asked questions, please visit our FAQs page or our Providers FAQs page.

Enrollment Data

The enrollment dashboard files below provide a summary of the program's enrollment information aggregated at a program-wide level, a county-level, and a plan level. The last page of each report includes a glossary of key terms. The monthly reports can be accessed by clicking the associated links below. 

County Participation Map

Healthy Connections Prime is available in almost every county in the state. Please click on the image below to see where the program is available and in which counties eligible members will be automatically assigned (passively enrolled) into a Medicare-Medicaid Plan versus needing to actively opt-in to the program.

Key Dates

  • October 25, 2013 - SCDHHS signs Memorandum of Understanding with CMS
  • February 1, 2015 - Earliest effective date for active enrollment.  Active enrollment means individuals sign up on their own to be members of the program.
  • April 1, 2016 - Wave 1 passive enrollment begins (Upstate to Northern Midlands).  Passive enrollment means individuals are auto-assigned to a plan.  Does not include members who receive Home and Community Based Services.
  • July 1, 2016 - Wave 2 passive enrollment begins (Southern Midlands to Lowcountry).  Includes members who receive Home and Community Based Services.

2016 Capitation Rate Report

For information about how Healthy Connections Prime comprises Capitiation Rates and rate-setting methodology, please view the report provided below. 

CY2016 Rate Report

Participating Plans

  • Absolute Total Care, operated by Centene Corporation (website link)
  • First Choice VIP Care PLUS, operated by Select Health of South Carolina (website link)
  • Molina Dual Options, operated by Molina Healthcare of South Carolina (website link)

More Information About the State Demonstration

The State Demonstrations to Integrate Care for Dual Eligible Individuals, also known as the Capitated Model, is part of a CMS project called the Financial Alignment Initiative.

The 13 states selected by CMS for the Capitated Model demonstration include:

  • California
  • Colorado
  • Illinois
  • Massachusetts
  • Michigan
  • Minnesota
  • New York
  • Ohio
  • Rhode Island
  • South Carolina
  • Texas
  • Virginia
  • Washington

Please click on this link to visit the CMS site and learn more about CMS’ initiative. As South Carolina is participating in the Capitated Model, please focus on content regarding that model for the most relevant information.

To learn about the status of each state’s participation in the financial alignment demonstration, please click here to visit the Kaiser Family Foundation’s website.

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