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Program Data

South Carolina is one of states selected and currently participating in the Centers for Medicare and Medicaid Services (CMS) initiative 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 Member/Stakeholder FAQs page or our Provider FAQs page.

Healthy Connections Prime Program Updates

Healthy Connections Prime's program updates showcase program activity and statistics for members, providers, and other stakeholders. 

August 2017: Learn more about about the program, access to care, member profile, and the program's goal for Better Care, Better Value, and Better Health.

June 2019: Learn about person centered program design and family caregivers, with a focus on four program design domains: assessment and care planning, benefit design, training, and quality improvement.

To view the full program updates, click the images below.


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 first section of each report includes a glossary of key terms. The monthly reports can be accessed by clicking the associated images below. 

2023 2022  
2021 2020 2019
2018 2017 2016


Healthy Connection Prime Eligible Beneficiaries 

South Carolina’s Healthy Connections Prime demographic is composed of  Medicare & Medicaid (dually eligible) beneficiaries 65 years and older. Beneficiaries in this demographic can enroll in Healthy Connections Prime if they meet the additional inclusion criteria by being:

  • Full benefit Medicaid enrollees;
  • Entitled to Medicare Parts A, B and D; and
  • Currently residing in a community setting in of one the participating counties; or
  • Meeting above criteria also enrolled in Community Choices, HIV/AIDS Waiver, and Ventilator Dependent Waiver

Note: Members who join Healthy Connections Prime and later transition into a Long-Term Care Facility, elect Hospice, or develop the need for ESRD services may remain enrolled in the Healthy Connections Prime program. See the Provider Tool Kit or Member Tool Kit to better understand how this process works with Healthy Connections Prime. 

County Participation Map

As of January 1, 2022, Healthy Connections Prime is available in every county in the state. Eligible members residing in South Carolina will be automatically assigned (passively enrolled) into a Medicare-Medicaid Plan versus needing to actively opt-in to the program.

For individual plan participation by county, click here.

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.
  • July 1, 2018 - Executed a contract amendment to extend the demonstration by two years to December 31, 2020
  • July 1, 2020 - Executed a contract amendment to extend the demonstration by three years to December 31, 2023

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

CY2017 Rate Report

CY2018 Rate Report

CY2019 Rate Report

CY2020 Rate Report

CY2021 Rate Report

CY2022 Rate Report

CY2023 Rate Report

Participating Plans

  • Wellcare Prime by 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 ten states currently participating in the Capitated Model demonstration include:

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.

To review the South Carolina Three-Way Demonstration contract and other regulatory information, follow this link.

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