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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 Advocate/Stakeholder FAQs page or our Provider FAQs page.

Healthy Connections Prime August 2017 Program Update

Healthy Connections Prime has issued an update showcasing program activity and statistics through August 2017. In the program update, you can learn more about about the program, current statistics on access to care, current member profile, and Comprehensive Assessment completion statistics. You can also learn more about core elements of the program including Healthy Connections Prime's goal for Better Care, Better Value, and Better Health and what Healthy Connections Prime is doing to achieve these goals.

To view the full 2017 program update, click the image 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. 

2016 2017 2018

 

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.

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

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 nine states currently participating in the Capitated Model demonstration include:

  • California
  • Illinois
  • Massachusetts
  • Michigan
  • New York
  • Ohio
  • Rhode Island
  • South Carolina
  • Texas

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 2017 South Carolina Three-Way Demonstration contract, follow this link.

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