South Carolina

The State's Medicaid program, Healthy Connections, works through Managed Care programs to establish medical homes for eligible beneficiaries. The program was not developed through formal legislation. First established as "Medical Home Networks," effective January 1, 2014, all current Medical Home Networks (MHN) Plans operating within the state became Managed Care Organizations (MCO) either through acquisition or conversion. Medicaid eligible beneficiaries previously enrolled in Medical Home Networks were placed into Medicaid Fee-For-Service effective October 1, 2013. Qualifying dual eligibles will have the opportunity to voluntarily enroll in the South Carolina Dual Eligible (SCDuE) Demonstration, which began July 1, 2014.

Primary Care Innovations and PCMH Activity

Dual Eligible	2703 SPA	CPC	CPC+	PCMH QHP	PCMH Legislation	Private Payer

Public Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
CMS CHIPRA Quality Demonstration Program - South Carolina	Grant	Statewide	CHIPRA Quality Demonstration Grant
Healthy Columbia - Eau Claire Cooperative Health Centers, Inc	Grant	Columbia, SC	CMS Health Care Innovation Award (Round 1)
South Carolina Healthy Connections Prime	Medicare, Medicaid	Statewide	CMS Dual Eligible Demonstration, Medicaid Section 1115 Waiver

Private Payer Programs

Program Name	Payer Type	Coverage Area	Parent Program
BCBS South Carolina Patient-Centered Medical Home Program	Commercial	Designated Practices in BCBS SC Network	Blue Cross Blue Shield Value-Based Care Program
Cigna Collaborative Accountable Care (CAC) Program - Novant Health SC	Commercial	Statewide	Cigna Collaborative Care Program
Cigna Collaborative Accountable Care (CAC) Program - Palmetto Primary Care Physicians	Commercial	Charleston and the TriCounty	Cigna Collaborative Care Program
Humana medical home program - Regional Healthplus	Commercial	Spartanburg	Humana Medical Home Program
Humana medical home program - St Francis Physician Services	Commercial	Greenville	Humana Medical Home Program