South Carolina Medicaid, called Healthy Connections, covers a broad range of medical services including doctor visits, hospital care, prescriptions, dental, vision, behavioral health, and transportation to appointments. Coverage applies regardless of which managed care plan you choose, though some benefits differ between adults and children.
Core Medical Services
Every Healthy Connections member receives coverage for doctor office visits, hospital stays (inpatient and outpatient), emergency room care, lab work, and X-rays. Prescription medications are covered with no monthly limit on the number of prescriptions you can fill, and certain drug classes are exempt from copays.
Beyond the basics, the plan also covers ambulance services, home health care, medical equipment like wheelchairs or oxygen supplies, occupational and physical therapy, speech-language therapy, audiology, podiatry, and hospice. Nursing facility stays and intermediate care facility services are included for people who need that level of support. Family planning services and well-adult checkups are covered at no cost to you.
Children Get Broader Coverage
Children from birth through age 20 receive an expanded set of benefits through a federal program called EPSDT (Early and Periodic Screening, Diagnostic and Treatment). This means that if a screening reveals a medical need, Medicaid must cover the treatment even if that specific service isn’t on the standard benefits list. In practice, this gives kids access to services that adults may not qualify for, including orthodontics when medically necessary, more comprehensive dental work, and specialty evaluations.
Well-child visits, developmental screenings, hearing tests, and vision exams are all part of this package. If your child needs follow-up care after any screening, Medicaid covers the diagnostic workup and treatment.
Dental Coverage
Adults and children both have dental benefits, but the scope is very different. For adults 21 and older, Healthy Connections covers preventive care, basic restorative work like fillings, and extractions, all subject to a $1,000 annual cap per state fiscal year (July 1 through June 30). Diagnostic services like exams and X-rays don’t count toward that cap. However, several common procedures are excluded for adults: dentures (full and partial), root canals, fluoride treatments, and cavity-arresting medications are not covered.
Children under 21 face no annual dollar limit on dental care. Their coverage includes everything adults get plus endodontic treatment (root canals), removable dentures, and medically necessary orthodontics through the EPSDT benefit.
Vision Care
Vision care is a covered benefit for all members. Children receive routine vision screenings as part of their well-child exams, and if a screening finds a problem, Medicaid covers the follow-up evaluation and treatment, including glasses. Adult vision benefits are more limited but still included in the standard benefits package.
Behavioral Health and Substance Use Treatment
South Carolina Medicaid provides extensive mental health and substance use coverage. If you have a mental health diagnosis, covered services include individual therapy, group therapy, family therapy, psychological testing, crisis management, and medication management. Community-based supports like peer support services and psychosocial rehabilitation are also available.
For substance use disorders, Medicaid covers screening, assessment, individual and group counseling, intensive outpatient programs, and partial hospitalization. Residential treatment is covered at multiple levels of care, from clinically managed detox to medically monitored intensive residential programs. Medication-assisted treatment, including injectable medications for opioid and alcohol dependence, is part of the benefit.
Children and adolescents have access to additional behavioral health services including therapeutic foster care, therapeutic child care, behavior modification programs, and evidence-based treatments like multisystemic therapy.
Pregnancy and Postpartum Care
Pregnant women qualify for Medicaid at higher income thresholds, up to 208% of the federal poverty level. For a single person, that’s roughly $2,766 per month. All prenatal care, labor and delivery, and postpartum follow-up are covered. Since April 2022, South Carolina has extended postpartum coverage from 60 days to a full 12 months, and members keep their full Medicaid benefits for that entire period, not just pregnancy-related services.
Long-Term Care and Home-Based Services
Medicaid covers nursing facility stays for people who meet both medical and financial criteria. If you’d rather stay at home, South Carolina offers home and community-based waiver services as an alternative to nursing home placement. To qualify, you must be aged, blind, or disabled, and a medical evaluation must confirm you need a nursing-home level of care. You also need to use at least one waiver service for a minimum of 30 consecutive days.
The financial requirements are strict. Monthly income can’t exceed $2,523 for an individual (300% of the federal benefit rate), and countable resources must be $2,000 or less. Waiver services can include personal care assistance, home modifications, adult day programs, and other supports that help you stay in your community.
Transportation to Appointments
Healthy Connections covers non-emergency medical transportation to doctor visits, dialysis, lab work, X-rays, pharmacy trips, and other medical appointments. You need to call at least three days before your appointment to schedule a ride, and cancellations require 24 hours’ notice. The service is managed by ModivCare across three regions covering all 46 counties. Call lines are open Monday through Friday, 8 a.m. to 5 p.m., and each region has its own phone number based on the county you live in.
Managed Care Plans
Most Medicaid members in South Carolina receive their benefits through one of five managed care organizations: Absolute Total Care, Healthy Blue (BlueChoice), Humana Healthy Horizons, Molina, or Select Health (First Choice). The core benefits listed above are the same across all five plans. Where they differ is in their provider networks and any extra incentive programs they offer, like rewards for completing wellness visits or managing chronic conditions. You can choose your plan when you enroll, and each plan assigns you a primary care provider to help coordinate your care.
Who Qualifies
South Carolina has not expanded Medicaid under the Affordable Care Act, so eligibility is more limited than in expansion states. Coverage is generally available to children, pregnant women, parents with very low incomes, and people who are aged, blind, or disabled. Children and pregnant women qualify at higher income levels than other adults. For a family of three, the income limit is roughly $4,308 per month (194% of the federal poverty level) for children’s coverage. Single adults without children or a disability generally do not qualify regardless of income.