South Carolina

Current Updates (as of 8/3/2021)

Medicare-Medicaid Integration

On May 12, 2021, the South Carolina Department of Health and Human Services (SCDHHS) released a brief summary of member experience interviews from the Healthy Connections Prime program, South Carolina’s financial alignment model demonstration for individuals dually eligible for Medicare and Medicaid. Partnering and CMS and an independent research firm, SCDHHS interview plan beneficiaries in urban and rural regions of the state in December 2020 and January 2021.

(Source: Healthy Connections Prime Member Interview Summary; 5-12-2021)


Past Updates

South Carolina Flag

State Demonstration to Integrate Care for Dual Eligible Individuals

South Carolina recently signed a Memorandum of Understanding with CMS/CMMI to implement a dual eligible initiative titled Healthy Connections Prime. The South Carolina demonstration will employ a three-way contract with Coordinated & Integrated Care Organizations (CICOs) to provide benefits to dual eligibles statewide under a capitated-managed care model of financing. The state indicates that the demonstration will begin no sooner than July 1, 2014 and continue until December 31, 2017.
Demonstration Proposal
Memorandum of Understanding
Three-Way Contract for Demonstration (9/5/2014)
State Website on Duals Demonstration

South Carolina has defined the individuals eligible to participate in the demonstration as persons 65 and over: (1) living in the community at the time of enrollment, (2) receiving full Medicaid benefits, (3) entitled to benefits under Medicare Part A, and (4) enrolled under Medicare Parts B and D. Individuals receiving HCBS services (e.g. HIV, Vent, and Community Choices) are also eligible for the demonstration. The state will not include individuals with intellectual or developmental disabilities in the demonstration. Enrollment includes an opt-in period followed by passive enrollment, but beneficiaries can opt-out, as well as change plans at any time. (Source: South Carolina Memorandum of Understanding; Integrated Care Workgroup Session, link no longer available 10/17/2013)

The state initially planned to carve HCBS waiver services out of the demonstration, but recently revised the proposed model to carve-in home- and community-based services. (Source: SCDuE Weekly Roundup, link no longer available 7/2013)

The state has delayed its duals demonstration implementation until January 2015. According to an updated implementation timeline, the state will begin opt-in enrollment in January 2015. The state will implement passive enrollment in three waves, beginning April 1, June 1, and August 1, 2015. (Source: State Duals Demonstration website)
Healthy Connections Prime PowerPoint/Updated Timeline (8/14/2014)

The South Carolina Department of Health and Human Services (SCDHHS) recently announced that Advicare Corp., a MCO, will no longer participate in South Carolina’s dual eligible demonstration following its purchase by WellCare on June 1, 2016. All of Advicare Advocate’s members in South Carolina—which number approximately 3,650—will have to choose a new MCO by August 30, 2016, or be passively enrolled into another plan. (Source: SCDHHS 7/6/2016; HMA Weekly Roundup 7/6/2016)  

On November 21, 2017, CMS announced on its website that South Carolina officially re-executed its three-way contract for its dual eligible demonstration, Healthy Connections Prime, which gave the program a new end date of December 31, 2018—an extension of a year. As of November 2017, South Carolina had an estimated 11,500 dual eligibles enrolled in Healthy Connections Prime. (Source: 11/21/2017; HMA Weekly Roundup 12/13/2017)

South Carolina’s Demonstration Year 1 (Calendar Years 2015-2016) for the South Carolina Healthy Connections Prime demonstration included four plans.  All Financial Alignment Demonstrations include a provision to ‘withhold’ a portion of the Medicare-Medicaid Plans’ capitation rate that can be recaptured if the MMPs meet quality measures.  Performance measures ranged from 75% (2015) to 79% (2016).  In 2016, two plans met 100% of their performance measures, while another plan dropped to 33%. The average percent of quality withholds recaptured  was 81%--with three of the plans receiving 100% and one plan receiving 25% of withheld funds for 2016. (Source: SC Medicare-Medicaid Plan Demo Year 1, 6-19-2018)

CMS released a summary of quality withhold analyses of South Carolina’s Medicare-Medicaid Plans (MMPs) for the second demonstration year (CY 2017) of the  Financial Alignment Initiative (FAI), called Healthy Connections Prime.  A percentage of both state Medicaid and federal Medicare capitation rates are withheld from the MMPs to ensure quality for dually eligible individuals. MMPs can earn the withheld funds back if Federal, CMS Core, and state-specific quality withhold performance measures were met.  MMPs in South Carolina met 90 percent of overall withhold quality measures, 87 percent of federal measures, and 100 percent of South Carolina-specific measures.

(Source: South Carolina Medicare-Medicaid Plan Quality Withhold Analysis Results; 8-14-2019)

CMS released the first evaluation report for South Carolina’s Health Connections Prime demonstration. The report includes findings on the evaluation of eligibility and enrollment processes, care coordination requirements and assessment processes, beneficiary experience, stakeholder engagement strategies, financing and payment, service utilization, quality of care, and cost saving calculation. The report also provides an overview on Medicare and Medicaid integration successes and challenges.

(Source South Carolina Healthy Connections Prime: First Evaluation Report; 9-24-2019)