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.
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, 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, 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)
Disclaimer: This project was supported, in part by grant number 90BC0018, from the U.S. Administration for Community Living, Department of Health and Human Services, Washington, D.C. 20201. Grantees undertaking projects under government sponsorship are encouraged to express freely their findings and conclusions. Points of view or opinions do not, therefore, necessarily represent official Administration for Community Living policy.
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)