SCDHHS's May 7, 2026 update to Community Long-term Care (CLTC) case managers lays out how the managed care carve-in works in practice. The confusion for providers is almost always the same: which claim goes where.
Who moved
Beginning January 1, 2026, Medicaid members age 18 or older in any of these groups moved to managed care for medical services:
- Dually enrolled in Medicare and Medicaid
- Enrolled in the HIV/AIDS, Mechanical Ventilator Dependent, or Community Choices waiver
- Residing in a nursing facility
Waiver services remain fee-for-service.
The billing dividing line
| Claim type | Where it goes | Codes |
|---|---|---|
| Medical claims, dates of service on or after January 1, 2026 | Member's MCO | |
| Incontinence supply claims | Member's MCO | |
| Nutritional supplements | FFS Medicaid | X1939 |
| Hand-held showers | FFS Medicaid | T2028 |
| Specialized medical equipment and supplies | FFS Medicaid | X1917, X1918 |
| Waiver services | Authorized through FFS |
The five plans
| Plan | Provider number |
|---|---|
| Select Health | HM1000 |
| Absolute Total Care | HM2200 |
| Healthy Blue | HM3200 |
| Molina | HM3600 |
| Humana | HM4200 |
Continuity of care
For 180 days, MCOs must honor existing prior authorizations and pay previously authorized services at 100 percent of the applicable Medicaid FFS rate, unless a negotiated rate exists, regardless of network status. Track when that window closes for each of your members; after it, network status and the MCO's own authorization rules matter.
Incontinence supplies: process change
Case managers should not start new incontinence supply referrals in Phoenix for managed care members. They send the MCO IS Referral form by secure email instead, and existing authorizations stay active until the supplier has fully moved them to the MCO.
Practical steps
- Verify each member's managed care status in Phoenix or through the SC Medicaid Web Tool before billing.
- Build a claim-routing checklist by procedure code so billing staff do not send MCO claims to FFS or the reverse.
- Name one contact at each plan using the single-point-of-contact list in the SCDHHS slides.
Last verified against the linked agency source on October 30, 2026. Regulatory details change; confirm before acting.
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