What changed: Effective January 1, 2026, SCDHHS began enrolling Healthy Connections Medicaid members age 18 or older into managed care for their medical services. The groups are adults who are dually enrolled in Medicare and Medicaid, adults in the Community Choices, HIV/AIDS or Mechanical Ventilator Dependent waivers, and nursing facility residents.
What did NOT change: Waiver services (personal care, respite, habilitation and similar) are still authorized and paid through fee-for-service. Waiver-only services remain FFS.
Nursing facilities: Nursing facility services are not carved in and stay FFS. Since January 1, 2026, facilities no longer bill MCOs for the first 90 days of Medicaid skilled nursing facility services. Residents enrolled in an MCO receive MCO case management, and the MCO pays medical services such as hospital care.
Hospice and Medicare: Hospice for enrolled members continues through FFS; SCDHHS does not authorize or pay Medicare services.
Continuity of care: 180 days. MCOs must honor prior authorizations and pay authorized services regardless of network status. After that, providers must be enrolled with the member's MCO.
OIDD waivers: The SCDHHS carve-in FAQ does not address the OIDD-operated waivers (ID/RD, CS, HASCI); confirm status directly with SCDHHS.
Last verified against agency sources on October 30, 2026.
General information, not legal advice. Requirements change; confirm against the official source before you act, or ask us how this applies to your organization.