What Are The Income Requirements For Medicaid
The income requirements for Medicaid are specific to South Carolina. So, when researching your Medicaid eligibility, be sure to only refer to those standards outlined by Healthy Connections in SC. Even though you may be eligible for Medicaid regarding the above listed requirements, you must financially qualify for Medicaid as well.
The Medicaid income requirements vary, depending on the type of patient you are and the eligibility group to which you belong. In South Carolina, financial Medicaid requirements are determined by the Modified Adjusted Gross Income system. The income requirements for Medicaid are broken down below :
Pregnant women Your expectant child and you will be covered by Medicaid benefits in SC if you remain within 194 percent of the federal poverty level.
Infants and children less than 19 years old As part of the Partners for Health Children initiative, your household must remain at or below 208 percent of the federal poverty level to meet Medicaid qualifications.
Parents and other caretakers Those who belong to the Low-Income Families group must earn no more than 62 percent of the federal poverty level to qualify for Medicaid.
Non-IV-E adoption assistance If you are special needs and belong to Adoption Assistance, your household income must remain at or less than 62 percent of the federal poverty level to financially qualify for Medicaid.
Do I Qualify For Medicaid
Medicaid provides free or low-cost health coverage to some low-income people, families and children, pregnant women, the elderly, and people with disabilities. Many states have expanded their Medicaid programs to cover all people below certain income levels. Medicaid qualifications depend partly on whether your state has expanded its program.
Benefits Of Sc Medicaid For Pregnancy And Cost
South Carolina Medicaid offers comprehensive coverage of medical care during pregnancy, labor and delivery, and postpartum care through its regular Family Access to Medical Insurance Security program. It also covers medically necessary services related to the diagnosis or treatment of a pregnancy complication. This includes routine prenatal and postpartum care, ultrasounds, lab tests, doctor visits, prescription drugs, transportation to medical appointments, maternity clothes and supplies.
Cost-sharing requirements depend on each familys income level and their share of the household budget. In general though, pregnant women who meet SC Medicaid eligibility requirements pay no costs out of pocket for necessary medical services related to the diagnosis or treatment of a pregnancy complication. Families whose income is between 100 percent and 185 percent of federal poverty guidelines may qualify for cost-sharing discounts for certain non-emergency services such as office visits or outpatient surgeries. Other than those costs sharing discounts, there are no other required financial contributions for qualifying families for SC Medicaid services related to pregnancy.
Also Check: Find A Neurologist That Takes Medicaid
Where Do I Look For Help With Healthcare
Various programs may provide assistance depending on the situation. Several state programs may be able to provide services based on area of need. Grant opportunities can help pay for care not included in state programs and not covered by insurance. The programs listed here may provide health care assistance, either by providing health care or through financial assistance.
Every Step Of The Way 2019/2020 Report To The Community
Our whole-person approach is serving members throughout the state by providing access to far more than clinical care. Through partnerships with community organizations, local businesses, state government, and many caring individuals, we are addressing the various social issues that affect a persons health, including healthy lifestyles, support networks, education, and technology supports.
*First Choice by Select Health rated higher by network providers than all other Medicaid plans in South Carolina, according to an independent provider satisfaction survey by SPH Analytics, a Press Ganey Solution and National Committee for Quality Assurance-certified vendor, February 2022.
Also Check: Dental Services That Take Medicaid
What Is The Coverage Gap
We do have a coverage gap because our state refuses to expand Medicaid. If you are an adult without children or disability, but have low income, you may fall in what is known as the coverage gap. Adults in the coverage gap fall between two zones. On the one hand, they do not make enough money to buy coverage through the Affordable Care Act health insurance marketplace. On the other hand, they also do not meet the minimum requirements for Medicaid under South Carolinas current program.
If we expanded Medicaid, the federal government would pay 90% of your coverage. South Carolina would only have to pay 10% of your coverage. If you were covered, you could get your medicine and doctor visits needed to stay healthy and able to work.
Also Check: Does Idaho Medicaid Cover Vision
Availability For Valley Falls Terrace
Nursing home facilities that receive funding from Medicaid & Medicare typically update their total beds available and residents currently occupying those beds. This information may not be up to date, and a nursing home does not have to give a bed to a Medicaid patient even if it is available. According to the Medicare.gov website, Valley Falls Terrace has 88 beds that are certified for either Medicare or Medicaid. The website also shares that there are currently 85 residents on Medicare or Medicaid. These numbers are not always kept up to date and you should check with Valley Falls Terrace for accurate information.
Show More
FamilyAssets Reviews for Valley Falls Terrace
We have 2 review for this provider.
trish
My father in law was a resident and had a very positive experience. The nursing staff was very caring. The NP visited hime often and answered all his and my questions. The building is old but in good shape. The food was very good, he gained 5 pounds while he was there. Although I could only visit him at his window, the staff was very accomodating to have the blinds up so I could see him. There was another window on a porch that allowed him to get closer to me to visit. I would recommend this facility to anyone who needs rehab.
R. Huss
Read Also: Colorado State Medicaid Phone Number
How To File An Appeal
You can ask for an appeal if your Medicaid coverage has changed, ended or been denied. You can also ask for an appeal if a medical service you need has been denied or delayed. For more information about the appeal process go to www.scdhhs.gov/appeals or call 1-800-763-9087.
To ask for an appeal, submit a request within 30 days from the date on your closure or other notice with your contact information , a copy of the denial or other notice received and a description of what and why you are appealing. You can submit an appeal:
Eligible For Medicaid Coverage In South Carolina
To complete the Medicaid application process:
How do I apply?
To apply for Healthy Connections, you will need to complete and submit an application. You can submit an application:
Online: , opens new window
SC Thrive is available to help you with the online application and can provide an assessment of your households most likely health coverage options. Call SC Thrive at 800-726-8774 or go to
, opens new window or at federally qualified rural health centers and most hospitals.
Return your application and supporting documents electronically to
Send your application and supporting documents to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101.
If you are a pregnant woman, you may be able to get medical care while you wait for Healthy Connections to process your application. Call Healthy Connections at 888-549-0820 for more information.
Recommended Reading: Immediate Care That Takes Medicaid
Using The Sc Medicaid Portal
While all options are viable, applying online certainly has unique perks. By using the SC Medicaid Portal, youll be able to see all of your free and affordable health coverage options, plus you can save your work and return to it later. This is important because the application requires a lot of paperwork and documentation that you may not have in front of you all at once. Plus, it takes a while to complete the application properly. It may be easier for you to spend a few minutes at a time working on it.
District Of Columbia Medicaid
Eligibility overview: Washington, D.C., has one of the most generous Medicaid programs in the U.S., covering adults with household incomes up to 215% of the FPL as part of its expansion program. It also has programs for pregnant, parent/caretaker, elderly, disabled and child residents.
Income requirements: The expansion covers adults without dependents who make up to $2,082 a month when applying on their own. Elderly, blind or disabled D.C. residents are eligible if they make up to 100% of the FPL, or $1,073.33 per month for one individual, and have resources below $4,000 for one person. D.C. also covers pregnant women with incomes up to 319% of the FPL, or $4,703.40 monthly for a two-person household, and parents/caretakers with incomes up to 216% of the FPL.
How to apply for Washington, D.C. Medicaid: You can apply online at DC Health Link or by visiting your closest Income Maintenance Administration Service Center.
Other notable programs: Long-term care and nursing home care services Spend Down, a Medicaid program for people who exceed income limits, but have high medical bills Emergency Medicaid for people who cant qualify for standard Medicaid due to citizenship/immigration status.
Also Check: United Healthcare Medicaid Dental Plan
Overview Of Eligibility Requirements And How To Apply
South Carolina Medicaid for pregnancy is a health care program that provides coverage for pregnant women and their unborn children. It covers inpatient and outpatient medical services, including transportation to appointments and labor and delivery. Eligibility requirements vary depending on the individuals income level, but all applicants must be legal U.S. residents, meet residency criteria within the state of South Carolina, and fall into specific categories such as low-income or disabled that may qualify them for coverage. In addition to providing healthcare coverage, this program can also provide support services such as case management, nutrition counseling, prenatal classes and other forms of assistance in meeting the needs of expecting mothers and their families. Individuals interested in applying should visit the South Carolina Department of Health & Human Services website for more information on eligibility criteria, required documents and instructions on how to submit an application.
Can I Have Medicare And Medicaid In Sc
If you qualify for Medicare in South Carolina but also meet the income requirements for SC Medicaid, you can get benefits from both programs. If you qualify for a DSNP , you can enroll in a Medicare Advantage plan during almost any time of the year instead of waiting for the Annual Enrollment Period to come around every fall. Your DSNP can make your Medicare coverage more affordable by covering your premiums, deductibles, and/or coinsurance and co-payments.
Read Also: What Are The Different Types Of Medicaid Plans
Does Firm Size Matter
For most consumer legal issues, the size of the practice is much less important than the experience, competence, and reputation of the attorney handling your case. Among the most important factors when choosing an attorney are your comfort level with the attorney or practice and the attorneys track record in bringing about quick, successful resolutions to cases similar to yours.
Medicaid Income Limits For Seniors And People With Disabilities
Medicare recipients can be “dually eligible”eligible for both Medicare and Medicaidinwhich case Medicaid will help cover Medicare premiums and some other out-of-pocket medical expenses.The eligibility criteria for these specific Medicaid pathways can be complicated,both in terms of how income is counted and what income needs to be under in order to be eligible.For all pathways below, there are significant deductions to your income that may apply, includingignoring half of your earned income. For a more accurate estimate use our Medicaid eligibility calculator.For more information, view our Medicaid for Seniors guide.
Aged, Blind, Disabled Medicaid Pathway
The Aged, Blind, and Disabled pathway to Medicaid eligibilityis the most common pathway to eligibility for those with a disability or over 65 years old.
Don’t Miss: Can You Apply For Medicaid If You Have Insurance
Sc Healthy Connections Dental Program & Vision Coverage
Adults in the SC Healthy Connections Dental Program can receive preventative services of up to $750 in value per year. This includes annual cleanings and exams, x-rays, extractions, and fillings. Most people will pay a $3.40 copayment. Kids also get six-month fluoride treatments, one sealant every three years, and one space maintainer. These services are provided through Dentaquest, so you can find a provider at the SC Dentaquest website.
Vision coverage is also much more comprehensive for kids than it is for adults. While kids can get coverage for both exams and glasses, adults can only receive medically necessary exams, like for those pertaining to eye diseases like glaucoma.
What Does South Carolina Medicare Cost
While your costs may be different based on the plan options you choose, the Part A and Part B costs are standardized. If you worked and paid your Medicare taxes for at least 39 quarters , you can qualify for premium-free Part A. If, however, you only worked and paid your Medicare taxes for 30-39 quarters , youll have to pay $240 per month in 2019. If you paid Medicare taxes for even less than 30 quarters, youll have to pay $437 per month. Most Medicare Part A beneficiaries will face coinsurance for hospital stays. In 2019, the cost is $341 per day for the first 90 days, and then $682 per day.
The 2019 standard premium for Part B is $135.50 per month, but that amount can change based on your income. The standard deductible is $185 per year.
Recommended Reading: Medicaid For Kids With Special Needs
South Carolina Medicaid Office
Below is the contact information for the Medicaid office in South Carolina. They can assist you with questions or concerns about the South Carolina Medicaid program, including the eligibility requirements and Medicaid enrollment in South Carolina. You can view their site online at scdhhs.gov. To find out if you are eligible for this program, South Carolina Medicaid eligibility.
The Medicaid program in South Carolina covers basic medical care. This may include doctor services, inpatient hospital care, laboratory and x-ray services, inpatient short-term skilled nursing or rehabilitation-facility care, outpatient hospital or clinic care, short-term home healthcare, ambulance service and prescription drugs for people not covered by Medicare. We suggest contacting the Medicaid office to find out specifically what coverage is provided as it can be different in each state.
Read Also: Pain Management Doctors In Nj That Take Medicaid
The South Carolina Department Of Social Services Medicaid Office In Greenville South Carolina
The South Carolina Department of Social Services Medicaid Office is a Medicaid office you can apply at in Greenville, South Carolina. This facility is funded jointly by the federal government and the state government. You need to legally reside in South Carolina in order to apply for benefits at this facility. This is because you may only receive Medicaid benefits in your home state. Even though the South Carolina Department of Social Services Medicaid Office is required to follow state and federal guidelines regarding operation, it still maintains autonomy. This means that each Medicaid office in South Carolina may have rules that are slightly different from one another.
For example, one Medicaid office in Greenville may encourage you to schedule an appointment before you apply for benefits. An office in another city, however, may not. You may use the information below to help you understand which rules you need to follow when you apply for support at the South Carolina Department of Social Services Medicaid Office.
Don’t Miss: How Do I Find My Medicaid Number Online
Expansion Under The Affordable Care Act
As of March 2022, 38 states and the District of Columbia have accepted the Affordable Care Act Medicaid extension 12 states have not. Among adults aged 18 to 64, states that expanded Medicaid had an uninsured rate of 7.3% in the first quarter of 2016, while non-expansion states had a 14.1% uninsured rate. Following a 2012 Supreme Court ruling, which held that states would not lose Medicaid funding if they did not expand Medicaid under ACA, several states rejected the option. Over half the national uninsured population lives in those states.
The Centers for Medicare and Medicaid Services estimated that the cost of expansion was $6,366 per person for 2015, about 49 percent above previous estimates. An estimated 9 to 10 million people had gained Medicaid coverage, mostly low-income adults. The Kaiser Family Foundation estimated in October 2015 that 3.1 million additional people were not covered in states that rejected the Medicaid expansion.
Studies of the impact of Medicaid expansion rejections calculated that up to 6.4 million people would have too much income for Medicaid but not qualify for exchange subsidies. Several states argued that they could not afford the 10% contribution in 2020. Some studies suggested that rejecting the expansion would cost more due to increased spending on uncompensated emergency care that otherwise would have been partially paid for by Medicaid coverage,
Ners For Healthy Children
Healthy Connections provides health insurance plans for children who live in families with income at or below 208% of the Federal Poverty Level .
A person who may qualify for the PHC program must:
- Be under 19 years of age
- Be resident of South Carolina
- Be a U.S. citizen or a Lawful Permanent Resident Alien
- Have a Social Security number or verify an application for one
Individuals who are eligible will receive all Medicaid covered services.
Apply online or complete the following form and submit it electronically to , by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101 or to your .
The Partners for Healthy Children program was authorized under Title XXI of the Social Security Act. This program provides Medicaid coverage for children who live in families with income at or below 208% of the Federal Poverty Level. The available plans include Medicaid and the Childrens Health Insurance Program .
Don’t Miss: Aetna Better Health Of Ohio Mycare Ohio Medicare Medicaid Plan
