Public Notice of Final Action for the Managed Care Enrollment Carve In

The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following actions regarding the managed care enrollment carve in under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

Effective on or after Jan. 1, 2026, SCDHHS will amend the South Carolina Title XIX State Plan to add certain populations to mandatory managed care service delivery assignment. Medicaid members who are dually enrolled in Medicare and Medicaid; members enrolled in the SC HIV/AIDS Waiver (0186.R07.00), SC Mechanical Ventilator Dependent Waiver (40181.R06.00), and/or SC Community Choices Waiver (0405.R04.00), and any individual residing in a nursing facility will be enrolled in a Medicaid managed care organization for coverage of Medicaid State Plan services. Waiver and nursing facility services will remain authorized and reimbursed through the fee-for-service delivery model.

Based on the actions above, SCDHHS anticipates a budget decrease of approximately $86.3 million (total dollars) in the fee for service program.

Copies of this notice are available at each South Carolina Healthy Connections Medicaid county office and at www.scdhhs.gov for public review. Additional information regarding these actions is available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at the SCDHHS, Bureau of Managed Care, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9 a.m. and 5 p.m.

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