South Carolina Medicaid Resources:

• State Medicaid Website: South Carolina
• South Carolina Developmental Disabilities Council Website
• The Arc of South Carolina

South Carolina Medicaid Facts: From Kaiser Family Foundation Medicaid Fact Sheet (2009)

There are 142,300 people with disabilities covered by Medicaid in Rhode Island. South Carolina spent $10,500 for each Medicaid recipient with a disability in 2007.

16% of all people covered by Medicaid in South Carolina have a disability, which is almost the same as the national percentage of people covered by Medicaid who have a disability (15%).

South Carolina spends 40% of all the money it spends on Medicaid on services for people with disabilities, which is almost the same as the national percentage of Medicaid spending on these services (42%).

South Carolina Health Maintenance Organization (HMO):

This program provides services to adults and children with disabilities who do not participate in an HCBS waiver, do not live in a nursing or intermediate care facility, and do not need hospice care. People who are also eligible for Medicare are not covered by this program.

Ages: under 65

• Community: transportation
• Health: alcohol and drug screening, durable medical equipment, early and periodic screening, diagnosis, and treatment, hearing, immunization, hospitalization, psychiatric exams, laboratory, pharmacy, some physical exams, physician services, skilled nursing facilities, x-ray
• Home: home health care

Medically Fragile Children Program:

This program was designed to meet the particular medical needs of children with disabilities or other chronic health conditions. It does not cover children who may be eligible for Medicare, those who receive care under an HCBS waiver, or those who live in a nursing or intermediate care facility.

• Community: transportation
• Health: durable medical equipment, emergency room treatment, family planning, hearing, immunization, occupational therapy, outpatient hospital services, personal care, physical therapy, pharmacy, physician services, primary care, psychological services, respiratory therapy, speech therapy, vision
• Home: home health care
• Social Services: case management

Medical Homes Program:

This program provides limited services to adults and children with disabilities, except to those participating in an HCBS waiver or living in a nursing or intermediate care facility. It covers people who are also eligible for Medicare.

• Health: early and periodic screening, diagnosis, and treatment, family planning, immunization, laboratory, physician services, x-ray
• Social Services: case management

Program of All-Inclusive Care for the Elderly (PACE):

PACE programs are designed for people 55 and older who need nursing care, which includes many people with disabilities. These programs provide integrated care and support including a high level of preventive care. PACE programs must provide all services otherwise included in a person’s Medicaid or Medicare benefit, as well as all other services deemed medically necessary.

Age: 55 and older

Level of Care: nursing

Restrictions: you must live close enough to a PACE center to have access to care.

• Community: day care, health-related transportation
• Health: primary and specialty care, nursing, physical therapy, occupational therapy, speech therapy, recreation therapy, prescription drugs,
• Home: home health care, home and environmental modifications
• Social Services: case management

Non-Emergency Transportation Program:

This program can help pay for transportation to and from routine, scheduled doctor’s appointments and related medical errands.

• Community: transportation

Community Choices waiver:

This waiver covers Medicaid-eligible older adults and adults with disabilities. It is intended to help people avoid institutional placement by providing services in the home or community.

Ages: 65 and older for adults with or without disabilities, 18 to 64 for adults with disabilities

• Community: adult day care, transportation, nursing home transition services
• Health: personal emergency response systems, specialized medical equipment and supplies, telephone monitoring
• Home: two levels of personal care, respite, adult companion services, attendant care, home accessibility modifications, home delivered meals
• Social Services: case management

Community Supports waiver:

This waiver is directed at people with intellectual and developmental disabilities of all ages who do not want to live in an intermediate care facility. It also allows people with intellectual and developmental disabilities opportunities to direct their own care.

Level of Care: intermediate

Option for Self-Direction: this program allows the person with the disability to manage and control their care.

• Community: adult day care, transportation, community services, day activities, support center services
• Health: nursing, behavioral support, psychological services, specialized medical supplies and equipment, assistive technology
• Home: personal care, respite, environmental modifications, in-home support, private vehicle modifications
• Work: career preparation, employment services

Head and Spinal Cord Injury (HASCI) waiver:

This waiver applies to people who have a traumatic brain injury (TBI), spinal cord injury, or similar disability that requires medical services. Unlike many TBI or SCI waivers, this waiver applies regardless of when the injury was sustained. The goal of this waiver is to provide services to individuals in their homes and communities, rather than in nursing facilities.

Options for Self-Direction: This waiver offers services and supports to encourage patients to be self-directed.

Restrictions: There may be a waiting list for particular services under this waiver, and not all services will be available in all areas.

• Health: information and referral, service coordination, assistive devices and technology, communication services, day habilitation, occupational therapy, physical therapy, personal emergency response systems, prescription drugs, private nursing, psychological services
• Home: home accessibility modifications, residential habilitation, residential services, respite care
• Work: supported employment, prevocational services

Medically Complex Children’s waiver:

This waiver is for children who have complex medical needs, including disabilities, or children who are technology dependent.

Ages: 18 and under

• Health: care coordination, incontinence supplies, children’s medical day care
• Home: in-home skilled respite

MR and Related Disabilities waiver:

This waiver is specifically intended to provide home and community-based services to people with intellectual and developmental disabilities.

Level of Care: intermediate

• Community: adult day care, transportation, community services, day activities
• Health: nursing, dental services, vision, audiology, behavioral support, personal emergency response systems, prescription drugs, psychological services, specialized medical equipment and supplies, assistive technology
• Home: adult attendant care services, companion services, environmental modifications, two levels of personal care, personal vehicle modifications, residential habilitation, respite care
• Social Services: support center services
• Work: career preparation, employment services