South carolina department of health and human services medicaid policy and procedures manual

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204.03.05 PHC Reviews

(Eff. 01/01/14)

For PHC households, in which all members receive SNAP benefits and/or FI benefits from the Department of Social Services (DSS), reviews will be automated. Eligibility in either the SNAP and/or FI program at Medicaid review will result in another year of continued eligibility for the beneficiary. The beneficiary will receive the Notice of Annual Review, ELD068, notifying him that Medicaid eligibility will continue for another year.

For PHC budget groups in which all members do not receive SNAP and/or FI, the regular review process will be followed. The WKR002 (Non-Institutional FI) Review Form will be mailed. The beneficiary must complete and return the form within sixty (60) days in order to continue receiving Medicaid benefits.

204.03.06 Adding New Members to an Existing PHC Integrated Case

(Eff. 01/01/14)

When it is necessary to add new members to an existing Integrated Case, the following procedures must be used.

A new application is not needed if an additional MAGI household member causes the MAGI household to remain eligible for PHC. The Eligibility Worker must gather all appropriate information needed to add the household member to the household.

Procedure for Adding New Members to PHC Budget Group/Integrated Case

MEDS Procedure:

  1. Close the current PHC budget group with RC004. The family will not receive a notice.

  1. Take a new application in MEDS to create a new budget group for PCAT 88. Make sure each active member of the PHC budget group and the new family member are applying in the PHC budget group.

MEDS will set the next review date for one year from the decision date for all of the active PHC budget group members.

ACCESS Procedure:
ACCESS will set the next review date for one year from the decision date for all of the active integrated case members.

204.04 Parent/Caretaker Relative

(Eff. 01/01/14)

204.04.01 Eligibility Criteria

(Rev. 09/01/16)

The basic eligibility requirements for the Parent Caretaker Relative program are:

  • Income limits must be less than or equal to established standard. (Refer to MPPM 103.03.)

  • A dependent child must be living in the home.

To be eligible for the PCR eligibility group, parents/caretaker relatives and children must meet MAGI income eligibility criteria. Effective January 1, 2014, applicants and beneficiaries are not required to participate in the FI Work Program with DSS in order to be eligible for PCR. A DSS work support sanction does not make an individual ineligible for PCR.

An individual must also meet the following non-financial requirements that are referenced in MPPM Chapter 102.

204.04.02 Change in Earned Income

(Added. 09/01/16)

Eligibility for Transition Medicaid Assistance (TMA) must be determined for a family who loses eligibility for PCR due to a change in earned income for any of the following reasons:

  • An increase in the earnings of the parent or caretaker relative;

  • An increase in the number of hours the parent/caretaker relative is employed; or

  • The addition of a parent or caretaker relative with earned income

Refer to MPPM Chapter 205 – Transitional Medicaid Assistance.

204.05 Healthy Connections Family Planning

(Eff. 06/01/16)

Through the Family Planning (FP) program, family planning services, family planning-related services, coverage for a biennial physical examination, and some preventative health screenings are available to individuals whose family income is at or below 194% of the Federal Poverty Level (FPL).

Men and women of any age, who meet categorical and income requirements but are ineligible for Medicaid under any other eligibility category, may be approved for Family Planning. Individuals approved for Family Planning are eligible for 12 months. A re-determination is required at the end of the eligibility period.

204.05.01 Family Planning Application Process

(Eff. 06/01/16)

The DHHS Form 3400, Healthy Connections Application, will be used to apply for FP benefits. For an individual to be considered for Family Planning, the applicant must check “Yes” for Family Planning on the application. If the individual answers “No”, or if the question is not answered, eligibility for Family Planning will not be determined.

Note: If an older version of the paper application (versions prior to June 2016) is used that does not provide the option to opt in to Family Planning, eligibility for Family Planning is to be determined.
Family Planning provides limited benefit coverage, and is not minimum essential coverage. Therefore, if an Applicant is not eligible for full Medicaid benefits but is approved for Family Planning, the individual’s application will be sent to the Federally Facilitated Marketplace (FFM).

Procedure for Transferring Applications to the FFM

Applications processed in MEDS for individuals who do not have Medicare and who are either denied for full benefits or approved for Family Planning (PCAT 55) must be referred to the FFM. An email must be sent to

  1. Subject Line of the email: Household Number

  2. Body of the email: First and Last Name

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