South Carolina

Healthy Connections Prime

Healthy Connections Prime is South Carolina's duals demonstration project, which began offering integrated Medicare and Medicaid services, including LTSS, to elderly adults (65+) eligible for both programs in 2015. Begun on a voluntary (opt-in) basis, passive (opt-out) enrollment in the program began in April 2016, initially in one region of the state but later extending statewide. People living in institutional settings are excluded, but participants in all Waiver programs are included, including those for people with intellectual and developmental disabilities.

There are four capitation rate tiers in Healthy Connections Prime:

NF1, for people residing in nursing facilities for more than 3 months and meeting the nursing home level-of-care criteria.
H1 (HCBS), for people getting HCBS and meeting nursing home or specific Waiver level-of-care criteria.
H2 (HCBS+), an enhanced rate for the first three months after a person transitions from NF1 to an HCBS waiver.
C1 (Community) for everyone else