Medicaid Eligibility Tips for School Districts

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Toll Free Eligiblity Inquiry 888-809-3040

  • Interactive voice response system verifies Medicaid eligibility for the previous 12 months.
  • Allows unlimited number of requests for beneficiary eligibility verifications per call.
  • The district billing office has the Medicaid Provider number you will need to access the automated system. (Each district has a Medicaid Provider Number starting with the letters ""SD."")
  • Eligibility information changes monthly. Districts therefore are updating the listings each month.
  • You can also contract with companies that perform eligibility checking services. <Back to Top>

Medicaid Identification Numbers

  • Each person enrolled in Medicaid has a unique number that remains the same during his or her lifetime. This is a 10-digit number.
  • SASI has alternate identification fields on page 3 of the Student Identification Atom; we advise that the Medicaid identification number be obtained and recorded so the district has it, K-12.
  • Medicaid beneficiaries who enroll in Medicaid Managed Care Organizations (MCOs) are also assigned member or plan identification numbers. Parents may confuse the MCO identification number with the Medicaid number. MCO identification numbers are unique to each health organization so they may vary in the number of digits used. Just remember that the Medicaid number is a 10-digit number.
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Medicaid Enrollment Information

  • Assisting families with information on eligibility and enrollment is a billable activity under administrative claiming (the gold or blue random moment sample sheets).
  • Many of the families eligible for free and reduced lunch will also be eligible for Medicaid.
  • Consider sending home information on Medicaid enrollment, a consent to treat, consent to bill, and identification number request with your free and reduced lunch packets in August.
  • HHS has a web page describing the various enrollment options and eligiblity criteria.
  • SC Healthy Connections Choices - new Medicaid initiative encouraging beneficiaries to use managed care or networks of physicians. Parents may make inquiries to school health providers and staff about new Medicaid enrollment packets for managed care. Instruct parents to call the Medicaid Enrollment Counselor at 1-877-552-4642.
  • At the time of annual eligibility re-determination, beneficiaries can chose to remain in the regular Medicaid program (fee for service) or select one of the managed care or medical home options available to them.
  • Medicaid managed care options do not impact school-based rehab and behavioral health services. School-based services are "carved-out" of the managed care options.
  • Frequently Asked Questions (FAQs) about Medicaid Managed Care.
  • Where do I apply?
  • Telephone numbers for local SCDHHS Medicaid eligibility offices.
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Sponsored Workers

  • Health and Human Services has a program for sharing the cost of a staff member who will perform the eligilbity and enrollment functions.
  • The staff member works in the district and has access to the HHS computer system to look up eligibility.
  • Eligibliity and enrollment occur immediately if the child is eligible; there's no need to mail the packet to Columbia and wait for a determination.
  • If you're interested, contact Rudy Long at HHS.
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Medicaid Applications

Income Levels for Partners for Healthy Children

  • Description of Partners for Healthy Children
  • Incomes up to 150 percent of the federal poverty level qualify. Higher income levels may qualify. Call the toll free number to discuss whether child care expenses can be considered in determining your income level.
  • These limits are effective March 1, 2007.
No. of people in the family.
Count parent(s) and children
living in the home.
Monthly Income
Annual Income
1
$1,276
$15,315
2
$1,711
$20,535
3
$2,146
$25,755
4
$2,581
$30,975
5
$3,016
$36,195
6
$3,451
$41,415

For each additional family member add $5,220 to the annual income. Divide by 12 and round up to the next whole dollar for the monthly income.

 
Niveles de ingreso para poder recibir ayuda de Partners for Healthy Children
en familia.
Incluya padre/madre e
(Ingreso mas alto puede que reuna los requisitos.)
hijo(s) viviendo en la casa.
Ingreso Mensual
Ingreso Anual
1
$1,276
$15,315
2
$1,711
$20,535
3
$2,146
$25,755
4
$2,581
$30,975
5
$3,016
$36,195
6
$3,451
$41,415

Estos limites estaran EN
efecto hasta enero del 2007.
Los limites de los niveles de ingreso aumentan
alrededor de febrero de cada ano.

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Redetermination

The Medicaid Eligibility Redetermination Review Form is used each year to renew a persons eligibility for Medicaid services. The parents may need to update their addresses and other information with SCDHHS. If you would like to be able to recognize these forms by seeing a sample of one of the forms (pre-update) used for this redetermination process, please email VChamber@ed.sc.gov (please include your fax number if you have one) or call SCDHHS. <Back to Top>

Proof of Citizenship

Effective July 1, 2006 certain Medicaid documentation is required to renew Medicaid benefits. To remain eligible, all Medicaid beneficiaries will be required to provide proof of citizenship/nationality and identity at their next annual review. DHHS accepts various documenation as proof of citizenship. <Back to Top>

Outreach Assistance

Covering Kids and Families. At this site you can obtain National Covering Kids and Families materials. <Back to Top>

Webtool Eligibility Lookup

Check eligibility individually or as a batch for multiple recipients - up to 50 recipients - using the South Carolina Medicaid Web-based Claims Submission Tool (SCMWBCST). <Back to Top>

Contact Information

Virgie R. Chambers, Director
Suite 1114
1429 Senate Street
Columbia, SC 29201
Tel: 803-734-2087
Fax: 803-734-3247
Email: ARMS@ed.sc.gov

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