HOW TO USE YOUR HEALTHY CONNECTIONS MEDICAID CARD

About the Card

Your Medicaid card allows you to get most health care for free. Sometimes there is a small co-payment you will need to pay. Each eligible member of your family eligible for Medicaid will get his or her own card.

Keep the Card

The card is your only identification card. You will not get a new card each month.

• Protect your card from damage, especially the black stripe on the back.
• Do not throw your card away.
• Do not let anyone else use your card.
• Do not let the pharmacy or doctor keep your card.
• Try not to lose your card.
• Keep your card away from heat.

Even if you are no longer eligible, keep your card. If you become eligible again, you will use the same card.

Carry the Card

Always take your card when you go to a doctor, hospital, dentist, drug store, or any other medical provider. You should have the card with you at all times in case you need emergency medical care.

Let the Provider See Your Card

The doctor, hospital, dentist, drug store, or other medical provider who accepts your card will use it to prove you are eligible. Do not leave your card with the provider. The provider can make a copy of your card.

If You Lose Your Card

If you lose your card, contact your Medicaid eligibility worker or call 1-888-549-0820. The list of local eligibility office telephone numbers and addresses is in the back of this booklet.

Unpaid Bills

If you have unpaid health care bills in the three months before you applied, let your eligibility worker know right away. We may be able to pay some of those bills.

Outside South Carolina

If you are in another state and need emergency care be sure to show your card to the doctor or hospital. There are instructions on the back of your card for out of state providers.

Other Insurance

The provider must bill all other insurance first. Please let your eligibility worker know right away if you get other health insurance. You can still have Medicaid if you have other insurance.

Don’t Lose Your Medicaid

You will receive a review form in the mail every 12 month (sometimes sooner). When you receive the review form, you must complete and return it or your Medicaid will stop.

Payment for Services; Co-payments

Some adults may have to pay a small copayment for some services. Call 1-888-549-0820 if you have questions about which services have a co-payment.

If the provider accepts you as a Medicaid patient, you can only be asked to pay for:

• Allowed co-payments
• Services that are not covered
• Services for which you have already used the limit allowed
• Services that exceed the limit of 12 doctors visits per year and 4 prescriptions per month for adults

The following services will require a copayment:

• Doctor office visits (Physician, nurse practitioner) $2.00
• Medical equipment $3.00
• Optometrist (Vision/Eyes) $1.00
• Chiropractor $1.00
• Podiatrist (foot) $1.00
• Home health $2.00
• Clinic visits (Federally Qualified Health Center, Rural Health Center, Ambulatory Surgical Center) $2.00
• Dentist $3.00
• Prescription medications $3.00
• Inpatient hospital $25.00
• Outpatient hospital other than emergency room $3.00

The following beneficiaries do not have to pay co-pay:

• Children under 19 years of age
• Pregnant women
• Women receiving Family Planning services
• Institutionalized individuals
• Individuals receiving emergency services
• Individuals receiving home and community based waiver services

Need a Ride to the Doctor?

To schedule a ride to a medical appointment call a Broker in your area to schedule you trip.

Broker: Medical Transportation Management (MTM) If you live in one of these counties call: 1-866-831-4130

Abbeville Anderson Cherokee Chester Greenville Greenwood Lancaster Laurens Oconee Pickens Spartanburg Union York

Broker: LogistiCare

If you live in one of these counties call:

1-866-431-9635 Edgefield Fairfield Lexington McCormick Newberry Richland Saluda Broker: LogistiCare

If you live in one of these counties call:

1-866-445-6860 Aiken Allendale Barnwell Bamberg Calhoun Clarendon Kershaw Lee Orangeburg Sumter

Broker: LogistiCare If you live in one of these counties call: 1-866-445-8915

Berkeley Beaufort Charleston Colleton Dorchester Jasper Hampton

Broker: LogistiCare If you live in one of these counties call: 1-866-445-9954

Chesterfield Darlington Dillon Florence Georgetown Horry Marion Marlboro Williamsburg

Keeping Appointments

Once you make an appointment with a doctor, dentist, or other provider, it is important that you keep the appointment. If you cannot keep the appointment, call at least 24 hours in advance to cancel or reschedule.

You must also call to cancel the ride that was arranged for you.

Try to get to the doctor’s office a few minutes early in case there are papers to be filled out. Be sure to take your Medicaid card and cards from other insurance companies.

MEDICAL HOME

Finding a Medical Home

You may choose your own doctor, dentist, hospital, drug store, and other medical providers, anywhere in the state of South Carolina. The provider must agree to be a South Carolina Medicaid provider and accept the payment for services to you. If you live near the state line, you can use your card in the next state as long as the provider is not more than 25 miles from the South Carolina state line and agrees to accept your card.

Providers have the right to limit the number of patients they are willing to treat and services they will provide. Before you make an appointment, ask if the doctor accepts new Medicaid patients and your card for payment of services. If they will not, you may want to call another doctor. If you cannot find a doctor who will accept your card, call you local eligibility office, or call 1-800-8680404, for help finding a doctor. If you go to any medical provider who will not accept your card, you must pay for the services yourself.

Having a Medical Home

Having a medical home means having your own doctor. If you have a medical home, you will know that there will be someone to treat you when you are sick.

You and your doctor will work together to keep you healthy; so do not be afraid to ask questions. This doctor will be someone who knows your health care history and can help you make the best choices about your health care. If you need to see another doctor, this doctor will refer you. Specialists will not usually see a patient who has not been referred by a regular doctor, so it is important to keep a regular doctor.

If you do not understand your illness or what you should do to get better, ask the doctor to explain. Then, do as the doctor says. Take medication as your doctor tells you to and go back for check-ups.

You should use the emergency room only if you have a problem that happens suddenly and needs medical attention right away. Talking to your doctor and having a medical home will help you to better understand the need for emergency room services.

Regular Medicaid

You can go to any doctor who takes Medicaid. It is up to you to find one who accepts Medicaid.

MCO – Managed Care Organization

An MCO is a company that contracts with clinics, doctors, hospitals, drug stores and other providers. You can choose a primary care doctor who is a member of the MCO. This doctor will provide or arrange all the care that you need.

MHN – Medical Home Network

In certain areas of the State, you may have the option of enrolling in a MHN to manage your Medicaid service needs. MHNs are operated by local physicians who will work with you to coordinate your health care.

Help Line

If you have questions about these choices, please call the Help Line at 1-888-549-0820. The Help Line can also tell you how to join the plan you choose. The Help Line is available 7:00 a.m. to 7:00 p.m. Monday through Friday.

IF YOU ARE PREGNANT

WIC for Good Nutrition

Good food for a future mother is very important for a healthy baby. If you qualify, the Women, Infants and Children (WIC) program will help get you some of the foods your body needs to be healthy while you are pregnant. WIC can help new mothers by getting special foods for your baby or child up to age five. Call your local health department or call 1-800-922-4406.

Caring for Tomorrow’s Children

Call 1-800-868-0404 for your free prenatal information book. It is a book with health tips that you and your baby can use.

Your Body is Your Baby’s First Home

Remember – everything you eat, drink, or breathe during your pregnancy and while you are breast-feeding can have an effect on your baby. Talk to your doctor about your special needs during this time, such as vitamins, and health risks such as:

• Long hours of standing or heavy lifting,
• The effect of fumes from paint, cleaning fluids, or other chemicals you might breathe, and
• The risk to your baby if you take drugs, drink alcohol, or smoke.

If you are a smoker you should quit as soon as possible. Call the Quitline at 1-800-Quit-Now, a free program available to all South Carolina residents who want to quit smoking. The Quitline provides intervention specifically designed to help pregnant women quit smoking. Also ask your doctor about the smoking cessation or nicotine replacement therapy that is right for you.

WELL CARE & HEALTHY HABITS

What the Check Up Includes

The screening includes a health and growth history, physical exam, nutrition and growth assessment, health education, routine shots, lab tests and vision, dental and hearing screenings.

How Often?

You should schedule check ups for children at:

• Birth
• Two months
• Four months
• Six months
• Nine months
• One year
• 15 months
• 18 months
• Each year from age two through six, and then every other year from age seven up through the month of the child’s 21^st birthday.

Call 1-800-868-0404 if you do not have a doctor or dentist.

Further Treatment

If the person who does the checkup finds a medical problem or something that may become a problem later, treatment will be planned. It is important that you follow the doctor’s advice about treatment and that you take your child for needed tests.

Dental

For children, a dental exam every six months is covered. Fillings are also covered. Your child should see a dentist at age one or with the eruption of the first tooth. For adults, only emergency dental care is covered.

Vision

Medicaid will pay for one eye exam and one pair of glasses for a child once a year. Adults can get an eye exam every year and a pair of glasses following cataract surgery.

Having Healthy Habits

• Do not smoke.
• Do not drink alcohol.
• If you are overweight, talk with your doctor about a good diet program.
• Exercise regularly, but talk with your doctor before starting an exercise program.

CHILDREN WITH SPECIAL NEEDS

Children’s Rehabilitative Services (CRS)

CRS can give your child needed care for a special illness or handicap. This program was known before as the Crippled Children’s Program. Call your local health department for more information on this program.

Family Connection

Family Connection of South Carolina helps parents connect with other people who have a child with special needs. Call 1-800-5788750 or contact

www.familyconnectionsc.org

Medically Fragile Children’s Program (MFCP)

The MFCP is a special program for medically complex children. There are three sites in SC: Columbia, Easley, and Charleston. Call 1-803-898-4614 for more information.

RIGHTS & RESPONSIBILITIES