What is Partners for Healthy Children?

 

Partners for Healthy Children is South Carolina’s name for the federal Children’s Health Insurance Program (or, ‘CHIP’) program.  It is a free health-insurance program for children under the age 19 and families with low income.  For example in 2006, a family of four with an income of  $30,000 a year would be eligible. Coverage is reviewed and renewed annually. 

 

For details, call 1-888-549-0820, or visit

 

DHHS' Website about Partners for Healthy Children

 

You can also go to this website and scroll down to find a current income chart for Partners for Healthy Children.

Income Charts

What is TEFRA?

 

Under Section 143 of the TAX Equity and Fiscal Responsibility Act (TEFRA) of 1982, states are allowed to make Medicaid benefits available to certain children with disabilities who would not ordinarily be eligible for Supplemental Security Income (SSI) benefits because of their parents’ income and other resources exceed the limit allowance. This allows states the option of extending Medicaid eligibility to children who would otherwise only be eligible in an institutional setting.

 

This optional coverage group is referred to as “TEFRA/Katie Beckett, ”  named after the first child to receive Medicaid under this ruling. Due to Julie Beckett’s unparalleled advocacy for her daughter, Katie, she received the first Medicaid waiver in the nation in 1982. "Katie Beckett" waivers have enabled many families to provide care for their children in their homes and communities, rather than in hospitals or institutions.  Julie is also the co-founder of Family Voices.  Thanks to the Becketts, Medicaid may provide your child’s primary coverage or provide secondary coverage for what your own insurance does not pay (you can read more about Katie and her mom under the ‘Medicaid Waivers’ link on this website).

 

What are the eligibility Requirements?

To be eligible for Medicaid coverage through TEFRA/Katie Beckett, a child must:

· Be age 18 or under;

· Be receiving appropriate care at home, at a cost less than care in an institution;

· Meet Supplemental Security Income (SSI) childhood disability requirements. Talk to a Family Connection Family Partner (800-578-8750) if you are denied this resource);

· Have low income and resources without counting those of the parents, and;

· Meet an institutional level of care.  The three levels of care are 1) intermediate care for the mentally retarded (ICF/MR), 2) nursing facility (i.e., skilled or intermediate) and 3) hospital care.  Meeting level of care does not mean your child is institutionalized (see above);

 

A child who meets these requirements is eligible for the full range of state plan Medicaid (traditional Medicaid) covered services including doctor visits, specialists, prescriptions and therapies.  If you would like to talk to another parent whose child has TEFRA contact Family Connection at 1-800-578-875.  You can also learn more about TEFRA through the

 

DHHS website on TEFRA

Text Box: There are several different types of programs offered through Medicaid.  In this section, the following options are described:

  Partners for Healthy Children (CHIP)
  Medicaid Options:  South Carolina Healthy Connections Choices 
  TEFRA (also known as the Katie Beckett Waiver)
  HIPP:  Health Insurance Premium Payment Program
Text Box: Medicaid Programs

Strengthening Families:

Resources for Partnering for

Healthy Development of Children and Youth

What is Health Insurance Premium Payment Program (HIPP)?

 

Medicaid may pay premiums for Medicaid recipients in order to keep their private health insurance whenever it is cost effective to do so.  Persons who are eligible to enroll in a group health plan which Medicaid has determined is cost effective, and who are otherwise eligible for Medicaid, may apply for enrollment in the employer group health plan as a condition of Medicaid eligibility.

 

To have your Medicaid case evaluated for premium payment, tell your Medicaid worker you are interested in HIPP or contact the Department of Health and Human Services, Premium Payment Project at 1-803-933-1825 or 1-888-549-0820

What are Medicaid Options?

 

South Carolina Healthy Connections Choices is a state program that will help Medicaid members understand and enroll in the best Medicaid plan.  The kinds of plans to choose from are Medical Home Networks, Managed Care Organizations, and regular “fee-for-service” Medicaid.  Those who are newly eligible for Medicaid or up for annual renewal will receive enrollment packets starting on the date enrollment rollout starts in each region.  The region enrollments dates are: Midlands and Marion County- August 27, 2007; Piedmont- January 1, 2008; Low Country- March 1, 2008; and Pee Dee- May 1, 2008. For your exact county please visit

 

www.SCchoices.com  

 

The first initial enrollment period will be the first 30 days after the packet is mailed, during this time members can choose to stay in regular “fee-for-service” Medicaid or pick from a plan available in the area.  In order to stay in regular Medicaid members will have to call Healthy Connections Choices.  All other plans available in the area will be specified on the enrollment form in the packet.  If the member does not make their chose, Healthy Connections Choices will choose a plan for them.  After the initial enrollment period there is a choice period which is the 90 days after enrolling in a health plan that members can return to regular Medicaid or transfer to another plan for any reason.  After the 90-day choice period if a member wants to change plans there must be a special reason and approval will have to be given.  To talk with enrollment specialist or to enroll call 1-877-552-4642 or visit www.Scchoices.com.

 

For your convenience there are frequently asked questions regarding Medicaid choices on Family Connection of South Carolina’s website www.familyconnectionSC.org and Healthy Connections Choices website www.SCchoices.com 

 

In addition, Family Connection of South Carolina has a parent on staff that is trained in Medicaid.  Please call 1-800-578-8750 or 803-252-0914 if you have any additional questions.