Your 2023 Medicaid Annual Eligibility Review Questions Answered   

Medicaid Annual Eligibility Reviews are changing in 2023, and you need to stay informed on the latest information.

As of 2023, all states have resumed checking Medicaid eligibility, also called Annual Eligibility Reviews, after a three-year pause due to the COVID-19 public health emergency. The restart of Medicaid’s annual eligibility review process may impact you or your clients, and you need to stay updated on the latest information. South Carolina restarted the Annual Eligibility Reviews process April 1, 2023.

Here are your top Medicaid Annual Eligibility Review questions answered: 

1. I’m currently receiving South Carolina Healthy Connections Medicaid benefits. Will I still be eligible after the Annual Eligibility Review?

The eligibility rules for Medicaid have not changed. Starting April 1, 2023, the South Carolina Department of Health & Human Services, SCDHHS, must determine if you remain eligible based on current income, asset and eligibility rules. It will take about 12 months for SCDHHS to complete reviews for everyone. This means some members will not receive a “Continuation of Benefits” notice or annual review form until March 2024. Make sure to submit your review when it’s time to renew. You can find out more at scdhhs.gov/annualreviews.

2. What if I need to update my contact information?

You can update your contact information in several ways.

• Go online to apply.scdhhs.gov.
• Call the Healthy Connections Member Contact Center at 888.549.0820 Monday – Friday from 8:00 am – 6:00 pm.
•  Visit your local eligibility office. 
• With help from an SC Thrive Benefits Counselor over the phone by calling 800.726.8774, Monday – Friday from 8:30 am – 5:00 pm. 

It’s essential to update contact information including your address, phone number and email, to make sure you don’t miss important notices and updates about your Medicaid coverage. SCDHHS will first attempt to renew individuals’ Medicaid eligibility with information that is already available. If SCDHHS can verify continued eligibility this way, a Medicaid member will receive a “continuation of benefits” notice and will not receive an annual review form.

3. I’m no longer eligible for Healthy Connections Medicaid, but I need coverage. What are my options?

If you are no longer eligible for Healthy Connections Medicaid, you can check with your employer to see if they offer healthcare coverage or enroll in either Medicare (if eligible) or the Marketplace. Special Enrollment Periods (SEP) are available for Medicare and Marketplace coverage. 

• The Marketplace SEP is available from April 1, 2023, to July 31, 2024.  
• The Medicare SEP is available up to 6 months after your Medicaid coverage ends. 

You can choose to have Medicare coverage begin either the month after enrollment or retroactive to the date your Healthy Connections Medicaid ended. There will be no late enrollment penalties; however, if you are not eligible for a Medicare Savings Program, you may have to pay premiums if you choose retroactive coverage. 

4. Can I make an appeal against my Healthy Connections Medicaid redetermination decision?

You can make an appeal if your Medicaid eligibility is not renewed. You should receive a notice with the potential end date of your Medicaid coverage, as well as information on how to appeal the decision and the right to a hearing. Information on how to file an appeal is available at scdhhs.gov/appeals. 

Additional information on the South Carolina Healthy Connections Medicaid annual eligibility review process and additional FAQs in both English and Spanish are available at scdhhs.gov/members/annual-reviews. 

Additional Resources:

• Administration for Community Living Blog: Public Health Emergency “Unwinding:” Changes to Medicaid Enrollment and Eligibility 
• Centers for Medicare and Medicaid Services: Medicare SEP fact sheet 
• Centers for Medicare and Medicaid Services: Unwinding and Returning to Regular Operations after COVID-19 
• NCLER Training: Medicaid 101