South Carolina Medicaid: Medical coverage for specialty and emergency care

We cover all medically necessary Medicaid-covered services for our Humana Healthy Horizons^® in South Carolina members. These services should:

• Meet your medical needs as ordered by your healthcare provider
• Help you achieve age-appropriate growth and development
• Help you attain, maintain, or regain functional capacity

Your Member Handbook includes a full list of your benefits and information about what your medical plan covers.

Covered services

Covered medical services include:

• Early and Periodic Screening, Diagnostic and Treatment (EPSDT) services for members under age 21
• Immunizations (vaccines) for children and adults (e.g., a yearly flu vaccine)
• Help with quitting dipping, smoking, and/or vaping
• Office visits with your PCP, including regular check-ups, routine labs, and tests
• Well-baby care
• Well-child care

You must get the above services from providers in our provider network. Services must be:

• Medically necessary
• Provided and managed by your PCP

Maternity care

• Care management services for members who have a high-risk pregnancy during pregnancy and for two months after delivery
• Childbirth education classes
• Inpatient hospital care
• Labs, X-rays, and other tests
• OB/GYN and hospital services
• Outpatient care

Learn more about our HumanaBeginnings™ care management program for our pregnant members

Specialty care

• Cardiac care services
• Chiropractic services
• Office visits to specialists
• Podiatry services
• Respiratory care services
• Surgical services

Emergency care

• Emergency care services (e.g., procedures, treatments, or services needed to evaluate or stabilize an emergency) you get in the emergency department, in an inpatient hospital room, or in another setting
• Care you may need after you get emergency care (to help make sure you remain in stable condition)

Home health services

• Home health aide services (help with activities such as bathing, dressing, preparing meals, and housekeeping)
• Medical supplies
• Specialized therapies, including physical therapy, speech therapy, and occupational therapy

For us to cover home health services, or time-limited skilled nursing services, the services must be:

• Medically necessary
• Ordered by your doctor

Disease management

Humana Healthy Horizons in South Carolina members can access resources from our Disease Management Program. We designed this program to help you understand and manage your disease(s) and follow the plan of care you develop with your doctor.

A nurse will:

• Find and talk to you about resources in your community
• Help you talk with your doctor
• Provide education and support to help you learn how to control diseases such as Asthma, Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure, Diabetes, HIV/AIDS, Hypertension, and Sickle Cell Disease

Learn more about disease management

You may need to get approval before getting any of the above screenings and diagnostic testing services. This pre-approval is called prior authorization.

To learn more about prior authorization:

• Refer to your Member Handbook
• Call Member Services at 866-432-0001 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m., Eastern time

You, your authorized representative, or a provider can submit a prior authorization request on your behalf.

Where should you go to see a doctor? You have choices.

Learn where to get care depending on the care you need

To find a doctor, specialist, hospital, healthcare facility, or other type of in-network service provider:

• Use our online Find a Doctor service
• Call Member Services at 866-432-0001 (TTY: 711), Monday – Friday, 8 a.m. – 8 p.m.