To Apply

Official source

Apply Online Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov , by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office .

Download Healthy Connections Application Form (PDF)

Provider Form FM 1716 – Request for Medicaid ID of Newborn

The Omnibus Budget Reconciliation Act of 1986 (OBRA 86) gave states the option to provide Medicaid coverage to pregnant women with low income.

This program may help pay your Medicare Part "B" Premiums. Healthy Connections will make a QMB determination for a Medicaid-eligible individual in any full benefits category if that individual is covered under Medicare Part A.

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To Apply

Official source

Apply Online Or complete the following form(s) and submit it electronically to 8888201204@fax.scdhhs.gov , by mail to SCDHHS-Central Mail, P.O. Box 100101, Columbia, SC 29202-3101, or to your local county office .

Download Healthy Connections Application Form (PDF)

Provider Form FM 1716 – Request for Medicaid ID of Newborn

The Omnibus Budget Reconciliation Act of 1986 (OBRA 86) gave states the option to provide Medicaid coverage to pregnant women with low income.

This program may help pay your Medicare Part "B" Premiums. Healthy Connections will make a QMB determination for a Medicaid-eligible individual in any full benefits category if that individual is covered under Medicare Part A.