Healthy Connections Prime: A New Option for Older Dual Eligibles

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The SC Health and Human Services Department has been approved to implement a new pilot program called Healthy Connections Prime for certain seniors age 65 and older. The purpose of the new program is to integrate and coordinate care for older individuals who are eligible for both Medicare and Medicaid and are not in a nursing facility.

This program has been designed so Medicare and Medicaid services can work within a single system, resulting in a simpler health care experience that will improve quality, reduce costs, and enhance patient satisfaction. It will merge all types of care services, including primary care, prescription drugs, home and community based services, behavioral health, and nursing facility services support.

Currently “dual-eligibles,” (those having both Medicare and Medicaid) must navigate a fragmented system to find the services they need. However, through Healthy Connection Prime, it will ensure they have access to the right kind of health care services when they need it.

The program is projected to serve approximately 53,600 dual eligibles who are 65 or older by December 2015.

The initial opt-in enrollment period may be as early as July 1, 2014. Later, there will be “passive enrollment,” where eligible people will be placed into a health plan that best fits their needs, with the understanding that they can leave the plan at any time.

Eligible people will be notified by mail of their opportunity to enroll and will be given a phone number to talk with a trained enrollment counselor about their options. The enrollment counselor will be able to tell them if their current doctors and pharmacies are in one of the plans within the Healthy Connections Prime Program.

Enrollees will be assigned a Care Coordinator to work closely with him or her to develop a health plan. Also, there will be a consumer advocate called an “Ombuds” who will be able to assist people if they have any problems or complaints about their services. For more information visit: www.scdhhs.gov/organizations/healthy-connections-prime

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