Every South Carolina D-SNP (dual eligible special needs plan) is one of two kinds, and only the highly integrated (HIDE) kind pairs your Medicare and Medicaid under one parent company. South Carolina's Medicaid agency currently names four HIDE dual eligible special needs plans: First Choice VIP Care, Humana Dual Integrated, Molina Medicare Complete Care Plus and Wellcare Absolute Total Care Dual Align. Under South Carolina's 2026 HIDE contract, a HIDE D-SNP may enroll only full-benefit dual eligibles who are 18 or older and in Medicaid managed care.

In This Guide

HIDE vs. Coordination-Only: Which South Carolina D-SNP Is Which?

A dual eligible special needs plan (D-SNP) is a Medicare Advantage plan for people who have both Medicare and Medicaid. The South Carolina Department of Health and Human Services (SCDHHS), which runs Healthy Connections Medicaid, partners with Medicare health plans to offer two types of D-SNP in South Carolina.

HIDE D-SNP Coordination-only D-SNP
Your Medicaid managed care plan Reassigned to the plan aligned with your D-SNP, under the same parent organization The D-SNP works with your existing Healthy Connections Medicaid plan
Who the plan may enroll Full-benefit dual eligibles only, 18 or older: Qualified Medicare Beneficiary Plus (QMB+), Specified Low-Income Medicare Beneficiary Plus (SLMB+) or Full Benefit Dual Eligible (FBDE) May choose to accept full-benefit dual eligibles (if the company has no HIDE plan) and partial dual eligibles, 18 or older
Appeals One integrated process across Medicare and Medicaid The HIDE contract's integrated appeals terms do not apply
CMS integration level Highly integrated (HIDE) Coordination-only

The table draws on SCDHHS's 2026 contracts for each plan type and on SCDHHS's description of how each type works with Medicaid. The appeals row reflects South Carolina's 2026 HIDE contract only.

The federal label matters, because it decides which integration rules a plan follows. The Centers for Medicare & Medicaid Services (CMS) contract year 2026 integration-status file lists South Carolina among the states with HIDE plans and coordination-only D-SNPs, and not among the states with fully integrated (FIDE) plans. Nationally, the Medicare Payment Advisory Commission (MedPAC) reported that in 2024, 15% of all dual eligibles were in HIDE plans and 3% in FIDE plans, while 27% were in coordination-only D-SNPs. For how the federal categories differ, see our guide to fully integrated dual eligible SNPs.

Who Can Join a South Carolina HIDE D-SNP?

SCDHHS's 2026 contracts with its D-SNPs set who each type of plan may enroll, and SCDHHS says those contracts decide which Medicaid groups are currently eligible. Under the HIDE contract, a HIDE D-SNP may only enroll someone who meets all three of these tests:

  • Full Medicaid: You are in one of three full-benefit dual eligible categories, QMB+, SLMB+ or FBDE.
  • Age: You are 18 or older.
  • Medicaid managed care: You are enrolled in the South Carolina Medicaid managed care organization (MCO) that is aligned with the HIDE plan. If your Medicaid is fee-for-service, ask SCDHHS about joining a Medicaid managed care plan first.

South Carolina treats QMB as a full-benefit dual eligible category, according to both of SCDHHS's 2026 D-SNP contracts. To check which Medicaid category you are in, or whether you qualify for help with Medicare costs at all, see our guide to South Carolina Medicare Savings Programs.

If you are in a partial dual eligible category (SLMB Only, Qualifying Individual or Qualified Disabled and Working Individual), a HIDE D-SNP cannot enroll you, but the coordination-only contract lets a coordination-only D-SNP choose whether to accept you.

One more rule shapes the menu: under the coordination-only contract, a company that also operates an approved HIDE plan of the same type may not enroll any full-benefit dual eligible in its coordination-only D-SNP, so a full-benefit dual eligible who wants a D-SNP from that company can join only its HIDE plan.

Which Four Plans Are HIDE D-SNPs in 2026?

SCDHHS currently lists four HIDE D-SNPs that a member may join:

  • First Choice VIP Care
  • Humana Dual Integrated
  • Molina Medicare Complete Care Plus
  • Wellcare Absolute Total Care Dual Align

CMS's contract year 2026 integration-status file separately lists South Carolina HIDE plans from four sponsoring companies, each marked as an applicable integrated plan: Absolute Total Care, Humana Benefit Plan of South Carolina, Molina Healthcare of South Carolina and Select Health of South Carolina. The state's list uses plan brand names and CMS's list uses company legal names, so match a plan to its company by asking the plan directly.

To compare a plan's premium, drug list, doctors and extra benefits for the coming year, use the Medicare Plan Finder or call the plan before you enroll.

What Happens to Your Medicaid Plan When You Join?

South Carolina requires exclusively aligned enrollment for its HIDE D-SNPs. When a Healthy Connections Medicaid member enrolls in a HIDE D-SNP, SCDHHS enrolls that member in an aligned Medicaid MCO where one is available, so the same parent organization manages both the Medicare and the Medicaid benefits.

South Carolina's 2026 HIDE contract describes the Medicaid side in two places. Its enrollment section says you must be in Healthy Connections Medicaid managed care when you first enroll in a HIDE D-SNP, and that you are reassigned to the MCO exclusively aligned with that D-SNP once your D-SNP enrollment takes effect. Its eligibility terms say a HIDE D-SNP may only enroll members of its aligned MCO. Read together, a member of a different company's MCO should expect to end up in the aligned MCO, but the contract does not spell out whether that switch must happen first, so ask SCDHHS or the plan how your enrollment will be handled before you apply.

Either way, a HIDE plan can change your Medicaid plan as well as your Medicare plan, so check that your doctors, pharmacy and any long-term care providers work with the aligned company. A coordination-only D-SNP is different: SCDHHS says it may not offer a Medicaid MCO and works with the Healthy Connections Medicaid MCO you already have.

How Do Appeals and Complaints Work in a HIDE Plan?

South Carolina's 2026 HIDE contract requires each HIDE D-SNP to have an integrated grievance process that complies with both Medicare and Medicaid, and a single appeals and grievance policy across both programs at the plan level.

Under the contract, a HIDE D-SNP must follow the federal unified appeals rules for applicable integrated plans, 42 CFR 422.629 through 422.634, including:

  • Integrated decisions: A process for making integrated organization determinations (coverage decisions).
  • Integrated reconsiderations: A process for integrated reconsiderations of those decisions.
  • Services during an appeal: Continuation of benefits while an integrated reconsideration is pending, under the conditions set by 42 CFR 422.632.
  • State fair hearing: Where it applies, access to South Carolina's state fair hearing system once you have used up the plan's own appeals and grievance process.

The federal rule at 42 CFR 422.629 also requires an applicable integrated plan to give you reasonable help completing forms and taking the other procedural steps in a grievance or appeal. If your appeal reaches the state level, our guide to South Carolina Medicaid appeals and fair hearings explains that process.

How and When Can You Join or Switch?

Under the contract year 2025 Medicare Advantage and Part D final rule, people with full Medicare and full Medicaid get a once-per-month "integrated care" special enrollment period to enroll in an aligned integrated D-SNP (a fully integrated, highly integrated or applicable integrated plan). CMS's contract year 2026 file lists all four South Carolina HIDE plans as eligible for that integrated care special enrollment period.

The contract year 2025 Medicare Advantage and Part D final rule also gives dual eligibles and people with Extra Help a once-per-month special enrollment period to switch to a stand-alone Part D drug plan, except while a person is identified as a potential at-risk or at-risk beneficiary under a Part D drug management program. Our guide to Medicare special enrollment periods lists the others.

Medicare and Medicaid are handled separately when you enroll. For the Medicare side, 1-800-MEDICARE (1-800-633-4227, TTY 1-877-486-2048) is Medicare's official contact line, and CMS says to call your plan first, using the number on your member ID card, for questions about a plan you're already in. For the Medicaid side, including your Medicaid category or managed care plan, contact SCDHHS.

If Healthy Connections Medicaid Ends, What Happens to Your HIDE Plan?

For a South Carolina HIDE member, a missed Healthy Connections Medicaid renewal puts two things at risk at once: the HIDE D-SNP, which requires full Medicaid, and the aligned Medicaid plan it is paired with. Federal law softens the Medicare side for a while. Under 42 CFR 422.52(d), when a special needs plan finds that a member no longer qualifies but can reasonably be expected to qualify again within six months, the member is deemed to stay eligible for at least 30 days and no more than six months.

How that federal cushion works for a D-SNP member, per 42 CFR 422.52(d) and CMS's contract year 2027 enrollment guidance:

  • Length is the plan's choice: Each special needs plan picks a deemed continued eligibility period of one to six months and must apply it the same way to all members and tell them what it is, so call your HIDE plan and ask.
  • Notice before removal: A special needs plan member who does not requalify within the plan's deemed continued eligibility period is expected to be disenrolled at the end of that period, with a disenrollment notice at least 30 days before.
  • A window to choose new coverage: A person who loses special needs status gets a special enrollment period from the month the status changes until three calendar months after the disenrollment takes effect.

The cushion covers D-SNP eligibility, so the first fix is the Medicaid renewal itself. Our guide to South Carolina Medicaid recertification and renewal covers the steps and deadlines.

Does the 2027 Federal Matching Rule Affect South Carolina D-SNP Members?

South Carolina HIDE members already have the pairing the federal rule asks for (see What Happens to Your Medicaid Plan When You Join?). The South Carolina members the 2027 aligned-enrollment rule can affect are those in a coordination-only or other D-SNP whose company also runs a South Carolina Medicaid MCO for full dual eligibles in their area, while they belong to a different company's MCO.

The federal rule is 42 CFR 422.514(h), and CMS's April 2026 questions and answers explain how its aligned-enrollment limits work:

  • New enrollment from 2027: When a D-SNP's company, or a company under the same parent, also runs a Medicaid managed care plan for full dual eligibles in the same service area, that D-SNP may take new enrollees only if they are in, or are enrolling in, that affiliated Medicaid plan.
  • Unmatched members until 2030: A member of a covered D-SNP who is not in the D-SNP company's affiliated Medicaid plan may stay in the D-SNP until 2030.
  • From 2030: A covered D-SNP may only enroll or keep members who are also in its company's affiliated Medicaid plan, and the company must disenroll members who are not.
  • Plans outside the rule: A D-SNP whose company does not run a Medicaid managed care plan serving full dual eligibles in the state is not covered by these limits.
  • Fee-for-service exception: Where a state does not require Medicaid managed care for all full dual eligibles and the state's Medicaid contract allows it, a company may enroll full dual eligibles who are in Medicaid fee-for-service in its coordination-only or HIDE D-SNP, but not people in an unaffiliated company's Medicaid managed care plan.

Both the 2027 and 2030 limits apply to all types of D-SNPs, coordination-only plans included. If you are in that position, ask your plan what applies to you, and an I-CARE counselor can help you weigh a switch.

Where Can You Get Free Help?

I-CARE (Insurance Counseling Assistance and Referrals for Elders) is South Carolina's State Health Insurance Assistance Program (SHIP), offered through the South Carolina Department on Aging (SCDOA). SCDOA describes I-CARE as free, one-on-one insurance counseling for Medicare beneficiaries, their families and caregivers, including help comparing and enrolling in Medicare Advantage plans and help with Medicaid, Medicare Savings Programs and Low-Income Subsidies. A session is a good step before you join, leave or switch a D-SNP. For more on the program, see our South Carolina SHIP guide.

Question Where to go
Free, unbiased Medicare plan counseling I-CARE (SHIP): call SCDOA at 1-800-868-9095 or your local Area Agency on Aging
A problem with the plan you're in Your plan, at the number on your member ID card
Medicare enrollment questions 1-800-MEDICARE (1-800-633-4227); TTY 1-877-486-2048
Healthy Connections Medicaid eligibility or your Medicaid plan SCDHHS

The I-CARE route comes from the state's SHIP listing and the Medicare numbers from CMS.

Frequently Asked Questions

What is the difference between a HIDE D-SNP and a coordination-only D-SNP in South Carolina?

In South Carolina, the choice decides whether your Medicaid plan changes: a HIDE D-SNP moves you to its own company's Medicaid plan, while a coordination-only D-SNP works with the Healthy Connections Medicaid plan you already have. The comparison table above sets out the other differences.

Will a South Carolina HIDE plan send me a letter when it decides on my coverage?

Where applicable, yes: South Carolina's 2026 HIDE contract lists coverage decision letters as part of each HIDE D-SNP's integrated appeals and grievance process. If you disagree with a decision, the integrated appeals steps described above apply.

Does CMS give South Carolina's HIDE plans integrated member materials?

For 2027, yes. South Carolina is among the 23 states and territories whose applicable integrated plan D-SNPs received CMS's contract year 2027 integrated model materials (member handbook, ID card, and provider and pharmacy directory). Ask your plan which member materials it will send you.

Learn More

MedicareFully Integrated Dual Eligible Special Needs Plans (FIDE-SNPs) ExplainedFIDE-SNPs are the high-integration dual-eligible plans replacing the MMP demonstration on 1/1/2026: definitions, state landscape, and family pitfalls. MedicareHow Medicare Special Needs Plans WorkMedicare Special Needs Plans restrict enrollment to specific groups. Learn the three types, C-SNP, D-SNP, and I-SNP, who qualifies, and how to enroll in 2026. MedicareMedicare Plans and Coverage in South CarolinaMedicare in South Carolina for 2026: Parts A and B, Medicare Advantage, Part D, Medigap, savings programs through SCDHHS, and free SHIP counseling. MedicaidSouth Carolina Medicaid: A Guide for Seniors and FamiliesSouth Carolina Medicaid (Healthy Connections): 2026 income cap $2,982, the Miller Trust rule, the $66,480 CSRA floor, Medicare Savings, and how to apply. MedicareMedicare and Medicaid Together: Dual Eligibility ExplainedWhat dual eligible means: how Medicare and Medicaid coordinate, full vs. partial duals, QMB cost protection, automatic Extra Help, and integrated D-SNP plans. MedicareTexas Integrated D-SNPs: What Replaced the Medicare-Medicaid PlanTexas ended its Medicare-Medicaid Plans on Dec. 31, 2025. See which Integrated D-SNPs replaced them in five counties, how they work, and what changes in 2027.

Find personalized help choosing a South Carolina D-SNP that fits your Medicare and Healthy Connections Medicaid coverage at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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