South Carolina Code of Regulations
Chapter 126 - DEPARTMENT OF HEALTH AND HUMAN SERVICES
Article 3 - MEDICAID
Subarticle 2 - ELIGIBILITY FOR THE MEDICAL ASSISTANCE (MEDICAID) PROGRAM
Section 126-360 - General Requirements

Universal Citation: SC Code Regs 126-360

Current through Register Vol. 48, No. 9, September 27, 2024

A. Medical assistance is available to residents of this State who meet the eligibility requirements of this chapter and who are United States citizens or who are aliens lawfully admitted for permanent residence or otherwise permanently residing in the United States under color of law. Residence is determined in accordance with Title XIX of the Social Security Act and the federal regulations promulgated in accordance therewith:

B. Initial Date of Entitlement for Medicaid.

(1) The initial date of entitlement for Medicaid benefits may be as early as the first day of the month in which the individual filed an application for financial or medical assistance, provided all eligibility requirements are met in the month of application. For initial date of entitlement by category reference is made to Title XIX State Plan.

(2) If an individual meets the requirements of 126-360(C)below for retroactive Medicaid, the date of entitlement may be as early as the first day of the third month preceding the month of application.

(3) As SSI recipient who moves into this State from another state shall be eligible for Medicaid beginning with the first day of the month in which he moves into the State.

C. Retroactive Medicaid Eligibility.

(1) Medicaid eligibility may be established retroactively up to the first day of any month in the three month period prior to the month of application provided the individual received Medicaid covered services at any time during that period and the individual would have been eligible for assistance at the time he received the services if he had applied. Persons found ineligible for Medicaid in the current month may be eligible for retroactive Medicaid. Prior approval shall not be required for medical services rendered during a period of retroactive Medicaid eligibility.

(2) Posthumous application may be made on behalf of deceased individuals. The individual must have been eligible for Medicaid when the services were rendered. The application must be filed before the end of the third month following death for any benefits to be received.

D. Medicare. Medicaid recipients who are eligible for Medicare benefits are automatically enrolled in the Supplemental Medical Insurance (SMI) Program (Part B). The State pays the premiums for Medicaid eligible persons who are enrolled in Part B.

E. Agreement With Social Security. The Health and Human Services Finance Commission (Commission) has an agreement with SSA under section 1634 of the Social Security Act for determining Medicaid eligibility for individuals who receive SSI.

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