SC MEDICAID MARKET

South Carolina

Name: South Carolina Medicaid Managed Care RFP & Procurement Intelligence | Precapture
Creator: Precapture

policy

South Carolina adds member populations to managed care for medical services

Last verified 318 days ago

Last verified 318 days ago · newest item is older than 21 days

POLICY

Verification tier 2

South Carolina adds member populations to managed care for medical services

January 1, 2026

SCDHHS moved medical services for additional Healthy Connections members into managed care effective January 1, 2026, while waiver services remain fee-for-service.

Precapture analysis

Plans need strong managed-care/waiver coordination, transition, authorization, encounter and provider-communication capabilities.

Plans in this market

Parent, plan, and program come from the plan graph. Enrollment and share use the latest CMS reported count. Operations counts are CMS MCPAR. A dollar amount is not on this page.

Plans in this market 55

Parent	Plan	Programs	Latest CMS enrollment	Share	MCPAR operations
Independence Blue Cross	Select Health of South Carolina	not reported	354,400 (2018)	47.5% calculated	not reported
AmeriHealth Caritas	First Choice by Select Health	not reported	423,307 (2022)	40.5% calculated	not reported
AmeriHealth Caritas	First Choice by Select Health	not reported	323,781 (2024)	39.8% calculated	2,740 appeals resolved
AmeriHealth Caritas	Select Health of South Carolina	not reported	348,112 (2019)	43.5% calculated	not reported
AmeriHealth Caritas	Select Health of South Carolina	not reported	393,063 (2021)	40.9% calculated	not reported

show all 55

Parent	Plan	Programs	Latest CMS enrollment	Share	MCPAR operations
not reported	BlueChoice HealthPlan Medicaid	not reported	98,342 (2017)	12.7% calculated	not reported
not reported	BlueChoice Healthplan Medicaid	not reported	96,346 (2018)	12.9% calculated	not reported
Blue Cross Blue Shield of South Carolina	BlueChoice Healthplan Medicaid	not reported	172,052 (2021)	17.9% calculated	not reported
not reported	Healthy Blue by BlueChoice Healthplan	not reported	121,441 (2019)	15.2% calculated	not reported
not reported	Healthy Blue by Blue Choice	not reported	150,728 (2024)	18.5% calculated	944 appeals resolved
Centene	Absolute Total Care	not reported	122,593 (2019)	15.3% calculated	2 sanctions, 1,217 appeals resolved
Centene	Absolute Total Care	not reported	108,032 (2018)	14.5% calculated	not reported
Centene	Absolute Total Care, Inc.	not reported	230,361 (2021)	23.9% calculated	not reported
Centene	Absolute Total Care, Inc.	not reported	167,573 (2024)	20.6% calculated	not reported
Centene	WellCare of South Carolina	not reported	75,389 (2018)	10.1% calculated	not reported
Centene	WellCare of South Carolina	not reported	81,982 (2019)	10.2% calculated	not reported
Centene	WellCare of South Carolina	not reported	85,372 (2020)	10.1% calculated	not reported
not reported	South Carolina Solutions	not reported	666 (2019)	100.0% calculated	not reported
not reported	South Carolina Solutions	not reported	890 (2021)	100.0% calculated	not reported
not reported	Greenville Health System	not reported	41 (2017)	9.3% calculated	not reported
Humana	Humana Healthy Horizons	not reported	29,918 (2024)	3.7% calculated	1 sanctions, 192 appeals resolved
not reported	Logisticare	not reported	1,195,703 (2018)	100.0% calculated	not reported
not reported	LogistiCare	not reported	1,217,302 (2017)	100.0% calculated	not reported
not reported	Logisticare	not reported	1,253,433 (2019)	100.0% calculated	not reported
not reported	Methodist Oaks	not reported	104 (2019)	25.0% calculated	not reported
not reported	Modivcare formerly Logisticare	not reported	1,446,070 (2021)	100.0% calculated	not reported
Molina	Molina Health Care of South Carolina	not reported	127,022 (2019)	15.9% calculated	not reported
Molina	Molina Healthcare of South Carolina	not reported	140,589 (2024)	17.3% calculated	1 sanctions, 3,511 appeals resolved
Molina	Molina Healthcare of South Carolina	not reported	166,458 (2021)	17.3% calculated	not reported
not reported	Greenville Health Senior Care	not reported	60 (2019)	14.4% calculated	not reported
not reported	Greenville Health System Senior Care	not reported	56 (2018)	12.7% calculated	not reported
not reported	Palmetto Senior Care	not reported	257 (2020)	59.8% calculated	not reported
not reported	Greenville Senior Care	not reported	77 (2020)	17.9% calculated	not reported
not reported	Prisma Health SeniorCare PACE - Midlands	not reported	274 (2021)	61.9% calculated	not reported
not reported	Prisma Health SeniorCare PACE - Upstate	not reported	86 (2021)	19.4% calculated	not reported
not reported	Palmetto SeniorCare	not reported	289 (2017)	65.8% calculated	not reported
not reported	Prisma Health Senior Care - Midlands	not reported	295 (2024)	54.7% calculated	not reported
not reported	Prisma Health Senior Care - Upstate	not reported	149 (2024)	27.6% calculated	not reported
not reported	Prisma Health Senior Care Midlands	not reported	311 (2022)	63.7% calculated	not reported
not reported	Prisma Health Senior Care Upstate	not reported	89 (2022)	18.2% calculated	not reported
Blue Cross Blue Shield of South Carolina	First Choice, by Select Health	not reported	359,040 (2017)	46.5% calculated	not reported
not reported	SC Solutions	not reported	995 (2024)	100.0% calculated	not reported
not reported	Orangeburg Senior Helping Center	not reported	95 (2024)	17.6% calculated	not reported
not reported	The Methodist Oaks	not reported	107 (2018)	24.2% calculated	not reported
not reported	Absolute Total Care	not reported	112,658 (2016)	15.2% calculated	not reported
not reported	BlueChoice Healthplan Medicaid	not reported	86,797 (2016)	11.7% calculated	not reported
not reported	Logisticare	not reported	1,235,361 (2016)	100.0% calculated	not reported
not reported	Molina HealthCare	not reported	104,560 (2016)	14.1% calculated	not reported
not reported	Orangeburg Senior Helping Center	not reported	83 (2021)	18.7% calculated	not reported
not reported	Palmetto Senior Care	not reported	278 (2016)	70.6% calculated	not reported
not reported	Select Health of South Carolina	not reported	346,764 (2016)	46.7% calculated	not reported
not reported	South Carolina Solutions	not reported	302 (2016)	100.0% calculated	not reported
not reported	The Methodist Oaks	not reported	96 (2020)	22.3% calculated	not reported
not reported	The Oaks	not reported	116 (2016)	29.4% calculated	not reported
not reported	WellCare of South Carolina	not reported	91,355 (2016)	12.3% calculated	not reported

CMS reported enrollment

CMS reporting years in this file run from 2016 through 2024. Retrieved 2026-11-01. The latest reporting year is 2024, which is behind the retrieval date. Enrollment figures are the CMS cell for that reporting year. Share is calculated from CMS reported total enrollment for that state, program, and year. Precapture does not combine rows. A year missing from a trend was not reported. A plan and region with more than one CMS row in a year has no trend and no year-over-year change. The dataset says a reported 0 may not truly represent 0 when a state suppressed a small count. CMS reported.

National market share

Medical Homes Network (Primary Care Case Management (PCCM))

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
South Carolina Solutions	Community Health Solutions	Community Health Solutions	Statewide	not reported	not reported	not reported	not reported	2016: 302; 2017: 456

Non-Emergency Medical Transportation (Non-Emergency Medical Transportation)

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
LogistiCare	Logisticare Solutions LLC	Logisticare Solutions LLC	Statewide	not reported	not reported	not reported	not reported	2017: 1,217,302
Logisticare	not reported	unmatched	Statewide	not reported	not reported	not reported	not reported	2016: 1,235,361

Program For All-Inclusive Care of the Elderly (PACE)

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
Orangeburg Senior Helping Center	The Methodist Oaks	The Methodist Oaks	Orangeburg, Calhoun, and Bamberg Counties	CMS reported 95 (2024)	17.6%	not reported	not reported	2024: 95
Prisma Health Senior Care - Midlands	Prisma Health System	Prisma Health System	Richland and Lexington Counties	CMS reported 295 (2024)	54.7%	not reported	not reported	2024: 295
Prisma Health Senior Care - Upstate	Prisma Health System	Prisma Health System	Greenville, Pickens, and Anderson Counties	CMS reported 149 (2024)	27.6%	not reported	not reported	2024: 149

Program for All-Inclusive Care of the Elderly (PACE)

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
Orangeburg Senior Helping Center	The Methodist Oaks	The Methodist Oaks	Orangeburg, Calhoun, and Bamburg Counties	not reported	not reported	not reported	not reported	2023: 89
Prisma Health Senior Care - Midlands	Prisma Health System	Prisma Health System	Richland and Lexington Counties	not reported	not reported	not reported	not reported	2023: 309
Prisma Health Senior Care - Upstate	Prisma Health System	Prisma Health System	Greenville, Pickens, and Anderson Counties	not reported	not reported	not reported	not reported	2023: 111

Program for All-Inclusive for the Elderly (Program of All-inclusive Care for the Elderly (PACE))

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
Greenville Health System	Greenville Health System	Greenville Health System	Greenville, Anderson, Pickens counties	not reported	not reported	not reported	not reported	2017: 41
Palmetto SeniorCare	Palmetto Health	Palmetto Health	Richland and Lexington county	not reported	not reported	not reported	not reported	2017: 289
The Methodist Oaks	The Methodist Oaks	The Methodist Oaks	Orangeburg county	not reported	not reported	not reported	not reported	2017: 109

Program of All-Inclusive Care for the Elderly (PACE)

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
Orangeburg Senior Helping Center	The Methodist Oaks	The Methodist Oaks	Orangeburg, Calhoun, and Bamberg Counties	not reported	not reported	not reported	not reported	2022: 88
Prisma Health Senior Care Midlands	Prisma Health System	Prisma Health System	Richland and Lexington Counties	not reported	not reported	not reported	not reported	2022: 311
Prisma Health Senior Care Upstate	Prisma Health System	Prisma Health System	Greenville, Pickens, and Anderson Counties	not reported	not reported	not reported	not reported	2022: 89

SC PACE (Program of All-inclusive Care for the Elderly (PACE))

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
Palmetto Senior Care	not reported	unmatched	Richland and Lexington Counties	not reported	not reported	not reported	not reported	2016: 278
The Oaks	not reported	unmatched	Orangeburg County	not reported	not reported	not reported	not reported	2016: 116

South Carolina Managed Care Organizations (Comprehensive MCO)

South Carolina Managed Care Organizations (Comprehensive MCO) 14

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
Absolute Total Care, Inc.	Centene	Centene	Statewide	CMS reported 167,573 (2024)	20.6%	-55,059 (-24.7%)	-1.3 pts	2020: 127,455; 2021: 230,361; 2023: 222,632; 2024: 167,573
Absolute Total Care	Centene	Centene	Statewide	not reported	not reported	not reported	not reported	2016: 112,658; 2017: 118,615; 2018: 108,032; 2019: 122,593
BlueChoice HealthPlan Medicaid	Blue Cross Blue Shield	Blue Cross Blue Shield	Statewide	not reported	not reported	not reported	not reported	2017: 98,342
BlueChoice Healthplan Medicaid	Blue Cross Blue Shield of South Carolina	Blue Cross Blue Shield of South Carolina	Statewide	not reported	not reported	not reported	not reported	2016: 86,797; 2018: 96,346; 2020: 143,070; 2021: 172,052
First Choice by Select Health	AmeriHealth Caritas	AmeriHealth Caritas	Statewide	CMS reported 323,781 (2024)	39.8%	-80,150 (-19.8%)	-0.0 pts	2023: 403,931; 2024: 323,781

show all 14

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
First Choice, by Select Health	Select Health of South Carolina	Select Health of South Carolina	Statewide	not reported	not reported	not reported	not reported	2017: 359,040
Healthy Blue by Blue Choice	BlueCross and BlueShield of South Carolina	BlueCross and BlueShield of South Carolina	Statewide	CMS reported 150,728 (2024)	18.5%	-35,980 (-19.3%)	+0.1 pts	2023: 186,708; 2024: 150,728
Healthy Blue by BlueChoice Healthplan	BlueCross BlueShield	BlueCross BlueShield	Statewide	not reported	not reported	not reported	not reported	2019: 121,441
Humana Healthy Horizons	Humana	Humana	Statewide	CMS reported 29,918 (2024)	3.7%	+6,182 (+26.0%)	+1.3 pts	2023: 23,736; 2024: 29,918
Molina Health Care of South Carolina	Molina Health Care	Molina	Statewide	not reported	not reported	not reported	not reported	2019: 127,022
Molina HealthCare	not reported	unmatched	Statewide	not reported	not reported	not reported	not reported	2016: 104,560
Molina Healthcare of South Carolina	Molina Healthcare	Molina	Statewide	CMS reported 140,589 (2024)	17.3%	-35,845 (-20.3%)	-0.1 pts	2017: 110,833; 2018: 111,302; 2020: 135,902; 2021: 166,458; 2023: 176,434; 2024: 140,589
Select Health of South Carolina	AmeriHealth Caritas Pennsylvania	AmeriHealth Caritas Pennsylvania	Statewide	not reported	not reported	not reported	not reported	2016: 346,764; 2018: 354,400; 2019: 348,112; 2020: 349,588; 2021: 393,063
WellCare of South Carolina	Centene Corporation	Centene	Statewide	not reported	not reported	not reported	not reported	2016: 91,355; 2017: 85,244; 2018: 75,389; 2019: 81,982; 2020: 85,372

South Carolina Managed Care Organizations (MCO) (Comprehensive MCO)

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
Absolute Total Care, Inc.	Centene	Centene	Statewide	not reported	not reported	not reported	not reported	2022: 237,734
First Choice by Select Health	Amerihealth Caritas	AmeriHealth Caritas	Statewide	not reported	not reported	not reported	not reported	2022: 423,307
Healthy Blue by Blue Choice	BlueCross and BlueShield of South Carolina	BlueCross and BlueShield of South Carolina	Statewide	not reported	not reported	not reported	not reported	2022: 188,682
Humana Healthy Horizons	Humana	Humana	Statewide	not reported	not reported	not reported	not reported	2022: 11,607
Molina Healthcare of South Carolina	Molina Healthcare	Molina	Statewide	not reported	not reported	not reported	not reported	2022: 183,832

South Carolina Medical Homes Network (MHN) (Primary Care Case Management Entity (PCCM Entity))

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
SC Solutions	South Carolina Solutions	South Carolina Solutions	Statewide	not reported	not reported	not reported	not reported	2022: 1,003

South Carolina Medical Homes Network (PCCM Entity)

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
SC Solutions	South Carolina Solutions	South Carolina Solutions	Statewide	CMS reported 995 (2024)	100.0%	-19 (-1.9%)	0.0 pts	2023: 1,014; 2024: 995

South Carolina Medical Homes Network (Primary Care Case Management (PCCM))

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
South Carolina Solutions	Community Health Solutions America	Community Health Solutions America	Statewide	not reported	not reported	not reported	not reported	2018: 558; 2019: 666; 2020: 756; 2021: 890

South Carolina Non Emergency Medical Transportation (Non-Emergency Medical Transportation)

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
Modivcare formerly Logisticare	Modivcare	Modivcare	Statewide	not reported	not reported	not reported	not reported	2020: 1,277,117; 2021: 1,446,070

South Carolina Non-Emergency Medical Transportation (NEMT) (Non-Emergency Medical Transportation)

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
Logisticare	Logisticare Solutions LLC	Logisticare Solutions LLC	Statewide	not reported	not reported	not reported	not reported	2019: 1,253,433

South Carolina Non-Emergency Medical Transportation (Non-Emergency Medical Transportation)

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
Logisticare	LogistiCare	LogistiCare	Statewide	not reported	not reported	not reported	not reported	2018: 1,195,703

South Carolina Program for All Inclusive Care for the Elderly (Program of All-inclusive Care for the Elderly (PACE))

South Carolina Program for All Inclusive Care for the Elderly (Program of All-inclusive Care for the Elderly (PACE)) 8

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
Greenville Health System Senior Care	PRISMA Health	PRISMA Health	Greenville Anderson Pickens Counties	not reported	not reported	not reported	not reported	2018: 56
Greenville Senior Care	PRISMA Healthcare System	PRISMA Healthcare System	Greenville, Pickens and Anderson County	not reported	not reported	not reported	not reported	2020: 77
Orangeburg Senior Helping Center	N/A	unmatched	Orangeburg, Bamberg, and Calhoun counties	not reported	not reported	not reported	not reported	2021: 83
Palmetto Senior Care	PRISMA Health	PRISMA Health	Richland and Lexington Counties	not reported	not reported	not reported	not reported	2020: 257
Palmetto Senior Care	PRISMA Health	PRISMA Health	Richland and Lexington County	not reported	not reported	not reported	not reported	2018: 279

show all 8

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
Prisma Health SeniorCare PACE - Midlands	PRISMA Healthcare System	PRISMA Healthcare System	Richland and Lexington counties	not reported	not reported	not reported	not reported	2021: 274
Prisma Health SeniorCare PACE - Upstate	PRISMA Healthcare System	PRISMA Healthcare System	Greenville, Pickens, and Anderson counties	not reported	not reported	not reported	not reported	2021: 86
The Methodist Oaks	N/A	unmatched	Orangeburg County	not reported	not reported	not reported	not reported	2018: 107; 2020: 96

South Carolina Program for All-Inclusive Care for the Elderly (PACE) (Program of All-inclusive Care for the Elderly (PACE))

Plan	CMS parent	Parent	Region	2024 enrollment	2024 share	Change from prior reporting year, calculated	Share change, calculated	Trend
Greenville Health Senior Care	PRISMA Health	PRISMA Health	Anderson, Pickens, Greenville Counties	not reported	not reported	not reported	not reported	2019: 60
Methodist Oaks	Methodist Oaks	Methodist Oaks	Orangeburg County	not reported	not reported	not reported	not reported	2019: 104
Palmetto Senior Care	PRISMA Health	PRISMA Health	Richland, Lexington Counties	not reported	not reported	not reported	not reported	2019: 252

Plan operations (CMS MCPAR)

Counts, rates, dates, and status are the CMS MCPAR cells for that plan, program, and reporting year. The appeal rate is calculated from CMS reported appeals resolved in favor of the enrollee divided by CMS reported appeals resolved. It is not a CMS-published rate. A plan links when the name matches one enrollment plan in that same state and program. Unmatched is shown and is not guessed. A sanction amount is not on this page. Retrieved 2026-11-02. CMS MCPAR.

National plan operations · Federal compliance deadlines

Appeals, grievances, and enrollment share (2024)

Plan	Parent	Program	Appeals resolved	In favor of enrollee	Appeal rate	Grievances resolved	Medicaid enrollment share	Managed care enrollment share
Absolute Total Care	Centene	Medicaid Managed Care	606	265	43.7% calculated	12	14.6%	21.5%
First Choice by Select Health of South Carolina	AmeriHealth Caritas	Medicaid Managed Care	1,360	691	50.8% calculated	992	27%	39.9%
Healthy Blue Blue Choice HealthPlan of SC	BlueCross and BlueShield of South Carolina	Medicaid Managed Care	436	153	35.1% calculated	1,390	12.5%	18.4%
Humana	Humana	Medicaid Managed Care	130	52	40.0% calculated	186	2%	2.9%
Molina	Molina	Medicaid Managed Care	1,794	809	45.1% calculated	3,026	11.8%	17.3%

Sanctions (2024)

Plan	Parent	Topic	Date	Corrective action plan	Remediation status
Absolute Total Care	Centene	Other, specify (Network Adequacy time and distance)	2023-10-13	No	Yes, remediated
Absolute Total Care	Centene	Other, specify (Network Adequacy time and distance)	2024-03-20	No	Yes, remediated

Award history

Medicaid standard eligibility redetermination services 2025-117: upheld. SCDHHS advertised an emergency award on October 31, 2024 for Medicaid standard eligibility redetermination services. This is not an MCO contract award. The Chief Procurement Officer dismissed the protest on February 6, 2025 because it was filed after the protest deadline.
Non-emergency medical transportation 5400028336: overturned. The Division of Procurement Services, for SCDHHS, posted a notice of intent on July 3, 2025 to award non-emergency medical transportation solicitation 5400028336. This is not an MCO contract award. The Chief Procurement Officer granted the protest in part on October 2, 2025 and remanded the procurement. Published point scores are included. Dollar figures from the decision are not copied here.
Medicaid MCO: not published by state.

Retrieved 2026-11-03. Sources and scores

Early procurement signals

No official early-procurement document has been retrieved for this state. This is not a finding that no signal exists. Early signals

Contract amendments

No official Medicaid managed-care contract amendment has been retrieved for this state. This is not a finding that no amendment exists. Contract amendments

Medicaid policy

Indiana rows are official policy instruments. Other states show only Federal Register notices of hearings on SPA disapprovals, which are a narrow slice and not waiver or SPA coverage.

Federal Register notices of hearings on SPA disapprovals are read from the Federal Register JSON API. That covers no approved SPAs, waivers, or section 1115 demonstrations.

Coverage not_collected.

No official Medicaid managed-care policy instrument has been retrieved for this state. This is not a finding that no waiver, state plan amendment, or rule exists. Medicaid policy

Federal Register SPA disapproval hearing notices (2015 or later): 1

Source receipts: 1 unchanged at 2026-11-15T11:15:57+00:00.

Plan financials

No official Medicaid plan financial filing has been retrieved for this state. This is not a finding that no filing exists, and it is not a zero. Plan financials. Coverage: not_collected.

Federal compliance deadlines

Cited federal Medicaid managed care deadlines, with the Federal Register citation, the effective date, the compliance date, and the plan obligation.

Subscriber analysis

Subscriber analysis is available to signed-in readers. This public page keeps the evidence and leaves out the interpretation.