Managed Care

The state of South Carolina contracts with different health care plans to provide individuals covered by Medicaid insurance with appropriate options for physician care.The Centers for Medicaid and Medicare Services (CMS) requires each state to assess its network of health care providers and its members' access to those providers. The assessment looks at whether each health care plan can adequately support its Medicaid members, ensuring its members have adequate access to health care.

According to CMS, access to health care has 6 dimensions:

Diagram of 6 dimensions of access to care

In its most recent guidance, CMS has instructed states to focus on these 4 of the 6 dimensions: Availability, Accessibility, Accommodation, and Realized Access. The following measures are used to evaluate access for these 4 dimensions:

  • Availability
    • Provider to Member ratios
    • Number of providers accepting new patients
  • Accessibility
    • Distance to care
    • Drive time to care
  • Accommodation
    • Number of providers with extended office hours
    • Number speaking language other than English
  • Realized Access
    • Utilization of services (HEDIS)
      • Adults’ Access to Preventive/Ambulatory Health Services (AAP)
      • Children and Adolescents’ Access to Primary Care Practitioners (CAP)

In response to this guidance, effective July 1, 2017, the South Carolina Medicaid program began incorporating this approach to frame and measure the network adequacy of managed care plans. As part of the larger issue of access to health care, the distribution and availability of health care providers within the state is an ongoing area of focus. Click here to explore related information that has been mapped for South Carolina.