Hi there,

See below instructions for applying to receive Institutional or In-Home Care.

If you are benefiting from medicaid and want to apply for Institutional or In-Home Care, you’ll need to complete a form called FM3400. This form gathers the necessary information needed for medicaid to make a decision about eligibility and approval.

Please find the document attached below, or it can be downloaded here.

Once completed, the completed form can be sent to Medicaid. 

See options below:

• Fax: 888.820.1204

• Email: 8888201204@fax.scdhhs.gov

• Upload: Upload here

• Mail: SCDHHS, P.O. 100101 Columbia SC 29202

The approval process can take up to 3 months,

For assistance completing or submitting the application please feel free to reach out to our patient representative Eli Taub at eli@clovercare.org or 864.693.1010 ext 101.

Or you can call your local CLTC office