Connecting a Resident to Care: A Starting Guide for Shelter and Housing Staff

Residents of shelters, transitional housing and recovery residences may arrive without a regular provider or any coverage, and staff end up as the people who help them find care. Here is a starting guide for housing staff: getting coverage started, connecting a resident to primary care and mental health care, the numbers to keep posted, and how to refer to Hope Health Network.

Start with coverage

The South Carolina Department of Health and Human Services (SCDHHS) takes Healthy Connections Medicaid applications online at apply.scdhhs.gov, in person at a county office, by phone at (888) 549-0820, or by mail. SCDHHS says a person who is not sure they qualify can still apply, either for Healthy Connections Medicaid or through Healthcare.gov. Our practices also offer self-pay rates.

A regular provider

Hope Medical Associates provides primary care, including care for diabetes, hypertension and COPD, the Medicare yearly wellness visit, and help establishing a primary care provider after a hospital stay. Routine labs and drug screens can be done at a lab of your choice, and vitals can be checked close to home through local clinical monitoring support where available.

Mental health and substance use care

Hope Behavioral Medicine provides psychiatric medication management and counseling for adults with anxiety, depression, ADHD, insomnia, PTSD, OCD, bipolar disorder and postpartum depression, in person in West Ashley and by video. Mental health care is available by video anywhere in South Carolina.

Hope Addiction Medicine provides medication-assisted treatment for opioid and alcohol use disorders. Treatment typically begins with an in-person assessment, followed by weekly in-person or virtual visits before moving to a monthly schedule, and each plan is tailored to the patient.

Numbers to keep posted

• 988 Suicide and Crisis Lifeline: call, text or chat, free, confidential and open around the clock. It is for anyone, including staff worried about a resident.
• The VA's National Call Center for Homeless Veterans, 877-424-3838, open around the clock, for a veteran who is homeless or at imminent risk.
• 911 for anyone in immediate danger.

When staff want updates

Staff can help a resident call us or make the referral with the resident's agreement. Hearing back about the resident's care is a different step: it needs the resident's written permission, and for substance use treatment records the consent has to meet 42 CFR 2.31.

How to refer

You do not need to choose a practice; we route each referral to the right one. The referral line, fax number and secure form are on our referral page, and housing staff can read more on our housing and shelters page. We typically contact the patient within two business days of a faxed referral, and initial evaluations are often able to be scheduled within a week of the request. If the patient needs to be seen sooner, call us.

Our practices accept Medicare, most major commercial plans, and all South Carolina Medicaid managed care plans except Select Health (First Choice). Self-pay rates are also available.

Our practices are not an emergency service, and the referral form is not monitored for emergencies. For someone in crisis, call or text 988, and in immediate danger, call 911.

This article explains these rules in general terms. It is not legal advice.

Sources: SCDHHS, Getting Started; VA, Homeless Programs for Veterans; 988 Suicide and Crisis Lifeline; 42 CFR 2.31, consent requirements.

This article is general information, not medical advice, and does not create a patient–provider relationship. Every situation is different, so see a provider who can evaluate yours and develop a plan of care. Any medication discussed here may not be right for you: the right choice depends on your diagnoses, other health conditions and current medicines, so take medication only as directed by the provider managing your care. If you are ever in doubt about an emergency, call 911 or go to the nearest emergency room.