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South Carolina Medicaid agency trying to cut costs through home visits

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COLUMBIA — South Caro­lina’s Medicaid agency hopes home visits steer patients away from expensive trips to the emergency room.

The idea involves training trusted community representatives to help Medicaid patients navigate the health care system. Their tasks would range from setting up doctors’ appointments to making sure prescriptions are filled and taken properly.
It’s about helping people make better decisions, said Tony Keck, the director of the state Department of Health and Human Services.

“They will become the eyes and ears for us to identify problems,” he said.

The pilot program is part of his agency’s efforts to improve residents’ health while reducing costs.

The agency is choosing up to 20 doctors’ offices to participate. The home visitors, dubbed community health workers, would be employed by the offices, not the agency. So far, 18 practices have applied. The pilot is expected to start in April with a six-week training course for the workers, who must pass a test to get the job. Home visits should begin this summer.

The House Ways and Means’ budget plan for 2013-14 has more than $80 mil­lion for Medicaid programs aimed at improving residents’ health, particularly in rural areas.

That includes up to $35 million in incentives for the “healthy outcomes initiative” – innovative, cost-cutting programs such as the community health workers. The federal government would provide two-thirds of that funding.

In the pilot program, each doctors’ office will receive a $6,000 grant, with up to $3,500 of that paying for the training. The rest would go toward administrative costs. The practice would fund the worker’s salary – suggested at $30,000 to $35,000. The incentive comes from the office’s ability to bill Medicaid for the certified worker’s services.
A spokeswoman for the agency could not immediately provide the program’s estimated budget for those service reimbursements.

The agency’s initiatives have been widely praised by both Democrats and Republicans, who laid out the initiatives’ funding as part of the committee’s spending plan for the fiscal year that starts July 1. Its budget plan, advanced last week, will be debated on the House floor next month.

Democrats contend the initiatives are no alternative to expanding Medicaid eligibility under the federal health care law to hundreds of thousands of additional poor adults. They plan to continue to fight for the expansion in budget debates.

But Gov. Nikki Haley is adamantly opposed, saying the state can’t afford the eventual costs. The federal government has promised to pay the full cost of the expansion for three years, and later fund 90 percent.

House Republicans are equally opposed, saying the state can’t simply add people to an already bloated, inefficient Medicaid system.

Democrats have faulted the Republican plan as being funded with one-time money from agency reserves.

But Keck said that’s a mischaracterization. Instead, he said, it’s funded with savings from other cost-cutting initiatives, which will continue.

“As we get better controlling costs, fundamentally we’re bending the cost curve,” Keck said. “It’s recurring savings that we’re redirecting. What we used to spend on ‘X,’ we’re now spending on ‘Y.’ ”

Budget spreadsheets show the initiatives are being funded by the agency’s surplus of more than $60 million. When Keck took over the agency in early 2011, it was projecting a deficit of nearly $228 million, which was dealt with through a combination of spending and benefit reductions that included lowering payments to doctors and hospitals.


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