Originally created 09/15/03

Choosing choice



By becoming a pioneer in providing more choice to Medicaid patients, the Palmetto State is opening up issues of long-term health care that should command a compassionate society's attention.

South Carolina is the first state to receive federal approval to allow people on Medicaid to pay a friend, relative or neighbor to provide care. Traditionally when the needy elderly or sick require at-home health care they must go through a state approved agency.

Gov. Mark Sanford christened the new program "SC Choice." It will be piloted in Spartanburg, Cherokee and Union counties and expanded statewide next year.

"Anything we can do that empowers seniors and disabled people with choices that let them stay in their homes for longer periods of time is only going to enhance quality of life," said Gov. Mark Sanford. "It's also going to result in savings to the state because it extends the time community-based care groups can continue to meet these needs, which in turn delays entry into an institutional setting."

Indeed, according to Sam Waldrep, who heads up the state's Health and Human Service's Community Long Term Care program, the cost of keeping a patient in a long-term care facility runs 58 percent higher than providing at-home care.

SC Choice is a good start toward de-bureaucratizing important aspects of the Medicaid program. That's good, but what about the notion of paying a friend or relative to be care-giver, even if it's just for a short period of time? Does it not open the door to paying all at-home care-givers?

Look at the incongruities of SC Choice. If a disabled Medicaid patient's wife is the primary care-giver she is not paid by Medicaid. But if the next-door neighbor is called in to provide care, that person can, under SC Choice, receive Medicaid pay.

Does that make sense? If the neighbor's husband is also disabled, then the two wives could get paid by taking care of the other's spouse, but not their own. That makes even less sense.

The purpose here isn't to criticize SC Choice. We're all for it. It can help provide Medicaid patients with better, more compassionate, care at lot less cost than an institution.

But when it comes to saving money, the best deal the state - and for that matter the taxpayer - gets is the at-home loved one who provides care, usually the spouse. He or she, the primary care-giver, gets paid nothing. How long can the state pay some care-givers but not others - particularly those who are carrying the heaviest burden?

The deeper issue here isn't a zany Medicaid payment scheme, it's that neither the states, nor Washington, has thought through, much less developed, a sensible, comprehensive long-term health care policy. In our aging population, that's a terrible oversight. And though programs like SC Choice help, they are only a Band-Aid until the nation comes up with more substantive treatment.