Originally created 09/09/06

Medicaid overhaul to cost S. Carolina recipients more

COLUMBIA - South Carolina is moving ahead with changes in the state's Medicaid plan, including charging adults more for nonemergency visits to ERs, an elaborate health care database and rapid rehabilitation efforts for people with spinal cord injuries.

For more than a year, South Carolina has been trying to get federal approval for a sweeping overhaul of the state's system of caring for the disabled and poor that relies on state and federal money to handle the health needs of about 800,000 South Carolinians.

In February, Gov. Mark Sanford said federal budget writers had allowed South Carolina and nine other states to begin implementing changes in their Medicaid programs to save money.

The changes South Carolina sought included allowing people to choose from several types of health care plans, including systems that looked like a traditional employer health plan and physician network plans.

That plan is in the works, state Department of Health and Human Services Director Robbie Kerr said in a letter this week to the director of the federal Center of Medicaid and State Operations in Baltimore.

However, it's been scaled back. For instance, a proposal to have Medicaid recipients use debit cards has been dropped.

The state also has begun a pilot program to create a personal health record database. It includes information on services, drugs and health problems and will let doctors add information on lab tests. Eventually, data such as air quality conditions in different parts of the state can be matched to those records.

That capability can help doctors more quickly and accurately diagnose illnesses, Mr. Kerr said in his letter.

South Carolina will increase co-payments when adults visit hospitals. Those charges won't apply to children or patients who are institutionalized, pregnant, in waiver-based programs or getting family planning services.

Care providers will be able to deny nonemergency services until patients agree to pay before they are treated or see a doctor. If they don't pay, the provider can stop services, regardless of the patient's ability to pay.

Copayments are used to discourage the use of emergency rooms for regular health care. Copayments for hospital inpatient care rise to as much as $40 from $25, and for ER use for nonemergency needs as high as $25. Those visits cost nothing in the past. To encourage people to use generic drugs, copayments on those fall to $1 from $3, while copayments for using drugs that have a generic equivalent can double to $6.

People suffering head or spinal cord injuries could become immediately eligible for care under a pilot program that presumes they will become eligible for Medicaid help. The best chances for people to regain any ground lost to those injuries comes with intensive rehabilitation when they are stable, the state says in its letter.

"This will expedite entry of patients into rehabilitative care. The result of this early intervention program should be reduced cost to Medicaid, improved care and outcomes for patients, and an overall decrease in long-term disability," the letter said.


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