Medicaid rolls could swell in SC, even as state rejects expansion in healthcare reform

jholleman@thestate.comSeptember 29, 2013 


— South Carolina turned down Medicaid expansion, so why is the state Medicaid agency ramping up its call center to handle more calls as the Affordable Care Act provisions expand?

When the tidal wave of new health insurance customers begins to build in October, a large secondary wave is expected to hit state Medicaid agencies, even in states such as South Carolina that turned down Medicaid expansion.

Tens of thousands of people required by provisions of the Affordable Care Act to get into the insurance market in 2014 will discover they are eligible for Medicaid benefits for which they’ve never applied. Estimates of the number of South Carolinians who are eligible but not enrolled in Medicaid range as high as 240,000. The state expects maybe two-thirds of those will end up on the Medicaid rolls rather than face a penalty for having no insurance.

That’s why the S.C. Department of Health and Human Services in July funded about 22 new call center positions and on Oct. 1 will unveil its new online application system.

State Health and Human Services director Tony Keck was the face, and authoritative voice, of the opposition to Medicaid expansion in South Carolina, but now his agency is making the process of signing up for Medicaid easier.

“At the end of the day, we’re all here to serve the citizens of South Carolina even if we may have differences about health care reform and its implications,” said John Supra, deputy director of the agency. When South Carolinians “need to get to the right place, it’s our responsibility to route them there.”

The agency 15 months ago shut down its in-house call center and transferred that work to the United Way-run 2-1-1 system that has become the go-to call center for many state and local health-related agencies. Under a contract, HHS pays for call center workers who deal with Medicaid calls, which often relate to eligibility questions or changes in family status. Agency staffers also have to provide training for the call center workers because government regulations change almost daily.

The statewide 2-1-1 operation also handles calls about food stamps for the state Department of Social Services as well as a wide variety of health and social service groups. “We get questions ranging from, ‘There’s an alligator in my yard; what do I do?’ to ‘How do I find a nursing home for my mom?’” said Tim Ervolina, president of the United Way Association of South Carolina.

The 2-1-1 center off S.C. 277 north of downtown Columbia handled about 1 million calls last year. Expecting the volume of calls to increase in the next few months, the staffing devoted to HHS calls has been nearly doubled in recent months.

Supra and Ervolina know some people familiar with the 2-1-1 system will call and ask questions about the new Health Insurance Marketplace when it goes online Tuesday. The 2-1-1 workers are trained to help callers get started shopping for insurance on, but that’s not the way the system is supposed to work.

Instead, people with questions about insurance on the new market should call the national help line at (800) 318-2596 or find local groups who received federal grants to guide people through the process. (The Cooperative Ministry and the S.C. Benefits Bank are the major Navigators in the Midlands.)

Once people enter their identification information, family size and household income in the online calculator for the insurance marketplace, they will find out whether they’re eligible for tax credits on health insurance. Some of them might discover they are eligible for Medicaid coverage.

The website was supposed to seamlessly transfer data on Medicaid-eligible applicants to state Medicaid agencies. Now, federal officials say that won’t happen until Nov. 1 because of difficulty in getting the system running.

Parents who sign up for health insurance also might find out that, while they aren’t eligible for Medicaid, their children are. South Carolina provides Medicaid coverage for children in families that make up to 200 percent of the federal poverty level. That’s up to $47,100 for a family of four. The state agency has made a special effort to get those children into the system, increasing the numbers of children covered from 485,000 in 2010 to 596,000 in 2012.

Agency leaders know another increase is looming because of the Affordable Care Act insurance mandate.

“This overall awareness is going to drive growth” of Medicaid rolls, Supra said. “A lot of people are going to be asking questions they haven’t asked before, and somebody has to answer them.”

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