SC Medicaid program growing despite rejection of Obamacare

abeam@thestate.comDecember 3, 2013 

MICHAEL MCCLOSKEY/ISTOCKPHOTO.COM

— S.C. lawmakers – led by Republican Gov. Nikki Haley – refused to expand the state’s Medicaid program under the federal Affordable Care Act, saying the state could not afford it. But the enrollment and costs of the state’s health insurance program for the poor are growing rapidly even without that expansion.

Since 2010, when Haley was first elected and brought in Tony Keck to lead the state’s Medicaid program, the number of Medicaid beneficiaries in South Carolina has increased to more than 1 million from 850,000.

Growth in South Carolina’s rolls has ballooned the state’s Medicaid budget to $6.4 billion this year from $5.7 billion in 2010 – and Keck expects that cost to pass the $7 billion mark in 2015.

That rising cost will be the subject today of the first of several state Senate hearings on the state’s Medicaid budget, jointly funded by state and federal taxpayers. Next year, the state Medicaid agency says it needs $467 million in additional federal and state money.

“My hope is that we’ll hear more about his vision for cost-savings measures ... so it’s not all about asking for additional money,” said state Sen. Thomas Alexander, R-Oconee.

The federal government said Tuesday that states that opted to expand Medicaid under the Affordable Care Act saw applications for Medicaid coverage jump by 13.2 in October. In states that did not expand Medicaid, like South Carolina, applications rose by 4.2 percent, on average.

But, in South Carolina, Medicaid applications increased by 20 percent.

South Carolina’s Medicaid program is growing because more people are discovering they are eligible for coverage, not because there are more poor people, state officials say.

For example, state officials have scoured the lists of people receiving food stamps and other federal poverty assistance to automatically enroll children in Medicaid. Since 2010, almost two-thirds of the state’s new Medicaid beneficiaries -- 103,000 of 150,000 -- have been children.

Adults also now can apply online for Medicaid coverage. In October, 15 percent of the state’s Medicaid applications were filed online. State officials also have set up “community outreach teams” that work with churches and nonprofits to find people who are eligible for Medicaid.

“A lot of states expand (Medicaid) so they can get the votes, and everybody feels good. But with a wink and a nod, the Legislature and the governor say, ‘Don’t try very hard to get those people actually enrolled because they are really expensive,’ ” Keck said. “That’s happened for years around the country.

“I just can’t play that game, and the governor doesn’t want to play that game.”

Despite its growing Medicaid budget, Keck says the state has done a good job of controlling the program’s costs.

Last year, for instance, S.C. Medicaid stopped paying for women to deliver babies early for nonmedical reasons. Those women faced greater health risks -- and, potentially, higher costs, the state said. Last month, a study showed the move saved Medicaid $6 million during the first three months of 2013.

Also, in June, lawmakers approved a plan that would pay hospitals up to $35 million to steer poor people away from using expensive emergency rooms for medical care and into cheaper alternatives, including free health clinics. Normally, steering those patients away would cost hospitals money.

“This whole thing is a test,” Keck said. “Can we make this new way -- for rewarding hospitals for doing the right thing -- work? I think we can. I think they are already doing it.”

Critics applaud the state’s Medicaid program for seeking out people who are eligible for benefits, especially children. But they note that Keck’s plan to redirect poor patients to health clinics only will affect about 8,500 people.

Meanwhile, the state’s decision not to expand Medicaid means that more than 250,000 low-income South Carolinians do not qualify for medical acre.

“They are leaving roughly between a quarter of a million and 350,000 folks outside,” said Lynn Bailey, a health-care economist who favors expanding Medicaid under the Affordable Care Act. “And they are still going to show up in the emergency room.”

Reach Beam at (803) 386-7038.

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