Health Care

October 27, 2013

Prime program will focus on health of dual-eligible seniors

A new effort announced Friday by state and federal health agencies aims to better coordinate medical care, and costs for that care, for low-income elderly in South Carolina.

South Carolina is the ninth state approved by the Centers for Medicare and Medicaid Services to test programs to coordinate benefits for people who are eligible for both Medicare and Medicaid. South Carolina's version will be called Healthy Connections Prime. The S.C. Department of Health and Human Services has signed an agreement to run the program.

These so-called dual eligibles generally are low-income or handicapped people 65 and older. Many of their health benefits are paid by Medicare, but Medicaid steps in to pay for deductibles, co-insurance, some prescription drugs and some services. The dual Medicare-Medicaid coverage and payments can be inefficient and even hinder the health care services in some cases. Dual eligibles are among the state's neediest users of health care services, and among the most expensive to treat, according to the state agency.

``Currently, these patients must navigate a fragmented system to find the services they need,'' said S.C. DHHS director Tony Keck.

Under Healthy Connections Prime, eligible beneficiaries who enroll in the pilot program will be able to receive both Medicare and Medicaid services, plus additional behavioral health and community support services through one plan. Ideally, those coordinated services will increase access to primary care and delay the need for nursing facility care and reduce emergency room visits.

Healthy Connections Prime is voluntary. The initial enrollment period begins July 1, 2014. The agency expects to enroll about 53,600 of the dual eligible beneficiaries in the state in Healthy Connections Prime by December 2015.

Advocates for seniors back the program. AARP ``commends the state for working with stakeholders and the federal government to develop an ambitious and thoughtful program for integrating Medicare and Medicaid services for these individuals,'' said Teresa Arnold, state director of AARP.

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