Health Care

July 9, 2014

SC Healthy Connections Checkup could expand, improve health care for those on Medicaid

Disease may be diagnosed, but not treated, under newly expanded state medicaid plan.

By covering a wider range of screenings, a newly christened, limited version of Medicaid coverage could lure in – and improve the health of – hundreds of thousands of South Carolinians beginning Aug. 1.

S.C. Healthy Connections Checkup is an expansion of what has been called Family Planning coverage, but it’s not to be confused with the much-debated federal Medicaid expansion. On the contrary, it’s one of several programs pushed by Gov. Nikki Haley and S.C. Department of Health and Human Services director Tony Keck instead of Medicaid expansion.

One of the major concerns among health advocates is that many people who discover problems under Healthy Connections Checkup will not be able to pay for treating the problems. Healthy Connections Checkup is sort of Medicaid Lite, covering only the screenings and very limited procedures related to family planning and sexually transmitted diseases.

About 107,000 people now are enrolled in Family Planning through Medicaid, making up about 10 percent of the state’s total Medicaid population. Family Planning coverage is available for any S.C. resident who is a U.S. citizen or legal alien who earns less than about $22,500 and is not eligible for full Medicaid or Medicare benefits. Full Medicaid coverage is reserved for low-income parents, children, seniors, pregnant women and people with disabilities.

An estimated 300,000 in the state are eligible for Family Planning coverage but never have signed up. Many are single adults or adults with no children at home.

“They see it as Family Planning and say ‘Oh, that’s not me,’” Keck said.

The name change to Healthy Connections Checkup along with the more robust set of screenings could lead to a rush in new applications. The changes could boost the cost of the program from about $23 million in the current fiscal year to as high as $48 million next year.

Family Planning covers limited health screenings now, but those don’t include such basics as diabetes and cholesterol screenings. South Carolina wrote federal officials last year, asking if it could increase the types of screenings covered, and federal officials issued guidelines giving all states wide leeway.

Starting Aug. 1, South Carolina will cover a once-every-two-years physical exam with a wider variety of health screenings. Which screenings are covered depend on age, gender and risk factors. The additions to the list include diabetes, obesity, breast cancer, colorectal cancer, lung cancer, hepatitis C and mental health. Cervical cancer and breast cancer screening already was covered.

The state agency also will begin issuing different Medicaid cards, with colors varied depending on whether an applicant qualifies for full Medicaid coverage or Checkup.

The changes were discussed Tuesday at a meeting of Health and Human Services’ Medical Care Advisory Committee. While expanding the screenings available through Checkup is a major step forward, health advocates say the next step is the most critical – getting care when screenings uncover problems.

“Telling someone they have colorectal cancer then they don’t have any services available is devastating,” said Sue Berkowitz, director of the S.C. Appleseed Legal Justice Center.

“We have to admit on the front end we’re going to see a lot of diagnoses of disease,” said Dr. Tom Gailey, an ob-gyn from Greenville. “If we don’t realize the breadth, depth and scope of this, everyone is going to be miserable.”

Keck said discovering cancer early would be a step forward, considering people are showing up now at the emergency rooms with late-stage cancer. But he also acknowledged the bugaboo. “The trick here isn’t the screening, it’s the referrals,” he said.

Those on the advisory committee pledged to gather comprehensive information on the services available for those lacking full coverage, and to get that information to the health providers likely to do the screenings. Keck said there are many resources available through free and low-cost health clinics. Also, hospitals and individual physicians provide help in charity cases.

But Berkowitz, who pushed for the federal expansion of Medicaid, noted that many of the people who fall under the Checkup coverage gap would have been eligible for full health coverage if South Carolina’s leaders had accepted that expansion.

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