South Carolina’s Medicaid agency is offering residents who fall into an insurance gap due to Republican’s refusal to expand Medicaid eligibility a limited benefits program intended to catch illnesses early. What happens if a problem is detected is still being worked out.
The program, named Healthy Connections Checkup, provides physical exams every other year that include screenings for obesity, diabetes, high cholesterol, and several types of cancer. The coverage that began Aug. 1 expanded on a 20-year-old state program that provided only “family planning” services.
“You want folks to know their health status, and Checkup is a way for folks to stop wondering and start knowing, diagnostically, where they stand,” said Christian Soura, interim director of the Department of Health and Human Services.
The estimated 450,000 South Carolinians eligible for Checkup are mostly the same people who would qualify for full Medicaid benefits if the state expanded eligibility as the federal health overhaul intended.
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The limited benefit program represents the agency’s fastest-growing segment.
Roughly 140,000 people are enrolled in Checkup. That’s an increase of 30,000 since July 1 and more than three times the number enrolled in the previous “family planning” benefit when Gov. Nikki Haley took office in January 2011, according to the agency. It hopes 200,000 will be enrolled by next summer.
Signups generally occur when people fill out applications through the state agency or healthcare.gov and learn what they can get, Soura said.
He called it a cost-effective way to connect people in the gap to health care.
“This is very different than Medicaid expansion,” Soura said. “This is a tiny, tiny fraction.”
The agency’s budget for 2014-15 is nearly $6.9 billion. State funds account for $1.1 billion of that.
Last fiscal year, before the enhancement, the family planning program cost the state $19.5 million. The agency expects to spend $32 million on Checkup in the fiscal year that started July 1. For 2015-16, the first full year after the transition, the agency is seeking $68.5 million for the program.
An advocate for the poor notes that if the state expanded eligibility for full Medicaid benefits, the federal government would cover the full cost of their care through 2016, then phasing down to 90 percent.
“We’re going to let them know something is wrong but not take care of them. I don’t know if we’re being kind or cruel,” said Sue Berkowitz with Appleseed Legal Justice Center. “They can’t just take it for granted that suddenly some company or some facility will take care of the person.”
In repeatedly rejecting Democrats’ efforts to extend full Medicaid to more poor adults, Republicans have said the state can’t afford that eventual 10 percent match.
If a Checkup screening detects a problem, one option – depending on the severity – is moving the patient into the “healthy outcomes initiative,” which currently has 10,000 participants.
The agency launched that program last fall to target hospitals’ most frequent emergency room visitors. It involves evaluating patients’ medical and social needs, coordinating with existing safety net programs offering free- or low-cost care, and checking back to ensure patients are following doctors’ advice. Participation is expected to grow to 12,800 by July 1, Soura said.
Prescriptions could be available through Welvista, a nonprofit that provides free medicine for chronic diseases. The agency also is working with the state Hospital Association’s Access Health network on linking people to providers offering free services.
“Work on what that referral network looks like is a big part” of ongoing work on Checkup, Soura said.
Sen. Joel Lourie, D-Columbia, said anything the state can do to help the uninsured have access to health care is an improvement.
“For me, the No. 1 option is Medicaid expansion, but I recognize that doesn’t appear to be happening anytime soon,” he said. Checkup is “clearly a recognition that the more health care, particularly preventative care, we can provide, the better the chance we can cut down on emergency room visits and the better chance we can provide healthier outcomes for all South Carolinians.”