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| Monday, Jan 27, 2003 |
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Posted on January 22, 2003 Medicaid changes could save state $23 million COLUMBIA -- The state could save about $23 million if the Health and Human Services Department made changes in its Medicaid program, including charging an enrollment fee and improving debt collection, according to an audit released Tuesday. Members of the General Assembly asked the Legislative Audit Council to review the joint state-federal program, which pays for medical services for the state's neediest residents, because of concerns about the growth of Medicaid expenditures and number of recipients. In South Carolina, Medicaid is a $3.6 billion program. In fiscal year 2002, HHS paid about $480 million in state funds on Medicaid. From 1999 to 2002, Medicaid expenditures increased 25 percent, while the state's general fund revenues decreased 1.53 percent. Lawmakers are looking for ways to reduce the cost of the program without cutting services. One plan would raise tobacco taxes to help fund Medicaid. Each penny increase in the cigarette tax generates about $3.7 million. An increase of at least 50 cents would be needed to collect $180 million to pay for the state's Medicaid program. Representatives from taxpayer groups and tobacco and business associations met Tuesday to oppose such an increase, saying the government needs to set priorities before raising the cigarette tax. "It's been sold as a quick fix for Medicaid. It won't do it. We'll be back here a year and a half from now debating this very issue," said House Majority Leader Rick Quinn, R-Columbia. Quinn, who serves on the budget-writing Ways and Means Committee, said the program could find money within its own spending plan to make reforms, including updating its computer system. While "states cannot control health care costs on their own," actions that can slow the rate of growth by 2 percent to 3 percent could result in savings, the report said. The audit council found several areas where HHS officials could cut costs and save about $22.9 million. House Minority Leader James Smith, D-Columbia, said the audit shows there is no need for significant reform in the Medicaid program. "I think we will continue to find that, by and large, the program continues to serve the population that it's intended to serve and performs a critical function in our state," he said. In South Carolina, the number of people receiving Medicaid coverage increased 18 percent from 1999 to 2002. To cut down on the growth of the program, HHS should improve its application process to better determine whether an applicant has private insurance. Medicaid is required by law to be a last resort. The agency also could strengthen eligibility criteria to limit enrollment of low-income families and those who are just getting off welfare but still require aid. By frequently reviewing the status of these recipients and limiting the transitional Medicaid to one year, the state could save some $4.7 million, auditors found. Another cost-saving measure would require the agency to implement a preferred drug list. Such a system would tightly screen the authorization process for drugs prescribed to Medicaid patients. In other states with the system, the Medicaid program will not pay for prescriptions unless they are on the preferred drug list. Drugs not on the list would be reimbursed only if the doctor obtains authorization before prescribing them. The report also recommended directing more resources to home and community-based care programs, which include professionals coming into the patients' homes. Nursing home care for Medicaid recipients costs more than twice as much per person as care in their homes, the report found. The audit council also suggested HHS could improve its collection of unpaid Medicaid debts by using the state Revenue Department's collection program. HHS Director Bill Prince, in a written response, said his agency already has or will implement most of the suggestions contained in the audit. |
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