Article tools  E-mail this story  Print this story PROPOSED MEDICAID CHANGES DEBATES The issue The state wants changes to rein in exploding growth in costs, but opponents say that could leave poor, sick people without services or confused by the increasing complexity of self-managed plans. The meeting Tuesday at 6:30 p.m. at Reedy River Missionary Baptist Church, 1012 Mauldin Road, Greenville _____ Related news from the Web _____ Advertisement Sponsored links

_____ Top stories _____ • Health-care change may hit poor

South Carolina wants to change its Medicaid program to save money, saying the program is poised to gobble up a third of the state's budget in a decade.

But a growing number of groups -- AARP is the latest -- oppose the changes, saying they could leave poor, sick people without health care. And they worry that beneficiaries may not be able to navigate the complicated self-managed plans proposed with the change, leaving them short of money for care.

About a quarter of the state's population, or 1 million South Carolinians, are on Medicaid, the federal health-care plan for the poor, elderly and disabled.

The $4.5 billion program -- $1.16 billion is state money -- pays for more than half of all births in the state and covers more than 40 percent of South Carolina's children and nearly 30 percent of its senior citizens.

Up to now, the law limited cost controls to benefit cuts, provider reimbursements or eligibility limits.

But Gov. Mark Sanford, saying Medicaid's growth is unsustainable, last October proposed sweeping changes. The proposal, which was submitted to the Center for Medicare and Medicaid Services (CMS) for approval in June, includes developing new health plans and offering beneficiaries a choice, increasing co-payments, ending childhood eligibility at 18 instead of 21, and streamlining administration of the program.

Dwight C. James, executive director of the South Carolina chapter of the NAACP, said his group's primary concern is that people don't know about the changes and how they may affect services.

"We're concerned there wasn't sufficient public review of the document before it was sent to the federal government," he said, "and we wanted to make sure we provided an opportunity for people to learn more about it."

The NAACP has been hosting a series of public meetings about the program around the state. The next is Tuesday in Greenville.

The administration's plan calls for beneficiaries to get a Personal Health Account with funds to buy insurance on their own from state-approved plans. Adult coverage must include Medicaid medical services, pharmaceuticals and durable medical equipment and children's coverage must include all mandatory and optional services.

Enrollees could opt out by getting care outside the program with Medicaid providing only a defined amount, such as paying for group health insurance at the beneficiary's employer, or by choosing a self-directed plan so a portion of the personal health account pays for a major medical plan.

But while the state hopes to save taxpayers money, some groups worry that beneficiaries will be without services or with reduced services, says the NAACP's James, adding the group expects to release a position paper after its annual convention in October.

Opponents also fear that self-managed plans may not be appropriate for some people because of the level of care they need or because they are not accustomed to managing their health care, he said.

"In some scenarios as funds run out, then what do you do for those who are chronically ill?" he asked. "Some of those questions have not been answered."

AARP joined the opposition last week, issuing a position paper that called the proposal "too risky and untested." It worries about the state's "capacity to offer choices of plans and providers to beneficiaries," particularly in rural areas, and the willingness of insurers to participate because of changing rates and additional risk.

In addition, AARP says some of the state's most vulnerable beneficiaries, including those with the most complex health care needs, will be affected by the plan.

Instead, AARP proposes making the program more efficient by negotiating better drug prices through "more accurate pharmacy payments, higher manufacturer rebates, evidence-based formularies and purchasing pools." The increase in medication costs more than doubled since 2003 from 6.7 percent to 16.0 percent, according to the state.

AARP also opposes what it calls a lack of consumer protections in the plan, such as definitions or standards of terms, and no ceiling or floor for copayments, as well as inadequate monitoring of service quality.

Furthermore, AARP says extending the look-back period from 36 months to 60 months for an asset transferred to a trust to be eligible for nursing home care would deny coverage to those who helped family or charities long before illness used up their resources.

Loopholes that permit abuses should be examined, they said, adding that many people are forced into Medicaid because there are so few affordable private sector options.

The state could save more money with a broader range of long-term care options instead of sinking money into costly and unnecessary nursing home care, they said.

"Big dollars aren't impacted by this waiver," said Teresa Arnold, legislative director for AARP.

"They are limiting what people can spend, but they're doing it on a population that is probably the least expensive in the program," she added. "As a state, we spend so much money on the nursing home side. Spending it on home and community-based services would get a lot more bang for our buck."