Medicaid proposal has mom in panic

AMANDA RIDLEY, Staff Writer

Noel Prossi spends her days shepherding her four children from doctor to doctor.

Three of her four daughters have neurofibromatosis -- a genetic disorder that causes tumors to grow along various types of nerves throughout their bodies and leads to developmental abnormalities and learning disabilities -- and each has several appointments a week.

The 31-year-old mother from Greer spends most of her time worrying about appointments, medications -- and money.

Now that South Carolina is working to overhaul Medicaid, Prossi said she is terrified that her children won't receive the medical services they need.

"I don't even want to think about it. It's just not fair," she said.

Because of the care her children need, Prossi works two part-time jobs instead of full time.

Her husband, Michael, 39, also has neurofibromatosis and hasn't been able to work, which means they do not have health insurance.

The family relies on Medicaid, a federal program that helps low-income people with medical bills.

But the S.C. Department of Health and Human Services -- which administers Medicaid -- says a new program could help control costs by giving the state's 850,000 beneficiaries more responsibility for their spending.

The cost to operate South Carolina's program, in state and federal funds, is $4.8 billion for the current fiscal year that will end next June 30.

Medicaid is allotted $824 million in state funds, or 14 percent of the state's $5.8 billion budget.

With more money being spent on Medicaid, state officials are looking for ways to hold down costs and still provide necessary services.

"As it is now, the recipients are allowed to go shopping and never see the bill. There's no incentive to use it properly," said Bryan Kost, a spokesman for HHS.

Health care providers are hoping that any changes will preserve their ability to care for low-income patients.

"The number of Medicaid patients has certainly increased over the years. We would hope that full funding of the program is possible so that care can be received by the poor, disabled or elderly citizens of our state," said Betsy McMillan, executive director of marketing and public relations for Spartanburg Regional Healthcare System.

But state officials said action must be taken to conserve resources and cut costs.

In the proposed program, called South Carolina Healthy Connections, Medicaid recipients would be paired with enrollment counselors and given a personal health account with a specific amount of money for health care.

The account would be managed and monitored through use of a swipe card -- similar to a debit card -- and counselors would be available to help make adjustments to the recipient's account as necessary to provide a safety net of limited benefits, Kost said.

Even with the extra help, Prossi is afraid the new program would force her to gamble with her children's lives.

"What if it's something severe, and I can't go to the doctor because I don't have enough money? I don't want to be wrong, but I can't touch those bills if I am," she said.

"I just wish someone could walk in my shoes and see what it's like to have to care for your sick child and worry that you're going to lose your house or car."

Prossi's daughters are all under 10 years old, but under the new plan, once they turn 18 they will lose their child status -- instead of age 21 as it stands now -- and the number of doctor's visits and medications they're allowed would be limited.

But Kost said recipients still would have regular appointments with their primary care physicians. If patients meet certain wellness requirements, they could get extra benefits as a reward, Kost said.

The executive director of Spartanburg's New Day Clubhouse -- a psychiatric rehabilitation center for adults with serious and persistent mental illness -- said she is concerned about what the changes could mean for more than two-thirds of her program participants, who rely on Medicaid.

Jane Clemmer said if the limits go into effect, which Kost said could be within the next year, she fears that some of those people couldn't afford to receive New Day's services, which cost about $3,600 a year per person.

The facility currently receives $13 an hour from Medicaid for the services they provide.

"The financial impact would be great, but it would go beyond that," Clemmer said.

"This is the only family that some of our members have. They would have no one to turn to for help."

Amanda Ridley can be reached at 562-7221 or amanda.ridley@shj.com.