With one out of every four South Carolinians on Medicaid, there's tremendous interest in, and concern about, the state's proposed changes to the Medicaid system. So the head of the agency proposing the changes spent hours Wednesday explaining the plan.

Robbie Kerr, director of the state Department of Health and Human Services, detailed the plan for about 30 members of the South Carolina House, then answered their questions, while lobbyists and others who are interested listened.

One of the first questions on many people's minds is, why the change? Kerr says it's necessary to control the growth of Medicaid spending. Showing a graph of spending on Medicaid, he told the crowd that it now takes up 19 percent of the entire state budget. In just five years, it will take up 25 percent, and that number goes up to 29 percent in just ten years.

He says the state can't sustain that growth, so the only options will be to cut benefits or cut the number of people eligible for Medicaid.

Or make the radical change the agency is proposing.

Kerr is asking Washington for a waiver, which is necessary to bypass Medicaid rules. What it would mean is, instead of recipients getting unlimited health care, they would get a personal health account that they would use to buy private health insurance.

"Critics will say--and it's something to look at--that, 'Oops. You're cutting out services,'" Kerr said. "No. I didn't change the amount of money I put in the account. It's the exact same amount as we spend today."

In fact, he says it would be a requirement of the private health insurance companies that they provide the same level of benefits that Medicaid recipients now get.

But not all lawmakers were convinced by his lengthy explanation of the plan. Rep. Todd Rutherford, D-Columbia, is especially concerned about the prospect of higher co-payments required of Medicaid beneficiaries.

"Inviting co-pays into the Medicaid system, looking at changing the product that Medicaid beneficiaries receive, it scares me. It scares a lot of working poor people out there," Rutherford says.

Kerr acknowledged that more details needed to be worked out regarding co-pays, possibly using a sliding scale. For example, an adult who makes only half of the poverty level might have no co-payment, or a small one of $2, while a pregnant woman whose income is 185 percent of the poverty level might have a higher co-pay.

He stressed that benefits for children, especially, would not go down. Half of all the children in South Carolina are on Medicaid.

But the definition of children would change. Under the proposed plan, childhood benefits would end after age 18, instead of the current age of 21. Kerr says 19- and 20-year-olds would then get adult benefits, not be dropped from the program. 

He also explained that the request for waiver is still early in the process, so it'll be at least nine months to a year before the proposed change takes place, if it's approved in Washington.