Gov. Mark Sanford’s vision of Medicaid for South Carolina is
centered on “self-directed care,” what some critics call the
riskiest element in his proposed changes to Medicaid.
If the federal government approves, most of the state’s 850,000
to 1 million Medicaid recipients will move from state-administered,
fee-for-service health care to managed health care, administered by
private insurance companies.
Using personal health accounts, all funded by Medicaid dollars,
almost all the S.C. recipients would choose either to become part of
a managed care organization, a medical home network or an
alternative coverage option bought outside of Medicaid.
But, at Sanford’s insistence, the S.C. reform proposal also
includes a small pilot program to test self-directed care.
Sanford and state Health and Human Services director Robbie Kerr,
whose agency oversees Medicaid, say the self-directed option — South
Carolina Medicaid Choice — is a linchpin of their reform proposal.
They say it would empower low-income patients covered by Medicaid by
giving them a choice in their health care.
Under Sanford’s self-directed proposal, low-income patients would
“create” the coverage they think they will need.
Here’s how it would work:
• A portion of the state dollars
in a Medicaid patient’s personal health-care account would go to buy
major medical insurance coverage.
• Money left over in the personal
health account could be used for other medical purchases or possibly
be carried over to a future year.
The risk is this: If a Medicaid recipient miscalculates his or
her needs — developing a chronic illness or suffering a catastrophic
accident — “the (medical) provider treats them as any other private
pay patient,” Sanford’s plan states.
In that case, the Medicaid recipient — people who typically earn
$1,241 a month for a family of three — would have to pay medical
expenses not covered by their insurance or personal health
account.
Now, the state and federal governments combine to pay all medical
expenses.
In a letter to federal Centers for Medicare & Medicaid
Services administrator Mark McClellan a year ago, Sanford said his
reform would “revolutionize health care purchasing by a population
that for far too long has had little control over their health care
coverage.”
However in nearly two months of negotiations, a mostly supportive
citizens’ 12-member advisory committee — hand-picked by Kerr — urged
the state to severely restrict Sanford’s self-directed care option,
the centerpiece of his Medicaid reform.
Committee members, who wielded no power beyond offering advice,
say as few as 5,000 residents may be allowed into self-directed
care. As a result, the pilot program would account for less than
half of 1 percent of the state’s Medicaid recipients.
Health and Human Services also proposes to severely limit people
who can enter the self-directed plan. Enrollees:
Cannot be Medicaid recipients with histories of unstable,
expensive acute care crises.
• Must have “a medical home” — a
primary care physician responsible for their overall care.
• Must show they understand their
family’s health-care needs and how to meet those needs.
As a result of those criteria and the pilot program’s small size,
critics are questioning whether Sanford’s proposed self-directed
care test really is valid.
“How can a plan that limits our ability to provide needed
health-care services to the citizens of this state be called
‘creative?’ ” asked Sen. Brad Hutto, D-Orangeburg. “I call it
cruel.”
“I believe South Carolinians know that when Gov. Sanford starts
fooling with Medicaid, it’s not going to be good news for them,”
said Tim Shock, campaign manager for Democratic gubernatorial
candidate Tommy Moore, the state senator from Aiken.
Last week, Sanford drew more fire after a U.S. Senate
subcommittee came to Charleston to tout his Medicaid reform plan.
The hearing heard from a half-dozen Republicans who favor the reform
proposal and a lone Democratic opponent. No Medicaid recipients were
heard.
“I was so demoralized and so insulted,” said Kimberly Snipes of
Charleston, a bipolar Medicaid recipient who attended the hearing.
“I felt completely demeaned and put down. I was outraged.
“You mean they couldn’t find one person out of 850,000 on
Medicaid that was educated enough to have any ideas or any thoughts
about how money could be saved and how health care could be
improved? And they say these are the people they want to
empower?”
Reach Burris at (803) 771-8398 or rburris@thestate.com
