(Published July 24‚ 2003)

COLUMBIA, S.C. (AP) - Directors from three of South Carolina's health agencies made budget pitches to Gov. Mark Sanford on Thursday, offering ideas on how to cut state spending while asking for more money to pay for key programs.

It was the latest round of budget hearings the new governor has held since the end of the legislative session to understand the needs and priorities of agencies as the state faces another bleak budget year.

After meeting with officials from the departments of Health and Human Services, Social Services and Health and Environmental Control, Sanford said one goal is to provide better health care for South Carolinians.

Too many caseworkers from different agencies are visiting individuals on Medicaid - the federal-state health care program for the poor and disabled - just one of many service duplications in state agencies, the governor said.

"We believe very strongly in having a medical home and a primary care physician being assigned, so that somebody knows the big picture of what's going on with this person's life with regard to their physical and mental health needs," Sanford said. "It doesn't exist with the way we presently have the system configured."

That results in duplication, a higher cost to the taxpayer and poorer service to the patient. He said a growing frustration is that different parts of government don't know what the other is doing.

Sanford grilled the leaders of DHEC about its divergent mission, asking what were the synergies of having health and environment under the same agency.

DHEC Commissioner Earl Hunter said the agency's mission is to protect the public's health through environmental regulations, testing and prevention.

There are "things that we do under the health part of our agency that certainly make sense to align and move with other health agencies," Hunter said.

But that could cause problems, he said, when the agency has to respond to a health outbreak, such as West Nile virus or rabies.

Hunter said Medicaid payments make up just $32 million of DHEC's nearly $500 million budget. The state Legislature allocates about $106 million of the agency's annual budget and the rest comes from revenue the agency generates and federal funds.

Hunter said his agency could cut programs like beach surf monitoring and tanning bed and swimming pool inspections to save money. Sanford asked the department to submit a list of additional programs that could be cut.

Hunter said DHEC needs $3 million to improve salaries for essential employees and $5 million for staffers to respond to emergencies ranging from terrorist attacks to hazardous waste spills.

Health and Human Services chief Robert Kerr said his agency is again faced with trying to find $170 million to fully fund its current Medicaid services. There is no specific source of funds to pay for the state's portion of the program's cost. That money is allocated each year by state lawmakers.

Kerr said his agency, which has a budget of more than $3 billion in state and federal funds, will look at changes in eligibility to curb growth in Medicaid costs and at cutting optional programs.

At DSS, which has cut almost 400 employees since January and plans to cut 250 more in September, Director Kim Aydlette is faced with a deficit because the agency needs $8.8 million for a federally required child-support enforcement system.

The state already has to pay $10.8 million in penalties for not having a system up and running.

Sanford asked what would happen if the state chose not to pay the penalties. Aydlette said that would jeopardize other federal funding, which is a significant portion of the agency's budget.