COLUMBIA - 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 - S.C.
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 money 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 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.
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.
