Gov. Mark Sanford on Wednesday asked the federal government for permission to overhaul South Carolina's Medicaid program, saying the changes are needed to improve recipients' health, give them more choices and control skyrocketing costs.

The plan would give most of the nearly 850,000 Medicaid recipients "personal health accounts" they could use to buy a private health plan. It also includes a pilot project that would allow some healthy adult Medicaid recipients in a location to be determined to use some of the funds to "self-direct" care.

Officials believe the plan could save the state $300 million over five years.

Those savings would come largely from the better coordination of health care among Medicaid recipients, many of whom are unhealthy and receive duplicate services from numerous doctors.

"When you have Medicaid patients visiting the emergency room 66 percent more often than other South Carolinians, coupled with a program that's on pace to consume almost 20 percent of the state budget, it's clear real reform is needed to make sure this program grows at a sustainable rate," Sanford said.

Some critics, however, don't think the plan will save as much as the state thinks.

"I don't see how this is going to be any less costly than what we're doing now," said Lynn Bailey, a health-care consultant in Columbia. "You're adding in the cost for the marketing and administration of managed-care plans."

Children would be left out of some of the biggest changes. They would not be allowed to participate in the self-directed option, and insurers would be required to provide them with the same benefits they get now. One exception: Children would be considered adults at 19 instead of 21, leaving some young adults with fewer benefits.

Children and pregnant women would not have to make co-payments, which would increase for most Medicaid recipients. Instead of $25, a hospital stay would cost $40, for instance.