COLUMBIA -- York County resident Michelle Van Hook, the mother of a medically fragile child, had planned to drive to Columbia today to participate in a Statehouse rally in support of a cigarette tax to fund Medicaid shortfalls, but she'll visit a Charlotte neurologist instead.

"My daughter got sick over the weekend and the neurologist told me she only sees those children -- Medicaid kids -- every other Wednesday," Van Hook said. "That's the kind of thing we get all the time."

Van Hook's daughter, Whitley, has a degenerative brain disorder and requires around-the-clock care. She is insured by Medicaid. Her specialized medical care, including therapy, costs thousands of dollars a month. Because reimbursement rates to specialists are so low, an increasing number don't accept Medicaid patients. Van Hook must drive her daughter across the state line to see most specialists.

While lawmakers in Columbia argue over which financial vehicle they will use to generate additional money for Medicaid, advocates for the poor, disabled and elderly point out that the state's version of Medicaid is modest relative to the reimbursement rates, services and eligibility provided in most other states.

According to Sue Berkowitz, director of the Appleseed Legal Justice Center in Columbia, North Carolina and Georgia observe less stringent income requirements for eligibility than South Carolina. While a person must earn no more than 150 percent of what the federal government sets as the poverty indicator, residents of North Carolina who earn 200 percent of that same amount can qualify for Medicaid. In Georgia, those earning 225 percent of the federal poverty limit can opt for insurance under Medicaid, while Vermont allows residents earning 300 percent of the poverty indicator to qualify.

Services in South Carolina are also conservative by comparison.

"South Carolina allows only four prescriptions a month for Medicaid patients," Berkowitz said. "By contrast, Mississippi just cut back their allowable prescriptions from 10 to 7."

Beaufort pediatrician Dr. Francis Rushton describes the state's program as "poor to modest." About 40 percent of the 17,000 patients his seven-physician practice serves are insured by Medicaid.

"In pediatrics, a lot is socioeconomically related," he said. "Some of the sickest patients, the ones truly needing care, come out of Medicaid."

Rushton said cuts to Medicaid often hurt children more than other groups.

"One hundred percent of people over the age of 65 are on Medicare, no matter what their income level," he said. "Why do we treat old people preferentially over young people? We limit children's access to health care based on their parents' income."