SC Medicaid Plan: End Adult Dental, Hospice Care, Etc.
By JIM DAVENPORT
The state’s Medicaid program plans to stop paying for adult dental, vision and hospice services and cut home health visits by a third for the state’s elderly and disabled in February.
Meanwhile, the agency plans to eliminate routine infant circumcisions, cut prescription drug benefits and shoes for diabetics. The reductions even include umbrella and crutch holders for people who use wheelchairs while telling people to use powered wheelchairs for seven years instead of five before they can be replaced.
The state Department of Health and Human Services faces a $228 million deficit and hopes those cuts will help convince the state’s financial oversight board on Tuesday to allow it to operate in the red for the rest of the budget year.
It’s the largest single agency deficit the Budget and Control Board has considered in at least 25 years. Four of the five members on the board chaired by Gov. Mark Sanford have to agree to it.
If it fails, the agency has said it will have to stop all Medicaid payments to doctors and hospitals in March.
It’s a vote that pits health care for more than 836,000 of the state’s poor, disabled and elderly against a cash-strapped state’s ability to pay for services to keep people healthy. And it is a financial gamble for the state: If state revenues don’t grow fast enough, Medicaid’s shortfall would wipe out much of the state’s $347 million cash reserves.
But the Medicaid program isn’t alone in seeking a budget bailout Tuesday. The Department of Social Services has a $29 million deficit even after announcing plans to cut 20 percent from welfare checks beginning in February and the Department of Corrections is $7.5 million in the red and will close a prison if it doesn’t get an OK.
Health and Human Services director Emma Forkner said the budget board could let the agency operate with a smaller deficit and order more cuts.
She said Friday that her discussions with members of the budget board lead her to think they want more cuts than she is proposing.
“The fact becomes that there is not the money in the state budget to pay for this. There’s no more money,” she said. “You’ve got to remember the agency has no reserves, so we are going to have to fit into whatever amount they recognize.”
Meanwhile, lawmakers are dealing with an $800 million deficit for the entire state budget year that starts July 1. Forkner’s agency needs $659 million more dollars just to keep existing programs at current levels.
Forkner said state and federal mandates limit her options in where she can cut services. For instance, state legislators have barred her from eliminating some chiropractic services and South Carolina is the only state in the nation where legislators have barred reducing payments to doctors and hospitals.
“I have so many state rules in place, I don’t have any options there,” Forkner said. “At this time, these are the limited options that we have available that we can act on.”
But doctors, dentists and advocates on Forkner’s Medical Care Advisory Committee said the cuts will create larger problems.
Columbia dentist Jim Mercer, for instance, noted the state pays for adult emergency dental services only when there is pain and swelling. He questioned plans to save $3.6 million by eliminating that care for 43,500 people. “Those emergencies aren’t going to go away,” he said. Instead those people will likely seek care at an emergency room, which can be more expensive.
The proposed cuts include eliminating hospice care for about 1,000 terminally ill adults. The service that lets those patients spend their final days at home rather than in a hospital or nursing home typically lasts less than 40 days and would save $3.3 million, the agency said.
“There would be pressure to enroll those folks in nursing homes earlier, which probably won’t happen, so they would end up back in the emergency department,” said Dr. Bill Moran, a Medical University of South Carolina professor and geriatric doctor on the panel. “A lot of docs are not equipped to handle end of life and hospice has been sort of stepping in to do that. Eliminating hospice, I think, will result in an increase in services at the end of life which is pretty sad.”
Forkner said other programs may be able to provide some of the services that hospice now provides.
“Hospice is an outstanding program, but these are our choices at this point,” Forkner said. “Yes, people will shift. Yes, care will have to move about. There’s just simply is no more money in the state to pay for these things. I just can’t reiterate it enough.”
Eliminating state Medicaid payments for routine circumcisions for 12,600 infants a year would save $114,800. The agency said a number of states have dropped that service.
And 8,600 children and adults would lose $2.6 million worth of rehabilitation therapy visits, including occupational and physical therapy. The agency now allows 75 visits for each of three types of therapy. The cuts would limit patients to a total of 75 sessions unless the agency approves an exception.
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