From The Associated Press:
By Seanna Adcox
Monday, Oct. 24, 2011
COLUMBIA, S.C. — The director of South Carolina’s Medicaid agency wants to make it easier for low-income children who already qualify for health care coverage to enroll, saying Monday it’s a conservative step toward meeting a huge unfunded liability looming in 2014.
Director Tony Keck is requesting an additional $35 million from the state in his 2012-13 budget proposal, submitted to Gov. Nikki Haley earlier this month. Nearly $30 million of that would pay to add an estimated 70,000 children to Medicaid rolls by streamlining the application process.
Officials estimate up to 89,000 children in South Carolina without health insurance qualify for a Medicaid program that covers only those 18 and under. Legislators passed a law in 2007 increasing eligibility – allowing parents’ incomes to be 200 percent of the federal poverty level, up from the state’s previous 150 percent cap. That allows a family of four, for example, to earn up to $44,700 annually and still have their children covered by Medicaid.
But advocates have long complained the previous administration didn’t work to sign children up.
“It was almost as if there was a mindset to do a lack of outreach – to not make the rules simple enough so that people didn’t get overwhelmed,” said Sue Berkowitz of the Appleseed Legal Justice Center.
Keck said his proposal would help the state prepare for portions of the federal health care law set to take effect in 2014. Most observers believe a Medicaid expansion will survive whatever the U.S. Supreme Court decides or whoever wins the 2012 elections, he said, so the fiscally responsible thing to do is begin preparing for the “minimum expected scenario.”
It’s estimated that, beyond those 89,000 children, up to 56,000 already-eligible adults without insurance also will sign up for Medicaid in 2014, he said.
If the state does nothing, it will be hit with a huge increase all at once, when it must pay not only for those newly eligible under the law, but for those previously eligible, Keck said.
“We’ve created this mountain we’re going to have to climb,” he said. “You can’t just expect the state budget to go from zero to 60 in one year. You’ve got to start to chip away at that unfunded liability. Let’s next year start to ramp up for whatever happens in 2014.”
His proposed “express lane eligibility” program is a matter of his Department of Health and Human Services communicating electronically with the Department of Social Services to require less paperwork.
Residents who qualify for food stamps or welfare – which require incomes to be much lower – also qualify for their children to be covered by Medicaid. But currently, parents have to fill out separate forms in separate agencies, providing the same information for agencies often in the same building in offices across the state.
Under Keck’s proposal, which the federal government has allowed since 2009, his agency would simply certify the documents already submitted to DSS to enroll eligible children. The move would allow South Carolina to collect roughly $25 million in federal bonuses for raising eligibility ratios – bonuses that go away after 2014, Keck said.
The agency also expects to save $1 million in administrative costs by collaborating electronically not only to enroll people initially, but to re-enroll.
Parents must re-submit their paperwork yearly to affirm they still qualify for Medicaid – twice-yearly for food stamps. Every year, 90,000 children fall off the Medicaid rolls, only to be re-enrolled within six weeks, because of paperwork issues, Keck said.
“It’s a huge paper churn. All those people are re-enrolling anyway, and we have to go back and pay for services,” Keck said. “It cuts out thousands of wasted man hours and is less hassle for doctors having all sorts of problems getting claims paid.”
Berkowitz praised Keck’s proposal as common sense and something the state should’ve done years ago.
“Because one agency refused to talk to another agency, parents were having to do things over and over again. Often parents didn’t realize their children were off of Medicaid until it was time to go to the doctor,” she said. “It was a stupid thing to have to do when the information’s already collected by another agency.”
Haley declined to address any specifics on the agency’s request. Spokesman Rob Godfrey said the governor will release her executive budget proposal in January after reviewing all agencies’ requests, in light of revenue estimates for 2012-13 that the state’s economic advisers make next month.
According to the nonprofit Kaiser Family Foundation, 13 percent of South Carolina’s children and youth are uninsured – 147,500 people 18 and under – ranking the state 46th nationwide.