Medicaid

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What is Medicaid?

The federal government and states jointly fund Medicaid. States administer Medicaid within federal guidelinesand set the rules that say who is eligible, what benefits are covered, and how the provider is paid. States receivefederal financial support, but also put up some state funds. South Carolina gets about $3 from Washington for every dollar we put up for Medicaid.

Medicaid in SC is called South Carolina Healthy Connections Medicaid. It provides health care coverage tolow-income individuals and families and the disabled. Medicaid does this by paying health care providers fortheir services given to eligible people.

Who does Medicaid serve?

South Carolina’s Medicaid program covers almost 1 million South Carolinians each year. To get Medicaid aperson must be either pregnant, totally and permanently disabled, under the age of 19, or a caretaker relativeliving with a child under age 18 and also have a low income. Children and adults who are neither elderly nordisabled make up more than 3/4 of people getting help from Medicaid.

Elderly and disabled individuals make up less than 1/4 of Medicaid enrollment. Services for the elderly anddisabled mostly fill the gaps left by Medicare.
Who is eligible for Medicaid?Eligibility is determined by family income. Children who live in a household under 200% of poverty ($37,060for a family of three) can get Medicaid.
Different types of Medicaid programs have different income limits for adults. For example, adults havedifferent income limits that depend on the type of program. Those in need of long term care or nursing homecan get help if they are at or below 300% of poverty.

What services are covered?

There are certain services that Medicaid must cover. States can choose to cover more services. The federal lawhas not required states to provide these additional services under Medicaid, so they are technically optional.In South Carolina, some of the services covered by Medicaid are: inpatient and outpatient hospital services,12 doctor visits a year, periodic screenings, therapy, and ambulance transportation and prescription drugs.Prescription drug benefits for adults are optional and are limited to four prescriptions a month.

Children get unlimited doctor visits and prescriptions. In addition, if a child is diagnosed with a medicalcondition, she has the right to treatment under the Medicaid EPSDT program.

What would happen if Medicaid funding were cut?

Medicaid is the foundation of our healthcare system. Currently the state is lookingat cutting $125 million from the program.

If this happens South Carolina would lose $504,000,000 in business activity, 4,881 people would lose their jobs and $181,000, 000 in salaries and wages would belost around the state.

Most importantly, services once covered by Medicaid will be reduced or eliminated.

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