Dying residents of South Carolina may lose hospice benefits, and sick children may not have coverage for cough medicine in the wake of the state's budget crisis.
Medicaid released a 21-point list of services to be cut as of Feb. 1. The slashing is in response to the $61 million budget cut handed down last week. To date, Medicaid has been cut by a total of $137 million this fiscal year. Combined with matching federal dollars, that amount swells to $459 million.
One sweeping change is the elimination of the Medicaid hospice benefit. Patients currently admitted will have Medicaid pay through April 30, said Tamra West with The Carolinas Center for Hospice and End of Life Care, which represents more than 100 hospice providers in North and South Carolina.
"(Hospice) costs money to provide but saves money through avoiding hospitalizations, trips to the ER and stays in ICU," West said.
West said she was notified Tuesday afternoon of the changes and has been on the phone ever since. "Our goal is to avoid this happening. We have to act aggressively," she said. If the change took place today, about 500 dying residents would be left without reimbursement for their care, she said.
Jeff Stensland, director of public information for the S.C. Department of Health and Human Services, the agency responsible for Medicaid, said there is nowhere else to turn except programs and services when cuts are this deep. Legislators have restricted Medicaid from cutting provider reimbursement, and Medicaid's administration costs are so low that cuts must come on the backs of the state's most vulnerable, he said.
Many cuts come in the reduction of services. Psychological counseling will be limited to six visits per year. Adults may receive no more than one routine physical every five years, and Medicaid will no longer cover adult dental procedures.
Children's dental care took a hit, too. Medicaid will no longer cover full-view X-rays for children under age 8, and will only reimburse dental sealants on permanent molars for children under the age of 6.
"There must be a typo in there," said Tammi O. Byrd, chief executive officer and clinical director of Health Promotion Specialists, a dental health contractor with more than 30 school districts in the state and the S.C. Department of Health and Environmental Control.
"There are two things the (Centers for Disease Control and Prevention) has said prevent dental decay: fluoridation of water and sealants," Byrd said. "Why cut prevention?"
While groups scramble to be heard by legislators, others are moving to action and helping however they can. The Rev. Don Flowers, pastor of Providence Baptist Church on Daniel Island, was struck by the news that Medicaid was no longer paying for the construction of home wheelchair ramps. Flowers reached out to DHHS with an offer to help.
"We don't have the capability or capacity to help with prescription cuts, but wheelchair ramps, we can help," Flowers said. "Churches are willing, able and desirous to make changes in these situations that could be life and death to someone."
Federal help could be on the way in January with a $40 billion bill with temporary, additional federal funding for state Medicaid programs. South Carolina's allotment could be $404 million, according to the health care consumer group Families USA.
"We haven't seen any specific details on that," Stensland said. "It's too early to tell what it could mean. Theoretically, it could restore programs, but strings could be attached."
Effective Feb. 1, unless otherwise indicated, Medicaid:
• Will no longer cover nutritional supplements for those enrolled in waiver programs. Many supplements can be purchased through the state's food stamp program. • Will require that admission to the HIV waiver be frozen. • Will allow waiver beneficiaries a maximum of seven home meals per week. • Will suspend reimbursement for home wheelchair ramps. • Will require women applying for the Medicaid Breast and Cervical Cancer Program to be first screened through the Best Chance Network). This does not affect those currently eligible and receiving treatments through the program. • Will limit adult chiropractic visits to eight per year. • Will require GAPS to be reduced to 10 percent of the Medicare Part D "doughnut hole." • Will limit psychological counseling sessions to six per year. • Will apply utilization limits to speech/language, occupational, and physical therapies provided to children through private therapists. • Will limit hospice coverage to Medicaid beneficiaries who are also eligible for Medicare. • Will reduce Home Health visits from 75 per year to 50 per year (effective March 1). • Will no longer cover Panorex dental X-rays of children under 8. Only dental sealants on permanent molars for children younger than 6 will be reimbursed. • Will change durable medical equipment coverage: Will no longer cover alcohol swabs; will restrict the use of cranial bands; will now pay for one nebulizer every two years; nebulizer supply kits will be reduced from 31 per month to 15 per month. Manual wheelchairs will be rent-to-purchase only. • Will no longer cover expectorants or cough and cold medicine. • Will now cover one routine physical for adults every five years. • Will no longer cover additional physician visits beyond the 12 allowed for the general fee-for-service population. This does not apply to beneficiaries enrolled in Managed Care Organizations and Medical Home Networks and certain special populations, such as oncology patients. • Will no longer cover adult dental procedures. • Will no longer cover podiatry services except when indicated through the Early and Periodic Screening, Diagnostic, and Treatment service. • Will no longer cover after-hours code 99051. • Will no longer cover adult vision services.
— Source: Department of Health and Human Services