COLUMBIA - South Carolina's Medicaid director asked legislators Wednesday to support providing dental care to adults, weight-loss help for obese adults, and health screenings.
Those three new benefits were part of director Tony Keck's budget presentation before a House Ways and Means panel. The initiatives would cost $15.3 million from state taxes and $52 million total when including federal money.
Currently, Medicaid in South Carolina only covers emergency tooth extractions for adults when certain medical conditions require that a tooth be removed.
For example, if an adult Medicaid patient needs an organ transplant, but must have a tooth extracted before undergoing the surgery, Medicaid pays for the extraction. Extractions by themselves are not covered by the agency.
A broader emergency dental benefit disappeared in 2011 when the agency eliminated all adult dental services during the economic downturn to prevent going into a deficit.
"We recognized it was a cost shift to hospitals and in some cases dentists," but it was a cut the federal government allowed, Keck said.
He said the agency will restore the emergency dental services with existing agency money. He is asking the Legislature for more funds to cover preventive dental services for the first time.
He told legislators the need for dental care extends beyond improving health, because missing teeth, cavities and abscesses can make it difficult for people to find a job and - if they're in pain and can't concentrate - keep it. He estimates that up to 40 percent of the state's Medicaid-eligible adults would use preventive dental services, costing about $35 million, $10.3 million of which would come from state general funds. Federal money would cover the remainder of the cost. Children covered through Medicaid already receive full dental services.
The agency is developing a plan to cover services for the estimated 86,000 Medicaid-covered adults with a body mass index of 30 or more. That roughly translates to a 5-foot-9 adult weighing more than 200 pounds, according to the Centers for Disease Control and Prevention.
"The reality is, in a nation that's getting fatter and fatter and fatter, South Carolina is among the fattest," Keck said. "The country is slowly killing itself through obesity."
His Medicaid agency is the nation's last to recognize obesity as a primary reason to seek care. The change allows obese adults to seek help losing weight before they develop diabetes or the host of other health problems linked to obesity, Keck said. The $3.1 million he's seeking in the 2014-15 state budget would pay for visits to a doctor and licensed dietitian, and possibly other programs such as Weight Watchers. Such possibilities are still under discussion.
He's also seeking $1.9 million in state money for enhanced screenings for health issues such as blood pressure, cholesterol, and breast cancer.
The new initiatives are part of his agency's total request of $1.15 billion from the state's general fund, an increase of $56 million over the current fiscal year. When including all funding sources, the agency is seeking approval for a $6.9 billion budget.
That includes money to cover more already-eligible people enrolling in Medicaid due to the federal health overhaul. South Carolina is among states refusing to expand eligibility as the law intended. But more people are enrolling, Keck said, as people learn about their option or sign up to avoid the federal penalty for not having health care.
Keck said fewer already eligible people are enrolling than the agency predicted for this fiscal year due to problems with the federal government's Oct. 1 rollout of its online marketplace. His revised projection is that about 100,000 will be added to Medicaid rolls by June 30, rather than roughly 200,000.
He still expects additional enrollments to reach initial estimates, but over a longer period - by January 2016.
"We assumed a very large marketing effort around exchanges and lots of advertising and a robust call center and a website that would draw a lot of eligible people in. We all know what happened," he said. "But what we expected to happen last October will happen next October. I think that rush will come through in the next enrollment period."
Post and Courier reporter Lauren Sausser contributed to this report.