Medicaid cuts will be severe
Hospice patients among those who would be hurt
By Jill Coley
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."
MEDICAID CHANGES
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
Reach Jill Coley at 937-5719 or jcoley@postandcourier.com.
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majorjohnson (anonymous) says...
I bet yall can't wait until the government is in charge of everyones health care.
December 18, 2008 at 7:49 a.m. ( permalink | suggest removal )
2cents (anonymous) says...
Again, cut the needed healthcare and leave the perks for the employees and elected officials alone. What sense dones any of this make???
December 18, 2008 at 8:39 a.m. ( permalink | suggest removal )
charlestonnative1963 (anonymous) says...
I am going to eventually move out of SC. I will take my multiple college diplomas with me to another state thus lowering the educated workforce further in SC-thus leading to fewer business transactions thus leading to even less revenue...then perhaps our politicians will look at reasons people need health care, teeth, healthy hearts, and good nutrition. Is there no one in this state that can see the connection to poverty and crime, poverty and health care, poverty and education. The less money you make the less you can spend on your teeth, linked to heart disease, linked to...well you get the idea. Or do you/
December 18, 2008 at 10:27 a.m. ( permalink | suggest removal )
majorjohnson (anonymous) says...
Well why don't you make some money with your multiple degrees and go pay for someones health care native? Oh wait, you want the government to take MY money to do that with. Do you just pay all of your taxes, or do you actually claim deductions and earned income credit and all that to minimize your tax burden every January?
December 18, 2008 at 11:01 a.m. ( permalink | suggest removal )
charlestonnative1963 (anonymous) says...
I doubt that you really want me to tell you the amount of taxes I pay-however I gladly pay them as I know roads, libraries, and schools are important in a democracy-and paid for by citizen taxes!!!
December 18, 2008 at 11:10 a.m. ( permalink | suggest removal )
eyfigueroa (anonymous) says...
"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."
Am I the only one concerned about this?
Want to cut general care to adults? I can understand. But hospice care? Care for small indigent children?
I realize that my tax dollars are going to be taken from me, I get that.
However, I would prefer that it be used to care for the MOST vulnerable as opposed to those who CAN care for themselves or to continue the bloated pyramid we call the govt. employment system.
Preventative and end-of-life care are far more important to our society than the superfluous spending Medicaid is accused of. Cut the fat off of other programs and care for the very young, disabled and dying.
December 18, 2008 at 11:21 a.m. ( permalink | suggest removal )
KidYendor (anonymous) says...
Watch how hospitals and health care providers drop prices as Medicaid fades away.
December 18, 2008 at 12:14 p.m. ( permalink | suggest removal )
DIS_A_PLAN (anonymous) says...
Grinch anyone? Holy smokes . . . when it rains the poor get wet. Where are the right to lifers? I guess you have rights before you are born but not after.
December 18, 2008 at 12:31 p.m. ( permalink | suggest removal )
SpiderJohn (anonymous) says...
Well said dis & native, let's start a caravan out of here.
December 18, 2008 at 12:42 p.m. ( permalink | suggest removal )
Abby88 (anonymous) says...
I feel no sadness for Medicaid being cut. It's a broken system abused by so many. As a person in the medical field, I regularly see Medicaid patients with German cars and designer clothing that I certainly can't afford!
Medicaid screws over hospitals and health care providers by paying pennies for procedures that, in turn, causes the rest of us to cover the shortfall with our skyrocketing insurance rates. Not only do we pay taxes for Medicaid, but we're screwed again with higher insurance costs. My husband currently has no medical coverage because it's too expensive. How can I feel sorry welfare scum not getting their teeth done?
December 18, 2008 at 12:43 p.m. ( permalink | suggest removal )
Abby88 (anonymous) says...
Don't get me wrong, there are deserving people out there who will be hurt by this. I'm sorry for that. It's just so frustrating that others feel no qualms about abusing the system.
December 18, 2008 at 12:59 p.m. ( permalink | suggest removal )
coolfreaknbeans (anonymous) says...
In no way shape or form should anyone be denied hospice care. Medicaid is often abused and the system is screwed on many levels. But for the love of God.....HOSPICE CARE?
December 18, 2008 at 1:29 p.m. ( permalink | suggest removal )
sig (anonymous) says...
I pretty much agree with Abby88. I have stated numerous times that DHHS should be closed and they should try again. There is a minimum of $100 Million in fraud waste and abuse. If they would monitor the programs they would not have to cut services.
I know more than one person that works part time because they continue to receive Medicaid benefits. If they worked full time for there company that offers health benefits then they would loose their Medicaid.
Why isn't DHHS going after all the people that committ fraud. I reported Fraud to them and the bottom line from them was is you think fraud was committed go and get a lawyer. I pay dearly for my health insurance and it does not cover dental, but the welfare scumbags have received free dental for years.
Do not cut the kids or the elderly. Get the welfare moms and dads off their backside. Taxpayers are tired of paying for these scumbags.
December 18, 2008 at 2:16 p.m. ( permalink | suggest removal )
DIS_A_PLAN (anonymous) says...
Personally I don't mind paying for those who do not have health care. I consider it honorable. 88 is your husband a scum bag b/c he has no health care. We will always have to pay for the poor and the stupid, that's just how it is. They will always have more children than they can afford and purchase cars, ect. they can't afford. That's what they do. They are unintelligent and having "things" makes them feel more complete. The only real solution is to minimize the number of poor and stupid and you can't do that by cutting their health care.
December 18, 2008 at 3:34 p.m. ( permalink | suggest removal )
SCSIGirl2 (anonymous) says...
Well said DIS_A_PLAN. I can't believe they want to cut hospice care and dental, the plans most in need at this time. I remember a popular saying my old boss once said, "There but for the grace of God go I." I have a decent job, with high cost medical coverage, which my employer pays, yes I am blessed, and I give thanks every chance I get.
Why do people drag welfare scum bag in conversations like this? I can hate those who cheat the system all I want, will it change anything? NO. Do I begrudge people who get a helping hand when needed? NO, I just live my life as best I can and try to remember my Bible, particulary Matthew, Chap 7, verses 1 through 5.
December 18, 2008 at 4:21 p.m. ( permalink | suggest removal )
palmettotree (anonymous) says...
I have medical and dental, even with the dental my dental bill is where I can't afford it. I have to go soon though I just have to come up with the money for my portion. it is cheaper just to get it yanked out for 40.00 on Rivers Ave. haha.
December 18, 2008 at 4:54 p.m. ( permalink | suggest removal )
yird (anonymous) says...
charlestonnative1963; I am going to eventually move out of SC.
=========================================================
Now is as good a time as any.
I think SpiderJohn wants to go with you. Make sure you hook up with Jimbo, GetDelerious, Guidedby Stupidity, and the wannabe doctor before you leave.
December 19, 2008 at 12:43 a.m. ( permalink | suggest removal )
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