Medicaid mailing out managed care plans

This week Medicaid members across the Lowcountry will begin receiving in their mailboxes enrollment packets for new health plans.

As part of the state's Medicaid reform plan, the program called Healthy Connections Choices is designed to help Medicaid members enroll in managed care plans.

The enrollment program, already rolling out in the Midlands and Piedmont, puts private companies in charge of public benefits. Eight health plan providers are participating, with one more pending.

More than 76,000 Lowcountry residents potentially could enroll, said S.C. Department of Health and Human Services spokesman Jeff Stensland.

Members will choose from two or three plans, depending on their county of residence. They can also choose to remain in traditional fee-for-service Medicaid.

Many Medicaid patients are left to find their way through the health care system, only seeking sporadic care or emergency help, Stensland said. Managed care will

pair beneficiaries with primary-care doctors, who will provide a medical home.

"Our goal is a healthier Medicaid population for South Carolina," HHS Director Emma Forkner said.

Participants will receive the same benefits as those in regular Medicaid and extra services offered through individual plans.

Doctors will receive a monthly fee for each Medicaid patient they accept, in addition to fee-for-service reimbursement.

Critics are skeptical of the "get more for less" promise of managed care. Lynn Bailey, a Columbia-based health-care consultant, said, "I don't understand how this saves money. The state can manage Medicaid for 5 to 7 cents on the dollar. Now we have someone stepping in who's going to cost more to administer, to market, to outreach — and make a profit."

Michael Jernigan, chief executive officer of Select Health, a North Charleston-based managed care plan provider, said that through prevention and outreach, managed care should reduce medical costs by creating healthier patients.

Select Health, which has been providing managed care plans for 12 years in South Carolina, has seen a 10 percent increase in members since the sign-up initiative began.

Barney Osborne, vice president of finance and reimbursement of the S.C. Hospital Association, said the group has been in touch with practically every hospital participating. "We have a lot of reimbursement questions remaining," he said.

Another concern is making sure patients understand the decisions before them. Beneficiaries will have at least 30 days from the date their enrollment packages are mailed to choose a plan or decide to remain with regular Medicaid.

If patients do nothing, Healthy Connections Choices will select a plan, possibly one that does not include their doctor.

Sue Berkowitz, executive director of South Carolina Appleseed Legal Justice Center, said that as people get notices, they need to call. She is concerned mental health patients may not understand the choice.

"If people get a medical home that's a very good thing," she said. But she will be watching closely.

Healthy Connections Choices

What is it?

An enrollment program to select a health plan that will cover traditional Medicaid benefits and offer extra services, such as unlimited doctor visits, eyeglasses or dental care.

Who does it affect?

All Medicaid beneficiaries will be mailed a packet on their enrollment anniversary. Members can choose from two or three plans, depending on their county of residence. Or they can stay with regular fee-for-service Medicaid.

Important deadlines:

Members have at least 30 days from the date their packet is mailed to choose a plan or tell Healthy Connections Choices they wish to stay in regular Medicaid. If you do nothing, you will be assigned a plan.

Members have 90 days after enrolling in a plan to transfer to another plan or return to regular Medicaid. After the 90-day period, members stay in their health plan until their one-year anniversary.

Will Medicaid benefits change?

No. Members will receive their current benefits, plus the enhanced benefits of their new health plans.

More questions?

To speak to an enrollment counselor, call 1-877-552-4642. Or visit www.SCchoices.com.

Reach <strong>Jill Coley</strong> at 937-5719 or <a href="mailto:jcoley@postandcourier.com">jcoley@postandcourier.com</a>.

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