Enlarged health plan had room for 60,000 children
16 months after authorization, only 7,000 are signed up
COLUMBIA — Tens of thousands of poor children aren't getting access to more than $160 million in medical attention they're due because of a slow-moving bureaucracy.
In June 2007, state lawmakers authorized the expansion of the entitlement program for children called South Carolina Healthy Connections Kids, which would give 60,000 more children access to a generous set of benefits for the first time.
Now, 16 months later, only 7,000 children have been signed up and a state budget meltdown could mean the rest never see the benefits.
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Sue Berkowitz is outraged.
"Nothing is more compelling than to get kids on this program, especially at this time," said Berkowitz, an advocate and director of the South Carolina Appleseed Legal Justice Center. "These families really need the help."
How did this happen?
The state Department of Health and Human Services is in charge of running South Carolina Healthy Connections Kids. Gov. Mark Sanford, who selects the agency's director, has never been a big fan of the program.
Twice, Sanford vetoed funding for it. In his message to lawmakers this year, he wrote that the program is "well-intended" but not smart because of the long-term cost of adding more people to the Medicaid roll.
Twice, lawmakers overrode his vetoes, setting aside $42 million in a special account. With a $4-to-$1 federal match, the medical program's total outlay has the potential to grow to $168 million.
But it had a slow start. The program required federal approval, and it took more than three months for the state to submit documents to the federal Centers for Medicare and Medicaid Services.
Then federal officials said the documents weren't complete, according to Mary M. Kahn, public affairs specialist for the Centers for Medicare and Medicaid Services. The state submitted a final formal response Feb. 22, and the federal government OK'd the program a month later.
Who qualifies?
The state's Healthy Connections Kids program has room to provide 53,000 more kids with health care coverage, including dental and vision.
Children younger than 19 who come from households between 150 percent and 200 percent of the federal poverty level are eligible. They must be uninsured for at least three months to qualify.
For more information, log on to scchoices.com or call 1-877-552-4642.
Jeff Stensland, director of public information for the Health and Human Services Department, said it takes time to structure a new program and compile all the information needed for federal approval.
"We did push for a quick approval of this program," Stensland said. And while South Carolina was in the process of seeking the expansion, a fight was brewing in Washington, D.C., over how to continue the national program.
Kahn said the federal agency does not have an average for the length of time it has taken to fully process similar expansions in other states. Five months, though, is not unusual, she said.
The approval process was "very thorough and very deliberate" to ensure the state program conforms with all Medicaid guidelines, Stensland said.
The impact
Berkowitz said the governor's opposition to the program might have made the agency less than enthused to hurry the start-up.
"I think the agency is probably in a very terrible position; the big boss who is the governor has showed his dislike for this program," she said.
Sanford's press secretary Joel Sawyer said the governor did not delay the program.
Sawyer noted that an aspect of Medicare, the Health Savings Accounts, that Sanford pushed for in 2005 is now offered in only one South Carolina county, 3 years later.
No matter who is to blame for the lag in the Medicaid expansion, children are suffering, Berkowitz said.
Her nonprofit organization is trying to get the word out because she does not believe the state agency has done enough to let people know it's available.
Sawyer said the Governor's Office believes the state Health and Human Services Department is doing all it can to promote the program, especially when the agency has no money for advertising campaigns.
Stensland also highlighted the logistics of the situation.
By the time the federal government OK'd the program, it was the end of the school year. Getting word to kids and families during the summer months is a challenge, Stensland said.
Enrollment is expected to jump in the next few months, because that is typically the time when children get sick, Stensland said. History also shows that families don't usually look for coverage until a child needs to go to the doctor.
He said the state agency distributed brochures and applications to schools, told community outreach groups, gave media interviews, provided posters for doctor's offices and encouraged health care providers to talk to patients about the program.
The agency also partnered with a company called Maximus Inc., based in Reston, Va., to promote the program with local providers and nonprofits.
Still, he acknowledged that the agency isn't promoting the program the way it had in 1997 when the state first offered its Children's Health Insurance Program, Partners for Healthy Children.
At that time the Health and Human Services Department had a goal of getting an application in the hands of every school-aged child and some hospitals were even handing out candy bars when applications were completed.
A side effect of that blitz, he said, was that it blew the lid off the entire state Medicaid system.
By June 2007, a decade later, the number of children on Medicaid had increased by 112 percent, according to S.C. Kids Count data. Meanwhile, the Health and Human Services Department declared a $25.8 million deficit in 1999.
Therein lies the reasoning for Sanford's opposition, according to his veto message.
What's next?
Now, legislators will have to ask themselves if they want to cap enrollment where it stands in the expanded children's Medicaid program and use the rest of the state money to plug gaping holes in the budget.
Today, the state's Board of Economic Advisors is expected to reset revenue forecasts and legislative leaders will decide whether to call lawmakers back to the Statehouse to figure out what programs will get the ax.
Reach Yvonne Wenger at ywenger@postandcourier.com or 803-799-9051.
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Comments
IValueU (anonymous) says...
The amount of taxpayer's money spent since the War on Poverty was established in 1964 by Lyndon Johnson, the subsequent dismantlement and transfer of this program's mission to other government agencies and the tax funds obligated for the Emergency Economic Stabilization Act to cover some of the "sub-prime" loans made to un-qualified borrowers makes the price tag for the Iraq war look cheap in comparison. At least the surge in troops worked in Iraq. The same results can not be proclaimed for the "War on Poverty." After the trillions of dollars spent, the relative percentage rate of poor in this country remains the same. Perhaps it is time for the tax dollars obligated for this and other "un-successful" programs to be refunded to the taxpayers.
October 8, 2008 at 8:31 a.m. ( permalink | suggest removal )
wjhamilton3 (anonymous) says...
In the end, SC doesn't care about its children or its future. From DSS and the schools to this, as long as Massah can send his kids to private school, they don't care what happens to the children of the people who mop their floors, repair their cars or cook their food.
Children get sick, get inadequate emergency care their parents can't pay for and families lose everything. It is any wonder that we are losing our skilled labor to other places.
It makes their weekly appearance in church pointless. They should just go fishing instead. They know nothing about the kingdom of God described by Jesus.
My family has lived in this state for over 300 years, buidling schools and churches, fighting in the Revolution, civil war and doing huge amounts of community work.
I have a perfect right to say what I do. I'm not from somewhere else.
October 8, 2008 at 8:32 a.m. ( permalink | suggest removal )
guidedbystewart (anonymous) says...
Great post as usual wjhamilton3!
October 8, 2008 at 8:55 a.m. ( permalink | suggest removal )
zekemire (anonymous) says...
Ridiculous! This is not State money, IT IS TAXPAYER MONEY! I do not deny that these type programs have a small place, but, to continually rape taxpayers for socialist programs is not constitutional! Oh, but, there is a 4 to 1 federal funding! STILL IS TAXPAYER MONEY whether is comes from Columbia or D.C.!! NOT THE AMERICAN WAY!
October 8, 2008 at 9:20 a.m. ( permalink | suggest removal )
ReasonSpeaks (anonymous) says...
As long as people like Sanford run the state, South Carolina will remain in the bottom 10 states by all measures of success. Not providing healthcare for children has real long-term implications. Kids who grow up without proper healthcare become unproductive adults.
October 8, 2008 at 9:21 a.m. ( permalink | suggest removal )
5thGenerationLocal (anonymous) says...
Don't blame the Gov't for this. It's the parents who continually breed that can't afford to provide that are at fault.
October 8, 2008 at 9:21 a.m. ( permalink | suggest removal )
ReasonSpeaks (anonymous) says...
5thGenerationLocal:
Agreed. However, the fact is that those kids are there and will grow up and become members of society. You can ignore their existence (like Sanford) and have them break into your house to steal money for drugs later on, or you can provide them with a decent education and basic healthcare and have them clean your floors later on. Most won't become rocket scientists and some will still end up miscreants, but at least with some support, we have a shot a making some of them productive members of society.
October 8, 2008 at 9:29 a.m. ( permalink | suggest removal )
5thGenerationLocal (anonymous) says...
ReasonSpeaks,
Good point, but being from the bible belt and a place where gambling is illegal, the odds aren't in our favor. Teach them early that with little effort that will get enough to get by and they will continue to keep their hand out. Personal accountability needs to become law and my money needs to be spent the way my family sees fit.
October 8, 2008 at 9:56 a.m. ( permalink | suggest removal )
holly123 (anonymous) says...
Our schools are failing to produce any students capable of joining the middle class. The only middle class people that these kids know happen to be their teachers and health care workers. Thats not good enough! Serious efforts to integrate these failing schools has to happen! Poor children need to know middle class children but the ratio (to be effective)needs to be around 30% title 1.This problem of severe poverty didn't just happen, its been happening for generations. It will not fix over night but CCSD needs to start.
October 8, 2008 at 10:14 a.m. ( permalink | suggest removal )
guidedbystewart (anonymous) says...
Children of all types need affordable healthcare. If their parents can not afford it, it needs to be provided for them regardless if they are able to afford it. You can call it socialized medicine, entitlement or whatever, I do not give a crap. I call it being ethically right!
Healthcare should be at the very least provided for children!
October 8, 2008 at 12:07 p.m. ( permalink | suggest removal )
MMitchum (anonymous) says...
People we are talking about children here. 1st of all from the age of 19 the kids get the boot off your insurance unless they attend college. Next is if they don't attend they have to cover themselves on jobs which our great businesses gives them under 30 hours a week so they want have to offer them insurance.
Right now my daughter has been trying to get medicaid transfered from Berkeley County to Aiken County...for 3 damn months.She had to fill out new paperwork and turn in which she did.(3 months ago) 2 weeks ago she went by and Aiken County told her well she should have been had it, and she should be receiving it in 6 business days. Then my Granddaughter 7 months old has 102 fever...ear infection. She calls medicaid and then they say we can't find anything on your children. Who do we have working in these offices anyway? Seems to be people with no clue. And yes this Grandmother paid out the $102.00 for the doctor and $24.00 for medication that I didn't have set aside for this so 1 of my bills had to go lacking.
My daughter is trying to find a job here, and guess what..she hasn't been able to. But hey with daycare, and her going out and working for that minimum wage...I'll have to help for awhile...I don't mine this but don't tell me my daughter and grandchildren don't deserve anything because I pay my taxes and she has before now...we deserve the best in South Carolina...all of us. They derserve to grow up and be healthy. They may be sitting on capital hill one day...OUR CHILDREN DESERVE THE BEST!
Yes I understand some take advantage of the situation...but that doesn't mean all do.
South Carolina healthcare and schools need help and improvement.
I agree SC does not care for the young....or...the...aging.
I think these politicians should have their salaries reduced. This way they don't just go out their to be in these positions so when they retire or voted out they do not still get that great income...
AIG had a blast with $400,000.00 after they received money to help them out....what do you think about that. CORRUPT! GREED! TAKE BACK WHAT IS OURS TO BEGIN WITH!
October 8, 2008 at 1:16 p.m. ( permalink | suggest removal )
5thGenerationLocal (anonymous) says...
Look, if you go off and have a child and don't have a plan, and I mean a real plan that involves a good savings account, you have nothing. I am not responsible for your grandchild. I am not responsible for my sisters child. I am responsible for my family, and that is all. People that deserve the best are the ones who get up early and go fight for it. With education and degrees and jobs that make life better for them. The others are simply SOL. If they are not determined to better themselves or their family, they get what they deserve.
I do not care about this being about kids. These kids are innocent, I understand that, but MY earning are innocent too. Yet they keep getting pulled by someone who did nothing to deserve/earn my money. Understand that.
October 8, 2008 at 1:49 p.m. ( permalink | suggest removal )
ReasonSpeaks (anonymous) says...
5thGenerationLocal:
You write clearly and intelligently and I respect your opinion. You may not be responsible for your neighbor's child, but you must at least admit that by not endorsing any intervention to help less fortunate (and, yes, likely less intelligent) children out, you are contributing to the crime rate, cost of healthcare, and dismal record on education here in SC. You cannot complain if some derelict breaks into your car.
Your username implies that you are proud of being a 5th generation South Carolinian. I wouldn't brag given that, after 5 generations, your decisions have gotten South Carolina where it is now - in the dump.
South Carolina will only start to see improvement when "traditional" thinking gives way to progressive thinking. Look at the states that are advancing and you'll see...
October 8, 2008 at 2:22 p.m. ( permalink | suggest removal )
laurasmorris (anonymous) says...
I don't know why I keep letting myself get sucked into looking at Comments; it's so depressing. There are a lot of ignorant people who seem to find their way to the Comments Section. Maybe life has been so good for these people that they have not experienced any of the problems others face like loss of a job or a spouse or a critically ill child. While it is difficult, I can almost imagine someone being so narcissistic that they can't have any empathy. What I can't possibly imagine, though, is why this good life they have produces such vitriolic bitterness. Why do they have a burning need to publically display their ignorance and complete refusal to even consider that others are having different experiences in life-largely through no fault of their own? What is it about the Comments that draws so many of you?
October 8, 2008 at 3:49 p.m. ( permalink | suggest removal )
back2u (anonymous) says...
Amen to you laurasmorris. I, too, get suckered into reading these comments -- mostly because the posts tend to get humorously sad. Earlier posts talk of Jesus & this being the Bible belt. Apparently those folks have a very shallow understanding of Jesus Christ &/or the Bible. The Bible instructs to pay taxes to help support the government, who is suppose to be the peoples "watchdog" of sorts. (Yes, I agree that role has gotten greatly distorted over time.) The Bible also instructs to help & lift up those in need, especially widows & children. Everyone has fallen on hard times at some point in their life. If you say you haven't, then either 1) you're lying through your teeth or 2) it just hasn't happened to you YET. Keep up those narcissistic attitudes & you'll end up eating a big, healthy helping of crow sometime in your life. I've been on both sides of the fence. I grew up middle-upper class & stayed in that economic class for years as an adult. A few unfortunate events later and I was knocked down quite a few pegs and now considered to be living in poverty -- with children. Humble pie is something many people have to taste. It has gotten very hard to trust the government to do anything fiscally responsible anymore. I was outraged when I heard about the AIG celebration after getting a ton of taxpayer money. However, keep in mind that the children had NOTHING to do with that. But, at some point in the future, todays kids will be our leaders. I would love to see the poverty cycle broken. However, you can flip through the Bible & read over 2000 years worth of history concerning the poverty class. Poverty is a curse! Always has been and always will be. And there's no easy, simple cure for this curse either. (sorry 5thgeneration). Seems like the government (all levels) are screwing society up more than those living in the unfortunate circumstances called poverty. I'd better stop now before my "sermon" really gets heated up.
October 8, 2008 at 8:46 p.m. ( permalink | suggest removal )
laurasmorris (anonymous) says...
When I originally went to the comments section it was to comment on the article; I got so depressed by the posts that I abandoned the idea. Back to the topic at hand. One of the reasons it has taken so long to get children enrolled in this program and why CMS took months to approve it, is that this is not just adding a few more children but rather a major change in the state's Medicaid program. Everyone in Medicaid is being put in an HMO. It took the state many months to negotiate contracts with these HMOs, most of which are out-of-state businesses with little or no local offices or staff that had to find office space and hire staff. Then, because they had created such a complex system, they brought in Maximus to help manage enrollment.
I consider healthy children a good investment of my tax dollars and am happy to pay health professionals fair compensation for providing these services. I am less happy to have my money used to line the pockets of the private sector. Let's face it, if I am a business in Virginia or Florida considering whether to bid on a Medicaid contract in South Carolina, I'm not concerned about whether SC has healthy children. I'm concerned about whether it will be profitable. The state is taking dollars (our dollars) and using them to pay a profit to private companies that do NOT provide health care. There are only 2 possible scenarios here: either it is going to cost the state more to pay these middlemen or these middlemen are going to restrict the services provided to these children enough to squeeze a profit out of the same dollars. Either way, it is the children and the doctors and nurses who actually provide the health care that lose. Sure enough, due to state revenue shortfalls, we are already talking about reducing payments to providers.
October 9, 2008 at 7:07 a.m. ( permalink | suggest removal )
lillycollette (anonymous) says...
*
October 9, 2008 at 7:17 a.m. ( permalink | suggest removal )
lillycollette (anonymous) says...
I agree with Laurasmorris (Oct. 9, 2008 at 7:07 a.m.) : [T]his is not just adding a few more children but rather a major change in the state's Medicaid program. Everyone in Medicaid is being put in an HMO. : [I]f I am a business in Virginia or Florida considering whether to bid on a Medicaid contract in South Carolina, I'm not concerned about whether SC has healthy children. I'm concerned about whether it will be profitable. : There are only 2 possible scenarios here: : [T]hese middlemen are going to restrict the services provided to these children enough to squeeze a profit out of the same dollars.
October 13, 2008 at 6:22 a.m. ( permalink | suggest removal )
lillycollette (anonymous) says...
There is some deceptive advertising and practice thru this managed care under Medicaid.
(See, http://www.state.sc.us/dmh/client_aff...
Medicaid in SC is Changing (excerpted from the DHHS Healthy Connections)
They say that "Members enrolled in the Healthy Connections Choices program will receive all of their current Medicaid benefits -- plus -- the enhanced benefits provided by their health plans." However, some enrollment counselors have disagreed with that statement.
They say: "That means Medicaid recipients will now have to choose a managed care plan :" and further down the page they say, "If they don't choose a plan or tell us they want to stay on regular Medicaid, we will assign them to a plan.
Why aren't people being told up front in the advertising and by enrollment counselors that they can stay on regular Medicaid?
Why was a disabled elder person on Medicaid improperly assigned to a managed care plan which only provided coverage for children? This person was therein defrauded out of all coverage.
October 13, 2008 at 7:41 a.m. ( permalink | suggest removal )
lillycollette (anonymous) says...
Interesting article:
http://www.madisonrecord.com/news/215...
Kay: Governor should be impeached over FamilyCare 'fraud'
10/7/2008 6:12 PM
By Ann Knef
October 13, 2008 at 7:43 a.m. ( permalink | suggest removal )
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