New primary care program may benefit former inmates

An estimated 9,000 inmates discharged from the South Carolina corrections system each year may soon benefit from a modified Medicaid program that would address some of their basic health care needs after they leave prison.

Officials from the S.C. Department of Health and Human Services and the S.C. Department of Corrections recently discussed enrolling these adults into a new program upon their release called Healthy Connections Checkup, which provides primary care screenings and family-planning benefits for residents whose income falls below 194 percent of the federal poverty level, or about $22,600 a year for a single adult. Most inmates discharged from prison would qualify.

"When men and women get out of prison, they're often without a job," said S.C. Medicaid Director Tony Keck. "You want to prioritize and try to find people who are most vulnerable. That's been one of most consistent strategies since I got here - find the most vulnerable people and connect them to care."

The benefits covered by Healthy Connections Checkup are less robust than most Medicaid plans. For example, Healthy Connections Checkup patients qualify for a free physical once every two years, but they must pay for follow-up treatment out of their own pocket. Traditional Medicaid plans cover more, including emergency room visits, prescription drugs and specialty care, but they also cost the state much more to administer.

Healthy Connections Checkup costs South Carolina approximately $300 per person per year, compared with at least $3,000 a year per patient enrolled in traditional Medicaid.

But most childless adults in South Carolina do not qualify for traditional Medicaid, regardless of their income, because the state chose not to expand eligibility for the low-income health insurance program under the Affordable Care Act.

The federal health care law intended to cover everyone whose income falls below 138 percent of the federal poverty level with a Medicaid plan, but the Supreme Court ruled in 2012 that states are not required to expand their programs. Two dozen states, including South Carolina, will not.

"Medicaid expansion just throws money out into the market," Keck said. "You've got to know what the problem is first and you've got to know where the people who need care are and what kind of care they need."

More than 114,000 South Carolina residents are already enrolled in Healthy Connections Checkup, compared with more than 1 million who are enrolled in regular Medicaid. The agency expects an additional 86,000 to sign up for Healthy Connections Checkup by next summer. That growth will cost about $20 million, most of which will be paid for by the federal government.

Thousands of adults newly enrolled in the program may be recently released inmates - a group of adults that has historically cost the health care system more than the average adult.

For example, in Spartanburg, the same 20 inmates who required the most mental health services in the county jail also cost Spartanburg Medical Center $541,000 in emergency room charges over 18 months after they were released.

"They end up bouncing between the community and the hospital emergency rooms and their jail," said Renee Romberger, the hospital's vice president of community health policies and strategy. "We need to partner with (the Department of Corrections) because we're treating the same people, but we've never thought of having a collective discussion."

Offering recently released inmates a Healthy Connections Checkup card and screening the families they leave behind when they become incarcerated for Medicaid eligibility may reduce the number of patients who unnecessarily end up in the ER, experts say.

"This is a start of a conversation," Corrections Director Bryan Stirling said. "It's early on and we'll see where it goes."

Reach Lauren Sausser at 937-5598.