S.C. Medicaid Director Tony Keck talks Medicaid reform on Capitol Hill

South Carolina Medicaid Director Tony Keck talks about the Charleston Promise health clinic at Chicora Elementary School in April.

One of Gov. Nikki Haley’s most outspoken Cabinet members had the ears of federal lawmakers Wednesday during a hearing on Medicaid reform on Capitol Hill.

Tony Keck, director of South Carolina’s Medicaid agency, told a U.S. House of Representatives subcommittee that the federal government should give states more flexibility to tailor the program for their own unique needs. The Centers for Medicare & Medicaid take years to process state-specific requests, he said.

“We run on a state fiscal year, and when I need to respond to my Legislature’s budgeting process and their requirements to implement policies, I cannot do that effectively when we operate on such timelines with the federal government,” Keck told the U.S. House’s Energy and Commerce subcommittee on health.

About 72 million Americans hold Medicaid cards, with a little more than 1 million in South Carolina.

In 2014 Medicaid rolls are expected to grow as many of the federal Affordable Care Act’s major reforms take effect. South Carolina is one of at least a dozen states that has decided not to participate in a federally funded expansion of the low-income health insurance program, but enrollment here still could increase as residents who are currently eligible for Medicaid, but have not yet enrolled, sign up.

The federal health care law will penalize individuals without health insurance starting next year.

Keck, often critical of the Affordable Care Act, told the subcommittee that the federal government should prioritize public health needs, not just Medicaid enrollment.

“Medicaid today operates under the default position that different populations and geographies face similar challenges,” Keck said during the hearing. “Medicaid currently treats states more like subcontractors operating at a discount than partners contributing over 40 percent of the bill.”

Health subcommittee Chairman Rep. Joe Pitts, R-Pa., agreed that the system needs reform.

“Clearly we are failing those most in need of our help,” Pitts said. “Medicaid is in trouble.”

There are no members of South Carolina’s congressional delegation assigned to the health subcommittee.

Two other experts also testified during the hearing — Seema Verma, a consultant with Strategic Health Policy, and Joe Thompson, Arkansas’ surgeon general.

Reach Lauren Sausser at 937-5598.