— South Carolina’s Medicaid agency is working to make health care more convenient for its enrollees, as part of efforts to improve residents’ health while decreasing costs, director Tony Keck told The Associated Press.

Initiatives to expand access include covering visits to walk-in pharmacy clinics and paying doctors more when they see patients outside normal business hours.

The idea is that if people can get medical care at times convenient for them, they are less likely to end up in the emergency room, where treatment is more expensive, especially if they’ve waited until their problems are advanced, said Keck, director of the state Department of Health and Human Services.

The state’s Republican leaders have repeatedly rejected Democrats’ and hospitals’ efforts to expand Medicaid eligibility to hundreds of thousands of additional poor adults beginning Jan. 1, as encouraged in the federal health care overhaul, saying the state can’t afford the eventual cost. Keck has repeatedly argued that simply adding people to the rolls of the government program for the poor and disabled doesn’t necessarily improve their health, as evidenced by the state’s poor health statistics.

Nearly 1 million of South Carolina’s residents are covered by Medicaid. Keck argues the state first needs to find a way to improve health while lowering costs.

Medicaid began covering visits to CVS MinuteClinics in April, giving all Medicaid recipients a seven-days-a-week option for treatment of common illnesses and minor wounds.

The company operates 28 clinics statewide and plans to add several more by year’s end, deputy director Melanie Giese said Thursday.

South Carolina is unique among states in providing the option to all of its Medicaid patients, said Dr. Andrew Sussman, MinuteClinic president at CVS Caremark Corp., calling the program a national leader.

The state agency also is in discussions with Walgreens to allow coverage at its clinics, opening over the next year, Giese said.

To encourage greater access to primary care doctors, the agency began in April paying an additional $12 per visit for patients seen on weekends, certain holidays and after 6 p.m. on weekdays. It’s too soon to know how many individual doctors or medical practices will take the agency up on its offer, or whether the incentive is enough to cover the cost of extended or shifted office hours, said Dr. Bruce Snyder, president of the state Medical Association.

Regardless, he said, physicians support the effort.

While after-hours availability is important for all residents, he said, the association realizes it’s a particular issue for Medicaid patients, who often use the ER for their care because they can’t get off work for an appointment or rely on others for transportation.

“We all agree that’s not in their best interest,” Snyder said Thursday. “If we can arrange a more accessible system for them, they’ll benefit medically and the state will benefit economically.”

Still, the association has continuity-of-care concerns about the state agency covering visits to pharmacy clinics: “We don’t want to see patients adopt those clinics as their primary provider of care,” he said.

Keck said the agency has tried to mitigate concerns by requiring clinics to communicate with patients’ primary doctor.

The head of the state Pharmacy Association said he expects pharmacies of all sizes to explore offering options for care outside the doctor’s office, benefiting patients, doctors and pharmacists.