Wednesday, November 02, 2005
Medicaid
The Columbia State on Sunday examined South Carolina Gov. Mark Sanford's (R) plan to make changes to the state's Medicaid program, including a proposal to implement self-directed care (Burris, Columbia State, 10/30). Under a plan submitted to CMS in June, most Medicaid beneficiaries would be enrolled in a personal health account with a set amount of money to choose a private health insurance plan or a network of private physicians to manage their care. A limited number of beneficiaries, not including children, could choose to self-direct their care, opting to spend most of their funds on major medical coverage and the remainder on health services as they choose. Such beneficiaries also could use the account to pay their share of premiums for employer-sponsored coverage. State officials are considering revising the plan by eliminating some other changes, such as ending coverage for some services and increasing copayments (Kaiser Daily Health Policy Report, 10/28). According to the State, Sanford and state Department of Health and Human Services Director Robbie Kerr believe that the self-directed care proposal would give beneficiaries more choices. A 12-member citizens' advisory committee has said only 5,000 state residents -- or fewer than one half of 1% of the state's Medicaid population -- might be eligible to participate in the pilot. The health department also has said beneficiaries who enroll in the pilot cannot have histories of unstable, expensive acute care crises; must have a primary care provider or usual source of care; and must show they understand how to meet their family's health care needs. Critics say the small number of eligible beneficiaries might make Sanford's proposal invalid and worry that participating beneficiaries could miscalculate their medical expenses and be forced to pay out of pocket for services, the State reports (Columbia State, 10/30).
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