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New state program to streamline services for Medicaid-Medicare enrollees

By Bill Poovey
Published Nov. 14, 2013

Gov. Nikki Haley’s administration has found something to like about the Affordable Care Act. S.C. Department of Health and Human Services director Tony Keck said $16 million will be included in next year’s budget for a program that will streamline health care services for up to 53,600 South Carolinians who are eligible for both Medicaid and Medicare.

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Keck said the Healthy Connections Prime program that will start accepting opt-in enrollees in July 2014 has been “authorized under the Affordable Care Act.”

“Well, we are opposed to 95% of it,” Keck said of the state’s refusal to expand Medicaid or join other states that have opened their own health insurance exchanges as part of the act.

Keck said the $16 million start-up cost of South Carolina’s Healthy Connections Prime will be offset in the long term by removing duplication and waste.

“Dual eligible are among the state’s highest need and highest cost users of health care services,” Keck said in a statement.

Keck said enrollees “will get more for their money. Additional services will be provided to help manage their care.”

“From the beneficiaries’ perspective, no longer will they be forced to navigate two different systems,” said Nate Patterson, S.C. Department of Health and Human Services policy director for managed care. “On their end it does consolidate and streamline.” Patterson described the streamlining, which will include potential savings and the simplicity of “one card” for enrollees, as a tremendous benefit.

The state’s program also includes a novel approach to palliative care.

Keck said in a statement that “eligible beneficiaries who enroll in the program will be able to receive both Medicare and Medicaid services, plus additional behavioral health and community support services through one health plan that promotes clinically integrated, patient-centered care and improves health outcomes, delays the need for nursing facility care, reduces avoidable emergency room visits and hospital readmissions and increases access to home and community based services.”

A summary of South Carolina’s program says “enrollees will be eligible to receive a palliative care benefit which focuses on pain management and comfort care. The demonstration affords an opportunity to test whether this new benefit can optimize quality of life for enrollees living with a serious, chronic of life-limiting illness who may not meet the hospice criteria. These conditions include, but are not limited to, Parkinson’s disease. Multiple sclerosis, Alzheimer’s disease and/or dementia, end stage cancers, chronic obstructive pulmonary disease, Huntington’s chorea, advanced liver disease or amyotrophic lateral sclerosis. Eligibility will also be based upon a history of hospitalizations, a history of acute care utilization for pain and/or symptom management, or based on the recommendation of a physician or the multidisciplinary team.”

Keck said providing palliative care ahead of hospice “is certainly novel to us in this state.” Palliative care involves relieving pain or alleviating a problem without dealing with the underlying cause.

The state’s program will have five coordinated and integrated care organizations: Absolute Total Care Inc.; Advicare Corp.; Molina Healthcare of South Carolina Inc.; Select Health of South Carolina Inc.; and Wellcare Health Plans Inc.

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