November 17, 2005
Knight Ridder
Roddie Burris

COLUMBIA - Concerns still linger, but the final version of Gov. Mark Sanford's Medicaid reform proposal appears less troublesome to some critics than the original.

Sanford's office sent the final version of a comprehensive, controversial waiver request to Washington on Wednesday.

Among significant changes that have eased the fears of some critics, the new plan would:

Reduce proposed co-payments

Limit self-directed care to a pilot program

Eliminate cuts to most children's medical services

Restore nonmaternity medical benefits to teens who become pregnant

"I have to say, I'm glad we saw some movement because I don't want to look ungrateful," said Sue Berkowitz, director of the S.C. Appleseed Legal Justice Center, which advocates for the poor. "I'm glad they made some of the concessions we were asking for."

Judy Solomon, a senior analyst at the Center for Budget Priorities and Policy in Washington, spoke against Sanford's plan at a U.S. Senate hearing in Charleston last month.

"They definitely made some improvements, particularly in the [co-payments]," Solomon said. "They have definitely become more moderate."

However, Solomon said, research shows that even moderate co-payments cause the poor to lose medical services.

State officials have asked the Centers for Medicare & Medicaid Services to approve the proposal by the end of the year. The earliest the changes could begin would be in July.

A lawsuit challenging the governor's authority to make the changes without the legislature's consent could affect the plan's implementation.

Sanford has quietly pushed to reform Medicaid in South Carolina for nearly two years.

He devised an initial plan that would have radically altered the 40-year-old program that provides health care for the state's poor, elderly and disabled.

The governor's latest plan still would:

Convert Medicaid to a private insurance plan

Cap benefits for recipients Be among the first in the nation to impose co-payments on the poor

Eliminate a more comprehensive children's benefits package for 19- and 20-year-olds in favor of a skeletal adult-benefits package

Even critics acknowledge that the new plan is not a "block grant" that would limit future enrollments, as first feared.

Sanford says the plan will slow growth in Medicaid and help deliver a higher quality of health care.

"Given the remarkably different health care needs of individuals, it makes sense to give people a choice in their health care plans," Sanford said.