July 1, 2005
The State.com: South Carolina's Home Page
RODDIE BURRIS

Pregnant teens from poor South Carolina families would lose free medical care under proposed changes in the state's Medicaid program.

The state Department of Health and Human Services, which administers Medicaid, included that proposal as part of a sweeping overhaul of the health insurance program for children, the poor and elderly.

As part of the proposal, the state also wants to take free medical care away from poor 18- to 21-year-olds now covered by Medicaid.

After a reporter asked about the provision to strip care from all pregnant teens which essentially declares anyone who gets pregnant to be an adult state officials said they would withdraw that plank from their plan.

It's unfortunate if a child of 14 gets pregnant; that's not what we want to promote as a state, said Sue Berkowitz, a child advocate and head of S.C. Appleseed Legal Justice Center, which does advocacy work for low-income communities.

But do we deny additional care up to age 18 as a result? What about the boy? Does the boy also get cut out of medical care? There's an equal protection question there.

Federal officials give states some latitude in crafting their Medicaid programs. States must obtain a waiver for any variances from federal standards.

Under S.C.'s waiver proposal, pregnant teens on the state's skyrocketing, $4.8-billion-a-year Medicaid program would lose access to regular medical checkups, dental care and eyeglasses, unless the proposal is changed.

Our intent is not to reduce the services of a child, whether they had a baby or not, said HHS director Robbie Kerr. We'll revise that section.

However, Kerr said he stands by a separate provision of the waiver that would lower the age of adulthood from 21 to 18.

When asked whether the proposed change might encourage pregnant teens to get abortions to avoid losing their health care coverage, a spokesman for Republican Gov. Mark Sanford who pushed for the reforms belittled the suggestion, saying Sanford is pro-life.

The plan is not intended to reduce the benefits for mothers or parents who themselves are children,� spokesman Will Folks said. These recipients will still be eligible for all the protections found in the South Carolina Medicaid program.

HHS has been working on a major Medicaid overhaul the most fundamental change to the program in state history for more than a year. If accepted by federal officials, several changes would occur:

State Medicaid recipients would get personal health accounts that would allow them to choose a coverage plan and pay for it, much like the insured in the open marketplace.

They also would get debit cards to pay hospital deductibles, doctor visits and for pharmacy needs.

Frequent Medicaid users would be forced into managed care, designed to streamline and coordinate care, while hopefully lowering expenses.

Kerr said such changes, and others his agency is considering, are needed if the state Medicaid program is to survive.

The state’s share of Medicaid spending in South Carolina costs about $800 million, or 14 percent of the state's $5.8 billion budget Kerr said, and that share is growing. His job is to manage the program so that its growth slows, he said.

We can't let this become a choice between education or health care,Kerr said of the competing forces within the state budget.That's not a position we want to ever be in South Carolina.

Medicaid growth in the state, in fact, has slowed to 5.8 percent in 2004, down from double-digit percentages in recent years.

But critics are strongly chiding Sanford and Kerr for going national with the controversial waiver request without first hearing from South Carolinians.

HHS could have given a comment period before filing, rather than coming back and trying to react after the fact,Berkowitz said. That approach would have given agencies, providers, consumers and others the opportunity to respond.

But Kerr said HHS has been open about the waiver process, compared with other states. The agency met with advocates, providers and others before submitting the request to the federal Centers for Medicaid Services in June, he said, though it decided not to air the waivers before the public.

The waiver request is posted on the HHS Web site. The agency this week put up a new feature frequently asked questions about South Carolina's waiver, which includes the teen pregnancy provision in response to growing public inquiries, the agency said.

Kerr also said that, while changes to the program are moving quickly at the federal level, there will be time for discussion of the waiver before final terms and conditions of the new Medicaid program become law.

HHS' Medical Care Advisory Committee is slated to discuss the waivers in a meeting Tuesday.

Members of that committee have raised other questions about the plan, ranging from new co-pays for Medicaid clients and discretionary spending accounts, to problems that could arise by approving the waivers before health care providers are secured to deliver the needed services at Medicaid rates.