MedicaidMedicare in South Carolina

1
Medicaid/Medicare in South Carolina

• SC Appleseed Legal Justice Center P.O. Box 7187
• Columbia, SC 29202
• www.scjustice.org

2
South Carolina Has a Health Care Crisis

• Between 609,000 and 850,000 South Carolinians are
  without public or private health insurance
• Almost eight percent of children in our state are
  uninsured
• Over 60 of South Carolinas small businesses do
  not offer health insurance to employees
• Workers health premiums rose 35.9 between 2000
  and 2004 while wages only increased by12.4.

3
What happens to the Uninsured?

• The uninsured do not have a medical home
• Often receive care late, when sicker and it is
  more expensive
• Care is often the emergency room, the most
  expensive and inefficient way to provide
  healthcare
• If the patient is unable to pay, the costs will
  be shifted to those who can through higher
  charges and premium increase
• No such thing as free health care.

4
What Public Health Care Insurance is Available

• For those over 65 and have a work history or
  receiving Social Security Disability for two or
  more years there is Medicare
• For some children, very low income families,
  disabled and elderly there is coverage under the
  state Medicaid program
• Some very low income Medicare patients are dually
  eligible for Medicare and Medicaid
• Community Health Care Centers.

5
What is Medicare

• Medicare is a federal program that provides
  health care insurance to individuals with a work
  history and have paid into the Medicare program
• Those who are on SSA Disability must wait two
  years before Medicare is available to them
• Does not generally pay for long term care or help
  with daily living activities such as eating,
  bathing or using the bathroom. Under certain
  conditions will pay for skilled nursing or home
  health care.

6
What is Medicaid?

• The Medicaid program is a jointly funded
  federal-state program that provides medical and
  long-term care coverage to low income individuals
  who meet certain income standards and categorical
  eligibility qualifications (e.g., aged, blind,
  disabled, impoverished, members of families with
  dependent children, etc.).
• The Medicaid Program had its fortieth birthday in
  2005.

7
Who is the face of Medicaid?

• It is your neighbor
• Your co-workers parent
• The child sitting next to your child at school
• The family worshiping with you
• It is the elderly, disabled and children.
• At any given time 850,000 South Carolinians are
  receiving Medicaid
• Approximately one million South Carolinians use
  Medicaid every year.
• Combined cost of program, federal and state is
  4 billion a year.

8
How is Medicaid Funded?

• Every state is required to fund a portion of its
  Medicaid program with state dollars
• By putting up state dollars it is then able to
  draw down money from the federal government
• Each state has a different federal match rate or
  FMAP
• Because South Carolina is a historically poor
  state we have a high FMAP rate
• SC receives approximately 2.5 dollars for each
  dollar we put up as a match. Huge economic
  driver for our health care system as it is a four
  billion dollar program.
• Good economics for our state since we receive a
  huge draw down of federal dollars.
• Every Medicaid dollar spent in our state has a
  multiplier effect by creating good jobs and
  generating tax revenue.

9
Who are SCs Medicaid Recipients?

• Medicaid covers 60 of births
• almost 75 of nursing home beds
• Over a quarter of a million elderly and disabled
  individuals
• 55 of South Carolinas children receive
  Medicaid
• Severely disabled adults who receive SSI
• Pays for low income seniors Medicare premiums

10
Who is Eligible

• Families at 50 of Poverty (8,045.00 annually
  for a family of three)
• Children at or below 150 of Poverty (24,135.00
  annually for a family of three)
• Aged Blind and Disabled at 100 of poverty
  (9,570 annually for one)
• Low income pregnant women and those needing
  family planning(185 of poverty, 29,755.00
  annually for a family of three)
• Many categories of low income disabled
• Clearly only available for very low income.

11
Who is Eligible for Long Term Care

• Individuals must be at three times the SSI level.
  The individual must be unable to return to their
  home
• Rules as to what assets you may maintain and
  still receive Medicaid.
• Nursing home and long term care is very costly
  therefore there are different rules

12
2004 Medicaid Expenditures by Service

• Hospital Services 24.4
• Pharmaceuticals 24.4
• Nursing Home 16.9
• Physician Services 9.6
• Other 24.6
• Nursing Home Services cost 421 million for
  16,626 beneficiaries. The number of beneficiaries
  who receive nursing home care is a fraction of
  the total recipients but third highest cost

13
Who are the high users of Medicaid?

• Children make up 55 of the Medicaid population,
  yet they only expend 24 of the funds
• The Medicaid agency finds that a very small
  percentage of Medicaid recipients utilize most of
  the services
• The chronically ill and disabled are using
  majority of funds.

14
Where are the dollars spent?

• While elderly and disabled are only 26 of those
  who are on Medicaid they expend 64 of the
  Medicaid dollars
• Low income families and children are 62 of the
  Medicaid population and yet they spend only 26
  of the Medicaid dollars
• Pregnant women are 10 of the Medicaid population
  and spend 12 of the Medicaid dollars.

15
Medicaid is Important to Health and Wellbeing of
State

• Covering over 4 billion each year for health
  care each year, Medicaid is very important for
  the health care system
• Increased aging population we will need more
  dollars for not just nursing home but community
  long term care
• Will be critical to ensure the affordability of
  all SC health care.