The Palmetto Insider

The blog of the South Carolina Policy Council

New Medicaid Mandates Are Going to Hurt

with 6 comments

Dealing with the fiscal—and physical (in terms of personnel and other needs)—implications of health care mandates is an ongoing battle for Medicaid, the state’s health care agency serving the poor and disadvantaged.  Medicaid’s ability to maintain the integrity of its mission is being jeopardized by a deluge of regulations and ever increasing mandates, while already managing:

  • 800,000 enrollees
  • 3,000-5,000 new participants monthly
  • 19% of the state’s budget (up 10% since 2007)
  • A projected enrollment increase of 61% by 2019

Remaining functional is a juggling act requiring compliance with state mandates and incorporating new, costly and growing numbers of federal regulations from the Patient Protection and Affordable Care Act of 2010 (the new federal health care legislation). The new law includes policies that:

  • Require the least restrictive standards for new Medicaid enrollment
  • Prohibit the state from actively confirming ongoing eligibility

In other words, South Carolina’s Medicaid program is required to take in as many new clients as possible, but not look too hard at whether these and existing clients are actually eligible. These two mandates alone will cost the S.C. Medicaid system hundreds of millions of dollars.

And Medicaid already has a $200 million dollar deficit.

Add to these burdens the new federal purchase-or-be-penalized mandate (for both individuals and businesses) that will drive more people out of private insurance and into government subsidized care.  In short, Medicaid can look forward to a tsunami of additional enrollees.

The cost of new regulations and mandates is projected to be nearly $1 billion by 2019.

That’s less than 10 years away.

In perspective, $1 billion equals $222 for every resident of the state. 

Another ball for Medicaid to juggle is the freeze (since 2008) on provider reimbursement rates.

As reported by The Nerve, South Carolina is the only state in the nation to impose this restriction—even as program costs rise. For every 1 percent increase or decrease in provider rates, Medicaid saves—or loses 1 million dollars.

Thanks also goes to The Nerve (see here and here) for alerting us to a new proviso inserted into the state budget by Rep. Tracy Edge. Pending approval by the Centers for Medicare and Medicaid, this proviso would increase prescription reimbursement rates by 30 percent—to $10 million annually, imposing the highest reimbursement rate in the nation on South Carolina (in a state that has the 47th lowest per capita income in the nation.)

If the challenges weren’t already dizzying, as Medicaid’s enrollment grows, the demand on physicians and hospitals will also increase. With provider reimbursement rates frozen, health care providers will likely respond by refusing new patients, sending many back to the costly care of emergency rooms—one of the “maladies” supposedly remedied by federal health care “reform.”

In short, government seems to have an insatiable appetite for imposing mandates and regulations, requiring more and more sacrifices from taxpayers to support a system that continues to fail. It’s the giving with one hand while taking away with the other trick.

Who will suffer most? 

No doubt it will be the poor and elderly who are most dependent on Medicaid, as well as physicians and other medical professionals. And, in the end, all of us, as the “ouch” of rising health care costs (and new taxes) continues echoing throughout the state.


Written by Dianna Lightfoot

September 16, 2010 at 2:07 pm

Posted in Healthcare

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6 Responses

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  1. Who’s going to bear the burden of this tsunami of increased health care costs? Sounds like it will be the taxpayers of this state.

    Who will ensure that the elderly and disabled get quality healthcare? Ideally families take care of their relatives who need medical treatment. But realistically that task will be the responsibility of an understaffed and overworked government agency.

    The solution is not simple. But it’s not hopeless. It requires that I take action to ensure that my state and federal representatives are knowlegeable about this issue and support solutions other than taxes and entitlements. That action is to register to vote (SC residents have until October 1 to do so for the upcoming election) and show up at the poles on November 2, 2010.


    September 16, 2010 at 4:09 pm

  2. This is an excellent and informative article by Dianna Lightfoot It is well researched and sheds light on a state and federal government that continues to impose new mandates despite being hopelessly bankrupt. A couple of things stand out: a whopping 19% of South Carolina’s budget goes to Medicaid and a projected 61% increase in Medicaid enrollment is only 9 years away! If socialized medicine becomes law and people look to the state and federal governments to supply all our needs, then it will be so much easier for Washington to move on total socialism. When a socialized health care system collapses for lack of funding (despite a heavy yoke of taxes) I can envision the “feeble” being allowed to voluntary commit suicide. Once that is law it will progress to the government choosing who dies for the good of the people and the country ( assuming we still have a sovereign country). Dianna Lighfoot’s understanding of the government and legislation is quite evident. I hope she gets more exposure and support. I would like to read more articles from her concerning our government and it’s insane policies and proposals.


    September 17, 2010 at 8:30 am

  3. I recently spoke to a physican friend who said he made more five years ago than he does now and that non of his children were interested in medicine any more as they could make a better living in other area without all the govenment intervention. This seems to be the feel I am getting from other bright young people. Too much government is destroying every area of our society. I am an educator who has taught against this but when over fifty percent of our nation has their hand in the governments handouts it is hard to see the forest for the trees. The medicaid issue is just another way to control people and for retired families like my husband and I we are already seeing our retirement being effected and the results of medicare was felt by him this year when trying to find a doctor in Florida to take him so many do not want medicare patients and we surely see why. We appreciate this article and councils such as this trying to keep us informed to the issues.

    debbie wilson

    September 17, 2010 at 9:25 am

  4. Government does have a huge appetite for control, while the real solution is to just let the free market work.

    Donna Watling

    September 17, 2010 at 2:20 pm

  5. Kudos to Dianna Lightfoot for forecasting the likelihood for a tsunami if South Carolina chooses to follow liberals down the road of “poverty for all” except for the Politians. They have conviently voted themselves out of this mess and given themselves their own politician only healthcare. The middle class will be no more and the citizens who are no longer considered “productive” will be last in line for medical care. All this is just smoke and mirrors for putting money in other pork spending pots at the cost of our weakest and neediest.


    September 17, 2010 at 7:29 pm

  6. […] Last week we reported on the regulatory problems facing Medicaid reimbursement – and the coming $1 billion increase in costs for South Carolina. […]

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