Fri, Nov 22 2013
Like half the states, South Carolina chose not to expand Medicaid under the federal health law next year, citing the program’s high costs and inefficiency.
Yet, state officials still forecast a 16 percent enrollment jump by the end of June, 2015, triple that of a typical year and even higher than the 12 percent average increase expected in states that are expanding eligibility.
What’s going on?
South Carolina officials say publicity for the Affordable Care Act and its requirement that most people get insurance will attract tens of thousands of people who are currently eligible for Medicaid but have not enrolled.
"The awareness component is huge," said Tony Keck, South Carolina's Medicaid director.
The state has recently revamped its enrollment process for Medicaid, the state-federal health care program for low-income residents. It is now actively trying to enroll more of those eligible for the program. South Carolina has opened an online enrollment system, added 20 positions to its call center and used government databases of people who qualify for food stamps to identify those eligible for Medicaid. It also is working with The Benefit Bank, an organization that trains dozens of nonprofit groups around the state to sign up people.
Still, because the state has strict limits on its Medicaid program, many of the new enrollees are expected to be children. Advocates for the poor applaud the effort but say the state has missed a good opportunity to help more people, especially adults, with a program expansion.
"This doesn't make up for the fact that a couple hundred thousand people who would have been covered are being left behind," said Susan Berkowitz, director of the South Carolina Appleseed Legal Justice Center, an advocacy group for the poor. "It leaves a bitter taste in my mouth."
South Carolina is not the only state expecting a large Medicaid enrollment jump even though its political leaders opposed expanding eligibility. Utah and Idaho each project a 14 percent increase. Again, most of that increase is expected to be children.
In other non-expansion states the percentage varies but is lower.
The health law expanded Medicaid to cover everyone with incomes up to 138 percent of the federal poverty level, or about $15,900 for an individual or $32,500 for a family of four. But the Supreme Court made the expansion optional, and most Republican-led states have decided not to expand. That means more restrictive eligibility rules in those states remain in place.
In South Carolina, adults without children, no matter their income, are not eligible for Medicaid and neither are working parents making more than 89 percent of the federal poverty level (about $17,400 for a family of three) and nonworking parents with incomes over 50 percent of poverty ($9,765 for a family of three).