Cuts In Medicaid Payments Take Effect In SC

Another round of cuts in payments to Medicaid providers began Monday in South Carolina. The state had already cut Medicaid payments to doctors and hospitals by 3 percent in April.

This new round of cuts ranges from 2 percent for primary care physicians up to 7 percent for physical therapy providers. The state Department of Health and Human Services expects the latest measures to save $125 million.

Columbia mother Jamila Phillips is worried about what effect the cuts may have on her two-year-old son Andrew, who has cerebral palsy. Through Medicaid, he receives physical, occupational and speech therapy four times a week.

"It has made a big difference in his development, definitely with gross motor and fine motor skills," she says.

But under these new cuts, he will be limited to 75 total therapy visits a year, 25 each for occupational, physical and speech therapies. "It's very important at this age for him to receive as much therapy as possible, because his brain is still developing," she says.

Cassie Miles is worried about the same thing. Her daughter Emma is also 2 and also has cerebral palsy, for which she receives therapy.

"You look at my daughter and she's kind of in the middle of the road and she has a good chance of walking independently," Miles says. "But that's not going to happen without PT (physical therapy) at least twice a week and that's obviously not in the budget, so that's a little frustrating as a parent."

But state Health and Human Services director Tony Keck says the 75 therapy visits a year is not a limit, it's a "checkpoint". "

He says, "We said at a certain point, when you exceed a certain number of therapies, that the physician and the therapist and the family need to come to the Medicaid agency and request additional hours.  And that's really a check to see if the therapies that are being implemented are actually having the desired outcomes.  And so we've had many, many requests for additional therapies and we've denied very, very few of them."

Phillips and Miles say limiting therapy visits would cost taxpayers more in the long-run. Miles says, "If Emma's able to get more independent, she may hold a job and have her own insurance and not rely on Medicaid. But without the therapies and early intervention, it's just not going to happen."

Under the cuts, Medicaid patients will also see their co-payments go up by $1 a visit, from $2.30 up to $3.30.

Some doctors who already lose money by treating Medicaid patients, because their reimbursements don't cover their costs, say the additional cuts could mean some of them will have to stop seeing Medicaid patients.

But Keck says the agency is monitoring that and can make changes, if necessary, to make sure people have access to the health care that they need.

For that same reason, the agency is exempting some hospitals from the cuts. Some small, medium and large rural hospitals will not be cut, along with critical access hospitals and qualifying burn intensive care unit hospitals.

Details about those exemptions are available here at the SC Department of Health and Human Services.