- Associated Press - Thursday, November 26, 2015

COLUMBIA, S.C. (AP) - Fewer South Carolinians than expected have enrolled in a limited benefits program for poor residents who fall in an insurance gap, and only a tiny portion of them are getting the free medical screenings it provides, according to the state’s Medicaid agency.

Director Christian Soura said there’s “much less interest” in Healthy Connections Checkup than his predecessor hoped.

“Even the folks who enroll in Checkup almost never use it,” Soura, who took the agency’s helm last November, recently told The Associated Press.

Asked about the low use, the House subcommittee chairman who writes the agency’s budget questioned whether the program should continue. An advocate for the poor said the data is evidence the state should expand Medicaid eligibility as the federal health law intended.

Checkup provides physical exams every other year, including screenings for obesity, diabetes, high cholesterol, and several types of cancer. The coverage that began Aug. 1, 2014, expanded on a 20-year-old state program that provided only “family planning” services. Birth control remains the program’s chief expense.

Former Director Tony Keck created Checkup as a cost-effective way to make health care connections for people who aren’t poor enough to qualify for Medicaid but don’t earn enough to qualify for federal subsidies toward buying private insurance.

Last November, Checkup represented the agency’s fastest-growing segment, with roughly 140,000 people enrolled. Keck hoped 200,000 would be enrolled by summer 2015.

Instead, the latest numbers show enrollment at just over 155,000 in July - nearly 3,000 fewer than January’s peak, according to the Department of Health and Human Services. Soura expects enrollment to continue to drop, since many Checkup beneficiaries aren’t filling out the application needed to verify eligibility and renew.

The agency’s annual application for Medicaid benefits had been five pages. But that grew to 15 pages Jan. 1, when the state’s waiver from new eligibility rules under the federal health care law expired, Soura said.

“Folks who have full Medicaid and need it and are regular users make sure they turn in their review forms and stay in the program,” he said. “Folks who are in Checkup and see less value in it are tending not to return those forms.”

As of Aug. 31, just 3,605 Checkup patients had undergone 5,715 total medical screenings. The agency says several people with positive screenings were linked to providers in their communities for follow-up evaluations. It could not provide details.

Checkup’s intent was to increase preventative screenings and, if a problem’s detected, refer patients to existing safety net programs offering free- or low-cost care.

But an advocate for the poor said it was ill-conceived to think people just want a diagnosis.

“What people want is health care,” said Sue Berkowitz, director of the Appleseed Legal Justice Center. “Being told, ‘You’re sick, but we can’t do anything,’ or, ‘We may be able to give you a referral to a free clinic or you can go somewhere 25 miles away’ - that doesn’t do anybody any good.”

Democrats are expected next year to renew their push for South Carolina to extend full Medicaid while the federal government fully pays for adults newly eligible, which continues through 2016. Republicans have repeatedly said the state can’t afford the eventual 10 percent match for hundreds of thousands of additional enrollees.

Last fiscal year, the state Medicaid agency spent roughly $11 million on Checkup enrollees, with about $1.5 million of that coming from state coffers. That includes birth control expenses. The agency could not separate how much was spent on screenings.

Rep. Murrell Smith, R-Sumter, said he plans to question Soura about Checkup when his Ways and Means subcommittee holds hearings on next year’s state budget.

“The premise is still sound,” he said. “Allowing people to identify chronic or catastrophic conditions is still a laudable goal, but if it’s not being utilized, we need to find out why.”

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