SCDHHS meets promise to insure more poor children through ‘Express Lane’ eligibility



COLUMBIA, S.C.— Approximately 65,000 children who are currently eligible for South Carolina’s Medicaid program but are not signed up will be enrolled and immediately able to receive services through a coordinated care health plan, the South Carolina Department of Health Human Services (SCDHHS) announced Thursday.  

Beginning this week, families who receive benefits from the Department of Social Services’ (DSS) food stamps or Temporary Assistance for Needy Families (TANF) programs, but whose children are not also enrolled in Medicaid, will receive letters informing them of their children’s eligibility. Letters will first arrive in Richland County and roll out statewide in October.  Those who prefer not to receive benefits through Medicaid can call a toll-free number and cancel their automatic enrollment.

Children enrolled in a Medicaid health plan through SCDHHS’ Healthy Connections program receive coverage for doctor visits, vaccinations and dental care, among other benefits. Enrollees join a coordinated care health plan in their counties of residence and are paired with a primary care physician and a network of specialty care providers.

In 2010 South Carolina ranked 5th from the bottom nationally for its percentage of insured children (13 percent). This is the latest in a series of efforts by SCDHHS to improve the health of children – a priority of Gov. Nikki R. Haley’s administration since she took office in 2011.  Earlier this year the South Carolina General Assembly approved the governor’s request and appropriated $29 million to SCDHHS to improve enrollment statistics.

“It is hard to justify large expansions of Medicaid under Obamacare when we haven’t even been meeting our current commitments to our most vulnerable children,” SCDHHS Director Anthony Keck said. “By connecting these children to a medical home we will help to ensure they get the preventive care they need to stay healthy and excel in school.”

SCDHHS has recently launched other programs focused on improving care for children, while reducing overall costs to the taxpayer:

  • Improving infant health through the SC Birth Outcomes Initiative, which  is designed to reduce pre-term births and health disparities among newborns;
  • Working with Medicaid health plans and other state agencies to identify and provide treatment for expectant mothers with substance abuse problems and those who suffer from depression or domestic violence;
  • Encouraging baby-friendly hospital policies by rewarding those with programs to promote breastfeeding; and,
  • Reducing administrative fees and creating financial incentives for health plans that meet and exceed certain quality benchmarks, including delivering recommended children’s health screenings and immunizations.

Under Express Lane eligibility, qualifying children were identified through a data match with DSS, which administers the food stamp and TANF programs. Families who participate in those programs must meet income requirements that are below the threshold for receiving Medicaid benefits.  Going forward, these children will be enrolled at the same time they are made eligible for food stamps/TANF.

Earlier this year, under a similar program, SCDHHS began automatically re-certifying Medicaid eligibility for currently enrolled children whose families continued to participate in those DSS programs. Utilizing existing DSS data greatly reduces administrative waste, saving an estimated 50,000 hours of staff time it would otherwise take to process paper applications.

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