Hitting bottom on Medicaid: South Carolina gives Arizona some competition

What kind of state eliminates Medicaid hospice benefits and cuts meal deliveries to disabled seniors? I liked South Carolina much better when we were all joking about the Appalachian trail.

Here’s an entertaining fact for you: My brother-in-law Vincent receives toe and toenail care at the podiatrist. No he doesn’t wear toenail polish like Frank Burns did on M*A*S*H. A combination of skin issues, chronic obesity, and intellectual disability create mundane but important foot problems for Vincent that require serious attention.

He’s unlucky enough to require Medicaid. Luckily for him, though, he doesn’t live in South Carolina (h/t Diane Meier’s valuable tweets), since that state will no longer cover these mundane but important services. As today’s WYFF4 news puts it:

Starting in February 2011, Medicaid will no longer cover podiatry services, routine eye exams or dental services for anyone older than 21. Routine circumcisions for newborns, diabetic equipment and services and some wheelchair accessories are on the list. Hospice care services will also be eliminated.

You read that last one correctly. The state will no longer provide Medicaid coverage for hospice care.

Like an anxious investor watching a crashing stock market, I’m seeing what’s happening with Medicaid and wondering when states will finally hit bottom. One might think Arizona’s transplant policy provides a credible floor (listen here if you haven’t been following this). But maybe not. Here’s what is coming later to South Carolina:

In April, Medicaid will eliminate services under the state’s Community Long-term Care Program, which provides services to people at their home. That includes chore and appliance services, nutritional supplements, adult day health care nursing services and respite service. There will also be a reduction in the number of meals delivered to the home each week.

That’s a new one. Meals on wheels will apparently reduce its weekly meal deliveries from fourteen to ten.

I don’t quite know what to say, except to hope that this is some budgetary game of chicken, and these cuts don’t actually happen. Given what is happening around the country, there’s little reason to be hopeful.

We’re becoming sadly accustomed to states which deny Medicaid recipients dental care and eye exams, not to mention the circumcision thing. But what kind of state withholds hospice care and cuts meal deliveries to disabled seniors? I liked South Carolina better when we were joking about the Appalachian trail.

Postscript: South Carolina provides a sad example of the trend noted in this terrific Monica Potts piece posted at TAP yesterday on southern cuts in anti-poverty programs. Hard times.

Author: Harold Pollack

Harold Pollack is Helen Ross Professor of Social Service Administration at the University of Chicago. He has served on three expert committees of the National Academies of Science. His recent research appears in such journals as Addiction, Journal of the American Medical Association, and American Journal of Public Health. He writes regularly on HIV prevention, crime and drug policy, health reform, and disability policy for American Prospect, tnr.com, and other news outlets. His essay, "Lessons from an Emergency Room Nightmare" was selected for the collection The Best American Medical Writing, 2009. He recently participated, with zero critical acclaim, in the University of Chicago's annual Latke-Hamentaschen debate.

11 thoughts on “Hitting bottom on Medicaid: South Carolina gives Arizona some competition”

  1. It's easy to focus on each new outrage. It seems to me that we are in a time of decline, both nationally and in the states, and it is being handled poorly – we are not comparing the things we used to afford broadly enough in deciding which ones have to go. Myself, I would drop South Carolina athletics from state-funded schools before I would drop podiatry for elders – but, silly me. Much of the choice will be guard rails which save predicted lives versus meals on wheels today (and circumcisions which will keep some boys from getting AIDS, but they could be abstinent, now couldn't they?)

    Waste Fraud and Abuse – I'd like to drop that, too. Hard to zero in on it, at the micro level, though.

  2. Much as I hate to say this, I see what has happened in Arizona and in South Carolina as almost inevitable,

    State governments are usually (constitutionally) forced to operate under balanced budget rules. If the Feds force them to expand expenditures in one programmatic area, there's a budget problem.

    What this case argues for, it seems to me, is something we should have done years ago–nationalize Medicaid, establish a single national standard of care, and fund it adequately.

  3. A lot of the cuts will turn into additional burdens on women, as family caregivers — hospice-like care, home care, hygienic and preventative care.

    I remember something from a couple of years back about "shovel-ready" jobs and a stimulus package …

    … the answers are too obvious to see, it seems …

  4. Part of me hopes for a sort of reverse starve the beast – in which vital services are cut and the public is outraged at the resulting pain and suffering. But then I remember that the public is largely ignorant of the lives lived at the margins of society, and won't see or feel the impact. When I worked at a residential facility for the mentally ill we couldn't afford to hire a janitor. Did the public notice?

  5. Minor niggle: why should Medicaid cover "routine circumcisions for newborns"? It's a cultural/religious choice not a medical necessity.

  6. @ Donald

    But our President took the effective mechanism (single payer) for accomplishing that off the table before negotiations ever started. Then, he traded away the next-best alternative (a public-owned alternative to Aetna/BC-BS/HCA) for Republican Senate votes that never materialized.

    Our Health Care Finance system is broken. No matter how bad you think it is, it's worse than that. If our system was an inner tube, we'd be unable to find the surface of the tube for all the patches. We have decided that people should have access to any health care they can afford to pay for, whether themselves or by access to other (employer's) deep pockets. At the same time, we've enacted Federal laws (most notably EMTALA, the Emergency Medical Treatment and Active Labor Act) which more-or-less say that health care is a basic right, at least if you're sick enough.

    These beliefs are in conflict with each other, and it's difficult to imagine any Hegelian synthesis that can join them. Certainly our attempts to construct one have failed to date. It pains me to have to agree with anyplace as backward as South Carolina, but a ban on infant circumcisions (or at least conducted at public expense) is probably reasonable. Circumcision is the ultimate elective surgery. But banning infant circumcision isn't the magic patch for this system. None of these proposals are.

    Reducing community health care is going to be more expensive in the medium and long term. Families will be forced to place loved ones in long-term care facilities (LTFs). This is more expensive to the families, and once their resources run out Medicaid/Medicare will have to pick up the difference. Families that were smart and planned ahead by transferring assets into the heirs' names will shift into Medicare sooner than those who didn't. Generally speaking, patients do better at home than in LTFs. Generally speaking, community care (meaning home care) is significantly cheaper than LTFs. But we'll ignore those realities in favor of some short-term savings derived by killing community care programs.

    Note that none of this will make any real difference to wealthy families. They'll hire home-care nurses and visiting physicians to provide for their loved ones, which they would likely do in any event. The affected people will belong to middle and lower income families, as always.

    It's always surprised me how prescient Republicans are. Sarah Palin predicted the coming existence of the Death Panels: Arizona has them and South Carolina appears prepared to bring theirs on-line. Republicans generally predicted the disastrous consequences that Hillary-care would bring, and sure enough they happened. Even though Hillary-care didn't happen, their forecasts came to pass.

  7. James Wimberly: please read up on the extent to which circumcision protects against AIDS after unprotected sex and then come back and tell us if you stand by your remark. Thanks.

  8. Well if cicumcision helps prevent HIV then the GOP sure won't fund it. AIDS is just the wages of sinnin' for all those heathens and gays.

  9. @ Eli — Women like me, at or below my income, will pick up the pieces, and that will be the political end of it.

  10. The United States has the highest circumcision rates and high HIV rates in the world.Up to 90% of boys were circumcised and it hasn't prevented Hiv/Aids.Europe's circumcision rates are much lower and so are their Hiv/aides rates.

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