Columbia State, SC
Posted on Thu, Sep. 04, 2003

Medicaid initiative offers choices
Pilot program lets S.C. patients make decisions about care and spending
By AARON GOULD SHEININ
Staff Writer

SPARTANBURG - Eighty-six-year-old Roberta Rentz of Woodruff doesn't want to go to a nursing home. Her family doesn't
want her to go.

A new state program will help her keep her independence - and her home.

Rentz was the first person to sign up for S.C. Choice on Wednesday. The initiative allows some elderly or disabled
South Carolinians to make their own health care decisions and control their health care spending.

Gov. Mark Sanford and Health and Human Services director Robert Kerr launched the program in Spartanburg on Wednesday.

The first program of its kind in the nation, S.C. Choice initially is available in Spartanburg, Cherokee and Union
counties. It will expand statewide next year.

Rentz suffers from Parkinson's disease, diabetes and macular degeneration of her eyes, said her daughter, Beth Grant.

"From time to time, Mom's needs change," Grant said. "Right now, she's doing pretty well, but at times she's been
bedridden and we need more in-home care."

Grant said she spends six nights a week at her mother's home, and Grant's brother spends the other night with her.

"It's put a big strain on our family," both financially and emotionally, Grant said.

Rentz qualifies for S.C. Choice because she already participates in Community Long Term Care, a program for Medicaid
patients who meet what is called "institutional level of care" criteria.

That means they're sick enough - or in need of enough help - to qualify under federal rules to have Medicaid cover
nursing home or hospital care costs.

But these patients, like Rentz, would rather remain in their own homes.

Under the existing program, Health and Human Services contracts with home health agencies to provide long-term care to
patients. But the individual plays no role in picking his or her provider, doesn't always know who will provide
services, and has little recourse to complain if not satisfied with the level of care.

Under S.C. Choice, patients can make their own decisions about how their Medicaid dollars are spent.

With the help of Health and Human Services advisers, the patients, their families or other representatives decide what
the patients need. The patients can pick providers, spend their Medicaid money to make their homes more accessible or
even hire someone to clean or cook.

Those enrolled in the Community Long Term Care program do not have to sign up for S.C. Choice. They can remain in the
current program and nothing will change for them. Kerr said he expects 10 percent of the 11,000 eligible patients will
participate.

"It improves quality of life" for seniors and the disabled, Kerr said. "If you can stay around familiar surroundings or
family or people you're comfortable with, you're going to be healthier."

Participants will receive the same amount of money they do now, Kerr said. There just won't be any strings attached.

Patients will be able to use the money only for health-related expenses, which can include paying a neighbor to pick up
prescriptions or paying for a ramp to be built for wheelchair access.

The approach also will save patients money. Staying at home is about 42 percent cheaper than nursing home or hospital
care, Kerr said. There will be no additional cost to Health and Human Services, Kerr said.

"If you look at a person's choice on whether going to an institutional setting or staying at home, that comes down to
quality of life," Sanford said.

S.C. Choice is a result of a recommendation from a state Medicaid study committee report issued in 2001.

The federal Centers for Medicare and Medicaid Services gave the state a grant in October 2001 to develop the program.
The federal agency, which administers Medicaid, approved S.C. Choice on March 11.

Reach Gould Sheinin at (803) 771-8658 or [log in to unmask]

SOURCE: Columbia State, SC
http://www.thestate.com/mld/thestate/news/local/6687424.htm

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