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Federal Officials Approve South Carolina's Duals Demonstration

By Rebecca Adams, CQ HealthBeat Associate Editor

October 25, 2013 -- South Carolina, a state whose Republican governor has criticized the Obama administration's health care policies frequently, is partnering with the Health and Human Services on a plan to shift elderly and frail people into managed care.

South Carolina is the latest state to get approval for a demonstration affecting people who are enrolled in Medicare and Medicaid. GOP Gov. Nikki Haley has opposed the health law (PL 111-148, PL 111-152) and refused to expand Medicaid.

About 53,600 people who are dually eligible for both programs are scheduled to start enrolling in the managed care plans on July 1. The program will be phased in and if a senior hasn't chosen a plan by Jan. 1, 2015, then the state will select one for the individual. By December 2015, a beneficiary's benefits are supposed to be coordinated.

The people who are enrolled will get behavioral health and support services through one health plan that also provides medical care. State officials hope the new program will delay some patients' move into a nursing facility and prevent avoidable emergency room visits by increasing coordinated care through home health care and community-based services.

"This federal approval marks another significant milestone for showing South Carolina's commitment to delivering quality health care to some of our most vulnerable citizens," South Carolina Department of Health and Human Services Director Tony Keck said in a statement. "Currently, these patients must navigate a fragmented system to find the services they need."

Keck said that the pilot project, known as Healthy Connections Prime, "ensures they have access to the right kind of health care services."

The seniors' group AARP praised the development.

"People who are dually eligible for both Medicare and Medicaid often experience fragmented, uncoordinated care that can drive up cost without adding value," Teresa Arnold, state director of AARP SC, said in a statement. "Assuring access to high-quality coordinated care for dual eligibles and finding ways to control their costs without compromising consumer protections" are a priority for the group, she said.

The state will hold a series of forums in November so medical providers can ask questions about the pilot project. The project is scheduled to run for three years.

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