As S.C. House budget writers begin sorting out the state's $6.3 billion general fund budget this week, lawmakers will have up to $900 million more in recurring and one-time money to spend than last year.
But the extra money doesn't mean everyone is happy.
While lawmakers won't have to fight about what to cut -- three years ago, lawmakers had to cut $190 million from state programs in one week -- they now will fight about which state programs to restore.
"Before, it was trying to protect what you've got. Now, it's trying to get what you can back. It's a lot different," said Rep. Brian White, R-Anderson, the chairman of the state House Ways and Means Committee, which meets this week to compile the budget. "There's a lot of worthwhile things for this increased revenue we are experiencing, but there is not enough to go around. We've got to pick and choose wisely and put our money towards debt, infrastructure and job recruitment."
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One example is $3.75 million to pay for emergency dental procedures for adults on Medicaid, the federal health insurance program administered by states for the poor and disabled.
While the dental care of children is covered under Medicaid, states don't have to offer dental coverage to adults. But if South Carolina will pay $3.75 million, the federal government will pay another $9 million to cover the estimated $12.7 million cost of an adult dental-care program, which covers things dentists determine are emergencies.
Officials at the state Department of Health and Human Services cut the program last year to deal with a $228 million deficit at that agency, which oversees South Carolina's Medicaid program.
In December, Human Services director Tony Keck told a House subcommittee he wanted money for the adult dental program restored in next year's state budget. A month later, however, when Gov. Nikki Haley released her budget proposal, money for adult dental care was gone.
"The issue with legislators, obviously, is that they were told adult dental was (to be) restored, and there is, obviously, a huge push from the dental community to restore adult dental," said state Rep. Murrell Smith, R-Sumter, chairman of the House Ways and Means subcommittee in charge of the Medicaid budget. "There is a push among a number of lawmakers to restore adult dental. That is something we are seriously considering."
Keck says he had been afraid that cutting dental care would drive up costs elsewhere in his agency's budget, including money spent on emergency room visits and hospitalizations for abscessed teeth. So he put a "placeholder" for the adult dental program in his budget for the coming year, just in case.
But after reviewing the numbers, Keck found his agency was paying $1 million less for dental-related hospitalizations than it had before the budget cut. That was enough justification to not restore the program, Keck decided.
"To some extent, when you stop paying for a service, you also stop paying for the waste, fraud and abuse in the service," Keck said. "Some of these things previously considered emergencies maybe no longer become emergencies because we weren't paying for them."
A spokesman for Haley said Keck asked her to remove the money from her executive budget proposal, and she did.
"Gov. Haley brought Tony Keck to South Carolina because of his experience and believes that he knows what is best for his agency to fund in their budget," Rob Godfrey said.
But some hospitals say they are paying higher costs because the dental program was cut.
At Palmetto Health, one of the largest hospital systems in the state, dental-related emergency room visits have been increasing, according to Vince Ford, senior vice president for community services. Ford said the increase has caused Palmetto Health officials to partner with local dentists, at Palmetto Health's expense, to divert some of that emergency room traffic.
"Dental is probably the biggest unmet need," he said.
One thing giving lawmakers pause about restoring the program is the recently passed federal health care law.
Once the Affordable Care Act is implemented -- if it survives U.S. Supreme Court challenges -- it will increase the number of people eligible for Medicaid.
In South Carolina, Keck says a staggering 500,000 more residents could be eligible for Medicaid. He predicts that influx could swell the federal and state cost of the dental program -- now projected at $12.7 million -- to $42 million.
"It's an evolving process," said Smith, the Ways and Means subcommittee chairman. "You evaluate it every year because we need to make sure the cost justifies what the potential cost is going to be in a few years."
The S.C. Dental Association supports restoring the Medicaid money, saying it will save taxpayers' money in the long haul.