Beaufort News

Critics warn cutting hospice care will add, not cut state's Medicaid costs

CHARLESTON -- Upcoming Medicaid cuts that eliminate hospice care coverage for terminally ill adults could end up costing South Carolina more than it saves, hospice providers said this week.

With the cuts taking effect Feb. 1, advocates are warning state officials about potential fallout beyond the human toll on patients and families: Medicaid patients denied hospice care will seek medical attention elsewhere at a higher cost.

"Folks in hospice are sick and dying," statewide hospice advocate Tamra West said. "If they're not in hospice, they're going to be sick and dying somewhere else. Cutting hospice is going to cost the state more, so why do it?"

State officials say they are aware of the economic risks and that they have no choice but to make immediate cuts to grapple with crippling budget shortfalls.

"We recognize a danger of driving up long-term costs, but we don't have the luxury of being able to think long-term in that regard," said S.C. Department of Health and Human Services spokesman Jeff Stensland. "We have to make cuts that chip away at this year's deficit."

Medicaid patients account for about 5 percent of South Carolinians who receive hospice care -- last year, that was 957 adults.

No new Medicaid patients will be eligible for hospice care beginning Feb. 1.

Medicaid beneficiaries already enrolled in hospice before the deadline can remain under care for 90 days.

Hospice Care of the Lowcountry, a nonprofit agency serving Beaufort and Jasper counties will continue caring for patients despite the cost cutting measures, said clinical director Kendell Brinkmann.

"Even if a person is not covered by any insurance plan, we never send a bill for services," Brinkmann said. "But hospice facilities all over are facing a lot of challenges. We hope our legislature will look at this differently."

Patient Susan Chapman, 57, of Hardeeville said Hospice Care has taken the burden off her and her loved ones during her struggle with a rare form of cancer.

Chapman, who receives Medicaid, said she is paying out of pocket for additional home care.

"People like me will end up in the ER for pain, or high blood pressure or something similar," she said. "It's just another strain on the otherwise strained medical system."

Chapman, who has undergone five surgeries and about 48 radiation treatments since she was diagnosed in 2008, recently entered hospice after her doctors told her they were taking a break from her treatment, she said.

Ending hospice payments is expected to save the state $233,000 a month this fiscal year and $3.3 million next year.

But a decrease in one column probably will mean a spike in another, critics said. Medicaid patients still remain in the system, and they will seek treatment unaffected by the cuts.

Patient advocates point to Arizona, where officials dropped Medicaid coverage for adult hospice care about a year ago. Arizona reinstated coverage in September after a cost analysis showed the state spent more money than it saved.

Hospice services were "often provided through more expensive inpatient settings including acute care hospitals and nursing facilities, as well as in-home settings on a fee for service basis," according to a September letter a director from the Arizona Health Care Cost Containment System sent to health providers.

Arizona health officials estimated that "costs increased by approximately 4.4 percent to provide the same services," according to the letter.

In February, South Carolina will be the only state in the country in which Medicaid does not cover adult hospice care.