SC gets federal approval for dual-eligible program

South Carolina has received approval from the Centers for Medicare & Medicaid Services to launch a program that would integrate the care of its dual-eligibles population, AHA News Now reported.

The program, known as Healthy Connections Prime, is expected to move more than 53,000 South Carolina seniors who are eligible for both Medicare and Medicaid coverage into integrated managed care programs beginning next year. The transition will make the Palmetto State the ninth in the nation with a special program coordinating the care of its dual-eligibles population. Transition into the program is voluntary. Enrollees also have the option of leaving the Healthy Connections Prime program at any time.

Dual-eligibles are among the sickest and most expensive patients to care for, costing the federal government $260 billion a year. Many payers are focusing specific segments of their business on serving these populations, seeing a huge growth opportunity.

"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's South Carolina chapter, said in a statement.

South Carolina proposed what is known as a three-way capitated model designed to delegate management of dual-eligible lives to a health plan. Officials have not yet disclosed whether there will be a bidding process for the Healthy Connections Prime contract, or if there are any health plans interested in taking on such a contract.

Meanwhile, states have been looking to alternative solutions to try and lower the cost of dual-eligible care. A study published last September in the Journal of the American Medical Association concluded that coordinated care for the dual-eligible population can save about $532 a year per patient,

To learn more:
- read the AHA News Now article
- here's the announcement
- check out the state's proposal to CMS (.pdf)
- here's the JAMA study