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Medicaid information, perceived impact update The Presidential Scholars Program brings students from each of MUSC’s six colleges together each year to study broad issues impacting health care. The overall theme this year is the relationship between health care disparities and legislation. Students worked in interdisciplinary teams on specific areas of this theme. This piece is the final of a series of articles highlighting the results of their work.   Medicaid provides health insurance for one quarter of South Carolina’s population, covers half of all births, and covers three-fourths of all nursing home beds in South Carolina. However, SC Medicaid expenditures rank 24th in the nation, while the state’s health status is ranked 46th by United Health Group. Although there has been an increase in Medicaid expenditures per recipient in the last few years, it has been unable to improve this dismal health status ranking.   South Carolina recently requested federal permission to radically change the state Medicaid program by adopting a waiver system. Under this system, eligible participants will receive a personal health account that they may apply towards a private insurance policy (i.e. MCO, PPO), a medical home network, or simply use the account as needed for health care. This system is designed to increase recipient responsibility and patient management, thus improving care while decreasing unnecessary expenditures. However, some obstacles still stand between this proposal and its success.   First, the medical home networks proposed to improve patient management do not exist. Only two Medicaid managed care plans exist in South Carolina and account for only 8.4 percent of participants and cover 28 of 46 counties. Since the success of the waiver plan depends largely on managing care to improve health status while streamlining costs, the proposal is not feasible without expanding the existing managed care network availability and enrollment. Second, the basis of the waiver proposal is designed to promote consumer-driven health care for Medicaid recipients through the use of personal health accounts. The funding for the private accounts would be based on the average cost of health care for each individual. Therefore, this money would be inadequate for all with above average health care needs, rendering the sickest people unable to pay for their medical care.   Health care providers must become aware of the new system so they can better advise participants. Our Medicaid group of Presidential Scholars took several approaches to determine how well providers are educated about the waiver system. We gained knowledge about the potential impact of the Medicaid Waiver on the MUSC community through key informant interviews and by reviewing the literature of current Medicaid legislation specific to South Carolina. We then created a survey to assess MUSC faculty members’ knowledge of the SC Medicaid Waiver and its impact on their current practice.   Our survey of MUSC faculty, those in position to educate future health care providers as well as treat Medicaid participants, revealed that more than a third are not aware of the proposed waiver system and nearly half do not know the major components of the waiver. One hundred thirty faculty members responded. If providers are not aware of or educated on specifics of the plan, how can Medicaid participants be expected to make educated decisions on how to manage their cost of care?        There is a great need for education and awareness of the general public and health care providers. As current providers and future providers, we have a duty to watch for changes in legislation and determine how that will affect our patients. It is imperative for us to evaluate the long term implications of a changing Medicaid system and how that will affect South Carolina recipients. Overall, the proposed waiver represents a noble effort to institute the radical changes necessary to improve health care in South Carolina without increasing expenditures. However, the waiver would remain unfeasible in its current form because it does not address the problems of managed care network availability/participation and provider education. Presidential Scholars Medicaid Group: Walter Bennett, CHP, Simone Chinnis, CON, Marcus Duvall, COGS, Adam Fernandez, CHP, Ashley Miller, CON, Melissa Minger, CODM, Danielle Moore, CON, John Payne, COM, Jacquetta Williams, COP     Friday, April 28, 2006 Catalyst Online is published weekly, updated as needed and improved from time to time by the MUSC Office of Public Relations for the faculty, employees and students of the Medical University of South Carolina. Catalyst Online editor, Kim Draughn, can be reached at 792-4107 or by email, catalyst@musc.edu. Editorial copy can be submitted to Catalyst Online and to The Catalyst in print by fax, 792-6723, or by email to catalyst@musc.edu. To place an ad in The Catalyst hardcopy, call Island Publication at 849-1778, ext. 201.