Report Fraud

Background

The South Carolina Department of Health and Human Service (SCDHHS) is the single state agency responsible for the administration of South Carolina’s Medicaid program. SCDHHS provides comprehensive health benefits for over 1 million South Carolinians, as well as a limited family planning benefit for additional 170,000 citizens. Children make up nearly two-thirds of South Carolina’s Medicaid population, making SCDHHS the healthcare payer for nearly three-fifths of all children in the state. Medicaid also funds nearly two-thirds of all births in South Carolina.

Over the past decade, SCDHHS has undertaken several efforts to improve maternal and child health to support positive birth outcomes for mothers and children statewide. These include:

  • The South Carolina Birth Outcomes Initiative (BOI) leverages payer policy to reduce pre-term births, support vaginal delivery, encourage breast-feeding, and address perinatal behavioral health and substance use disorders.
  • SCDHHS employs Healthcare Effectiveness Data and Information Set (HEDIS)-based withhold measures to incentivize Medicaid managed care organizations (MCOs) to focus on prenatal care, neonatal primary care and childhood immunizations.
  • In 2016, South Carolina launched a nursing home visitation pay-for-success program in cooperation with Nurse-Family Partnership, Social Finance, Children’s Trust Fund of South Carolina, and other stakeholders to improve outcomes for high-risk first time mothers and their families.

While these interventions have improved the quality of care provided to Medicaid members, the portfolio of services offered to address prenatal and infant health is incomplete. Efforts to date have focused on the period from conception to early development, and interventions for mothers are focused nearly completely on reproductive health and the brief prenatal period. This narrow approach no longer aligns with clinical evidence or nationally accepted treatment guidelines. A broader approach, one that ensures the delivery of high quality care during the preconception period, is an essential component of ensuring that the mothers, infants and children entrusted to Medicaid’s care can achieve their highest level of health and well-being.

To address these concerns, SCDHHS intends to engage in a series of policy initiatives designed to transition from the current state to one that facilitates the adoption of a preconception care (PCC) model. To accomplish this, SCDHHS intends to first modify the limited benefit available to those qualifying for family planning services to align with those services necessary to ensure quality care during the preconception period. Secondly, SCDHHS seeks to implement a more comprehensive set of provider qualifications to ensure that those providers engaged in the delivery of the PCC model are able to adequately care for the overall health needs of the Medicaid members they serve.

Back to Top