A Limited Review of Medicaid Managed Care Rates and Expenditures and Other Administrative Issues at the Department of Health and Human Services
July 2012
After the Department of Health and Human Services (DHHS) incurred a deficit in state general fund appropriations for FY 10-11, members of the General Assembly requested an audit of DHHS’s management of the state Medicaid program in South Carolina. We examined the following issues in this review:
- The number of clients enrolled in Medicaid from 2006 through 2011.
- How DHHS enrolls clients in Medicaid health plans and identify potential cost savings.
- How DHHS manages the administrative costs for managed care organizations and identify potential cost savings.
- If DHHS could achieve additional cost savings in other Medicaid programs.
DHHS administers the state Medicaid program. Medicaid is a health insurance program that pays for medical services needed by poor, elderly, and disabled people. In South Carolina, about 70% of the program is funded by the federal government, and about 30% is paid for with state funds. In the FY 11-12 appropriations act, DHHS was appropriated almost $5.8 billion in total funds, including $917 million in state funds. In November 2011, there were 896,132 individuals enrolled in Medicaid. Fifty-seven percent of these were children, 34% were adults, and 9% were elderly.