- CMS on Thursday approved Medicaid work requirements in South Carolina, despite a string of legal challenges to similar efforts in other states. No state is currently implementing a work requirement, due to these challenges and voluntary cessations from state government.
- The state's now-greenlit plan proposes to expand Medicaid coverage to low-income parents earning up to the federal poverty line. Currently, South Carolina only covers parents up to 67% of the FPL — roughly 1 million of its 5 million population.
- Medicaid beneficiaries are then required to work or volunteer for at least 80 hours a month unless the enrollee gets a qualified exemption, such as being pregnant, having a disability, receiving treatment for alcohol or substance use disorders or being the primary caregiver of a child.
Though the Trump administration heralds work requirements as a key to lift low-income Americans out of poverty, critics warn they will drop the most vulnerable from a safety net program meant to ensure access to care. Work requirements are also expensive: It cost taxpayers approximately $410 million to implement the programs in five states, according to the Government Accountability Office.
CMS did not clear South Carolina's request for funding authority to provide subsidies to purchase exchange plans for people who lose Medicaid coverage due to becoming employed but are not offered employer-sponsored insurance. CMS also did not approve the state's initial request to expand Medicaid benefits for pregnant enrollees so that mothers remain covered for one year after giving birth.
The administration has approved work requirements in ten states so far: Arizona, Arkansas, Indiana, Kentucky, Michigan, New Hampshire, Ohio, Utah, Wisconsin and now South Carolina. Of those, three (New Hampshire, Kentucky and Arkansas) have seen their programs struck down by a federal judge. The U.S. Court of Appeals is expected to rule a decision on appeal for those three cases any day now, with legal experts foreseeing it to uphold a lower court's ruling that the waivers are "arbitrary and capricious."
A slew of additional states have requested the so-called community engagement programs but have not yet been approved by CMS.
South Carolina Gov. Henry McMaster, a Republican, announced his plan Thursday morning at a workplace development center in Greenville, S.C., where CMS Administrator Seema Verma was in attendance.
"South Carolina’s economy is booming, wages are up, and our unemployment rate is at an all-time low at 2.6%," McMaster said in a statement. "Competition for workers is fierce and businesses are struggling to fill vacancies. In this economy there is no excuse for the able bodied not to be working."
According to a January report from the Georgetown University Health Policy Institute's Center for Children and Families, households headed by women, African-American families and those living in rural areas are disproportionately likely to be harmed by South Carolina's waiver.
Additionally, though being the primary caregiver of a child under 18 does exempt a Medicaid beneficiary from the work requirements, parents are not automatically exempted: they have to report their status and be granted an exemption.
"This is key," Georgetown CCF's Joan Alker wrote in a Thursday blog post, noting that in Arkansas, which required individuals to self-report their exempt status, saw a coverage loss ratio of more than 75%.
"Children are not exempt from harm's way when their parents' coverage is put on the chopping block," Alker said.