South Carolina’s Medicaid Waiver: Who Would be Impacted?

A few months ago, we released an analysis of South Carolina’s application to impose work reporting requirements on very low-income parents and caregivers with incomes below 67 percent of the poverty level insured through Medicaid. 

Since then, the state has revised its application, proposing eligibility expansions for several groups including parents, children, and pregnant women; however, the work reporting requirements impacting South Carolina’s poorest parents remain. 

Under the updated application, Medicaid income eligibility for parents and caregivers would be raised to 100 percent of the poverty level, or $1,775 per month for a family of three. The state projects over 32,000 parents monthly would gain Medicaid coverage through the eligibility expansion. While covering more parents appears to be a positive step, all of these newly-insured non-exempt parents would be required to report work, putting them at risk of losing their recently gained coverage. 

In fact, the state itself projects 7,100 parents would lose coverage in the first year as a result of not completing enough work hours or failure to meet the documentation requirements. These estimates appear to fail to account for the additional parents that would be subject to the new reporting requirement under the eligibility expansion. This means the state’s projections do not show the full impact of the reporting requirement on parents, or their children who will also be harmed if their parents lose coverage. As readers of Say Ahhh! know, when parents are uninsured children are more likely to be uninsured as well. 

Our updated analysis of the parent population targeted by the reporting requirement found results consistent with those of our previous analysis. Of the parents currently eligible for Medicaid or eligible under the proposed eligibility expansion, the majority are mothers (76 percent) and about half are African-American (45 percent). By comparison, only 27 percent of all adults in South Carolina are African-American, illustrating the disproportionate impact the requirements would have on this group. 

Among parents that are currently enrolled in Medicaid or would become eligible for Medicaid coverage under the waiver, 55 percent are already working and 12 percent report being unemployed. Around thirty percent percent of the targeted parents are not in the workforce, often because they are caring for someone else or have an illness or disability. In the state’s previous application, only primary caregivers of children under 6 were exempt from the requirement; the revised application includes an exemption for a primary caregiver of a child (no age limit is given). However, individuals who are caregivers would be required to prove their exemption to the state, adding red tape, which creates barriers to coverage. The negative effect of red tape on health coverage has been already been seen in Arkansas.  

If low-income mothers lose coverage due to failure to meet work hours or provide documentation of a qualifying caregiver exemption, they are unlikely to have other affordable health coverage options – only 14 percent of parents below the poverty line in South Carolina have employer sponsored insurance while 33 percent are uninsured.

The proposal does contain some good news: South Carolina is also seeking to increase CHIP eligibility levels for children, extend the Medicaid postpartum coverage period to twelve months, and extend CHIP eligibility to pregnant women with incomes from 199% FPL to 245% FPL. Based on the state’s estimates, an additional 26,000 pregnant women and children would be eligible for coverage monthly with these changes. 

Coverage gains that could be achieved with the proposed eligibility expansions in South Carolina’s application will be limited with the inclusion of work reporting requirements if approved. The proposal is up for public comment at the federal level until July 10. 

Allexa Gardner
Allexa Gardner is the Research Associate at the Georgetown University McCourt School of Public Policy’s Center for Children and Families.