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South Carolina approved to enforce Medicaid work requirements

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South Carolina was the first non-Medicaid expansion state to have a Medicaid work requirements waiver approved by the federal government.
Source: S&P Global Market Intelligence

As the future of Medicaid work requirements is being considered by a federal appeals court, South Carolina has received approval from the federal government to implement the controversial Medicaid policy.

The Centers for Medicare and Medicaid Services approved the state's waiver Dec. 12, making South Carolina the first non-Medicaid expansion state to have a work requirements waiver approved. Approximately 83,461 people will be required to provide evidence to be exempt from the policy or meet the work requirements, according to the state's Department of Health and Human Services.

"In this economy there is no excuse for the able bodied not to be working," Republican Gov. Henry McMaster said in a Dec. 12 statement. "Through collaboration with our federal partners we have designed an innovative initiative that will improve health outcomes while also addressing our state's workforce needs."

Medicaid is the dual state and federally run health insurance program for people with low incomes, a wide population that includes children and people who are elderly. Work requirements mandate that individuals work or participate in activities like school or volunteering for a set number of hours each month to maintain Medicaid eligibility.

The policies have been steeped in controversy for causing people to lose coverage and not increasing employment. A federal judge has struck down work requirements four times since June 2018, ruling that they violate the principles of the Medicaid program.

South Carolina's policy will require people to work 80 hours per month, according to the state's waiver. If someone does not meet the state's requirements each month, their eligibility will be suspended or they will have to apply for an exemption. People can be reinstated to Medicaid after suspension.

Joan Alker, executive director of Georgetown University's Center for Children and Families, said in a Dec. 12 blog post that parents will be at risk of losing their healthcare coverage, which also puts their children at risk of losing coverage.

"This harmful policy won't help parents get a job, but will put them and their children at risk of losing their health insurance," Alker said.

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In a separate waiver also approved by CMS on Dec. 12, South Carolina will partially expand Medicaid eligibility from 62% of the federal poverty level to 100% of the federal poverty level for parents or caregivers 19 years of age to 64. If people in this population gain eligibility through this partial expansion, they will be required to adhere to the work requirement or apply for an exemption.

The waiver also expands Medicaid coverage for one year to people between ages 19 to 64 that also "meet defined criteria that include being chronically homeless, justice involved, or needing substance use disorder (SUD) treatment," according to the waiver. These individuals will also be required to follow the work requirement.

CMS Administrator Seema Verma, who traveled to South Carolina on Dec. 12 to make the announcement, said in a statement that the state's waivers will help lift people out of poverty, a common talking point for supporters of work requirements.

"When actually given the opportunity, states have real solutions to offer," Verma said. "South Carolina's requirements — complete with appropriate protections — will lift South Carolinians out of poverty by encouraging as many as possible to participate in the booming Trump economy."

The federal government is appealing a district court's rulings that shot down work requirements in Kentucky and Arkansas before the U.S. Court of Appeals for the District of Columbia Circuit. Indiana's and Michigan's policies are being challenged in the U.S. District Court for the District of Columbia, and Indiana and Arizona have suspended their work requirements policies.