South Carolina’s governor and legislature has strongly rejected Medicaid expansion under the Affordable Care Act (ACA). As a result, there are about 92,000 people in the state who are in the “coverage gap” with no realistic access to health insurance. They are the state’s poorest residents, with incomes under the poverty level. They do not qualify for subsidies in the exchange and they also do not qualify for Medicaid. In many cases, they rely on emergency rooms and community health clinics, but future funding for those clinics is in jeopardy too.
Since 2017, Republican Henry McMaster has been the governor of South Carolina (McMaster was the lieutenant governor and took office as the governor when Nikki Haley was appointed by President Trump to be the US Ambassador to the United Nations). McMaster is opposed to Medicaid expansion, as was Haley. McMaster is up for reelection in November 2018. His Democratic challenger, state Representative James Smith, has vowed to expand Medicaid if he’s elected, making coverage available to 150,000 residents.
Medicaid in South Carolina
Medicaid became effective in South Carolina in July 1968, two and a half years after it was available in the first states that implemented it. Eligibility has been improved and expanded over the years through federal mandates that required coverage for children and pregnant women.
A primary provision of the ACA was to expand Medicaid to cover all legally-present residents with incomes up to 138 percent of poverty, with the federal government paying the full cost of expansion through 2016. After that, the states have gradually taken on a small portion of the cost, but it will never exceed ten percent. It was expected that this landmark expansion of Medicaid would be implemented in every state.
But in 2012, the Supreme Court ruled that states could not be penalized if they chose to not expand their Medicaid programs, and South Carolina is one of the 19 states that has not yet expanded Medicaid (Maine and Virginia have not yet expanded coverage, but Virginia will do so as of January 2019 and Maine will do so as soon as the legal battle with the governor is resolved). In late 2012, three Democrats in the South Carolina House of Representatives introduced a bill that called for the state to participate in the Medicaid expansion under the ACA, but it didn’t get much traction.
Former Governor Nikki Haley was staunch in her opposition to Medicaid expansion, although her comments on the issue seemed to indicate that her primary objective was opposing President Obama. In 2013, Haley stated that South Carolina “will not expand Medicaid on President Obama’s watch. We will not expand Medicaid ever.” Unfortunately, this means that South Carolina residents are paying federal taxes that are being used to fund Medicaid expansion in other states — and they’re getting nothing for themselves. The state is missing out on $15.8 billion in federal funding over the next decade by not expanding Medicaid.
In addition to the financial impact, there’s a human cost to not expanding Medicaid. A White House report in June 2015 noted that expanding Medicaid in South Carolina would save 200 lives per year. Democrats in the state legislature renewed their calls to expand coverage in 2015, but no progress was made during the 2016 legislative session. That has continued to be the case in 2017 and 2018, which is unsurprising given the strong Republican majority in the state’s legislature.
Although Medicaid coverage is still only available to a very limited number of adults in South Carolina, a small improvement came in December 2014 for adults who are covered by SC Medicaid. Preventive dental care, including cleanings, fillings, and extractions, was added to the existing Medicaid benefits, with up to $750 in annual benefits per member. Previously, this benefit was only provided for children.
Who is currently eligible?
The guidelines in South Carolina are unchanged from 2013. But the state still saw an enrollment increase of 97,403 people in its Medicaid/CHIP programs between late 2013 and July 2016, thanks in large part to the publicity surrounding the ACA and outreach on the part of enrollment assisters.
Here are the current eligibility guidelines:
- Children with household incomes up to 208 percent of poverty.
- Working parents with dependent children, if their household incomes do not exceed 89 percent of poverty.
- Jobless parents with dependent children, if their household incomes do not exceed 50 percent of poverty.
- Pregnant women with household incomes up to 194 percent of poverty.
No Medicaid coverage is available for non-disabled childless adults, regardless of how low their income is. This is the group most likely to fall into the coverage gap and have little in the way of realistic options for health coverage.
How do I enroll?
Despite political leadership’s opposition to expanding Medicaid, the state has taken steps to overhaul its Medicaid enrollment process and is actively working to enroll people who are eligible based on the existing guidelines. There are additional employees in the state’s Medicaid call center, an online application process (in addition to HealthCare.gov) and the state is using databases of people who already qualify for other income-based programs like SNAP to help identify residents who are eligible for Medicaid.
- South Carolina Healthy Connections Medicaid has a website where you can enroll online. You can also reach them by phone at 1-888-549-0820.
- You can enroll in Medicaid through HealthCare.gov
- You can enroll over the phone via HealthCare.gov by calling 1-800-318-2596
Medicaid enrollment is available year-round.
How many people have enrolled?
Medicaid enrollment continues year-round, and South Carolina’s poverty rate is high (20 percent of adults and 30 percent of children). From the fall of 2013 through June 2018, the population covered by Medicaid in South Carolina grew by 104,496 people — a 12 percent increase, despite no change in eligibility guidelines. Nationwide, enrollment in Medicaid has increased in most of the states that haven’t expanded Medicaid, due to increased awareness and outreach. People who were already eligible for Medicaid might not have known about their eligibility, but find out about it when they go to an enrollment center or reach out to the exchange to see about obtaining coverage.