The world of Medicaid is complicated. While the federal government issues guidelines about how it can be regulated and expanded, states have direct control over their policies. They can choose whether or not to adopt expansion measures and can apply for waivers that allow them to modify Medicaid guidelines for their own use. Some states have embraced Medicaid expansion heartily, while others remain on the fence about it or vehemently opposed to it. South Carolina is a state that has been opposed to Medicaid expansion, though it has successfully made some beneficial changes in spite of this.
Current State of South Carolina Medicaid
South Carolina has been running Medicaid programs since July 1968, but officials are and continue to be opposed to the implementation of expansion through the Affordable Care Act (ACA). While individuals with disabilities, pregnant women, children and the elderly can be eligible for government assistance, there is little to no provision for low income singles or couples without children. About 124,000 people remain in the coverage gap as a result, with a majority of those being the poorest residents of the state.
Recent updates will extend coverage to pregnant women making 199 percent (with a 5 percent disregard) of the federal poverty level (FPL) and to parents and caretakers of minor children if they make 100 percent of the FPL (assuming these parents follow recently adopted work requirements). Children can be eligible if their household income is up to 213 percent of the FPL. Once again, however, these updates leave non-disabled childless adults without Medicaid coverage.
Waivers and Work Requirements
One thing that South Carolina has accomplished where Medicaid is concerned is the successful approval of several Medicaid waivers, making South Carolina one of the first non-expansion states to have such waivers approved. In December 2019, the Centers for Medicare & Medicaid Services (CMS) approved a work requirement for the state (also known as a “community engagement” requirement) that will primarily apply to low-income adults with minor children, raising the FPL income percentage requirement from 67 percent to 100 percent.
Another waiver that has been approved would assist the “Targeted Adult” population, which includes chronically homeless individuals, individuals involved in the justice system (primarily defendants) and individuals working to recover from substance use disorder (SUD). This population will need to be involved in some form of work to get these benefits, like the low-income parent population, but between these two separate population categories, an estimated 45,100 people would become eligible for Medicaid. However, this will likely lead to more difficulties as individuals seek to navigate the complicated paperwork, eligibility, application and coverage retention processes that are involved with these requirements.
The governor of South Carolina created a task force to implement this work requirement, and the requirement itself will go into effect beginning or after July 2020. Currently, however, no timetables or other structures are in place to track, enforce or regulate adherence to the new policies.
How DECO Can Help
At DECO, our specialty is untangling the complex webs of coverage eligibility in order to help healthcare organizations get reimbursed for the care they’ve provided. We walk patients and clinical staff through the processes of applying and receiving Medicaid and other government programs, and our knowledge of the system helps us get more people the help they need to cover their medical expenses. If your hospital or healthcare organization needs assistance with getting patients Medicaid coverage, we can help. We are also certified Health Insurance Marketplace Navigators for South Carolina. Contact us today for more information!