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COLUMBIA — Gov. Henry McMaster asked federal officials Tuesday to quickly approve his request that would expand Medicaid eligibility for poor parents who are working or going to school.
If the Trump administration approves, more South Carolina adults would qualify for the government-paid health insurance if they can prove they’re either working, training for a job, going to school or volunteering for at least 80 hours each month.
The state’s Medicaid agency does not yet know how many people could be newly covered.
South Carolina is among 10 states that have not expanded Medicaid eligibility to cover all adults with incomes up to 138% of the federal poverty level, as the 2010 federal health care law known as Obamacare intended before a U.S. Supreme Court ruling made it optional. In states that followed the law’s intentions, people with incomes above that 138% threshold can get federal subsidies toward private health care.
McMaster reiterated Tuesday he remains adamantly opposed to expanding Medicaid that way.
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But he wants to end what he considers a disincentive for poor families on Medicaid to find better-paying jobs.
Under South Carolina’s existing eligibility rules, parents no longer qualify for Medicaid if they make more than 67% of the federal poverty level, which is just $17,856 this year for a family of three. But if they make less than 100% — or $26,650 for that same family of three — parents lose their coverage and get no help on the private marketplace.
“This presents working families with an undesirable choice: earn additional income to support their family or lose their healthcare coverage,” McMaster wrote in the letter to Acting Health and Human Services Secretary Dorothy Fink sent a day after Trump’s inauguration.
McMaster is seeking a federal waiver that would expand eligibility to the poverty level, when subsidies would kick in, closing the coverage gap for working parents. Childless adults would remain ineligible for Medicaid, according to Jeff Leieritz, spokesman for the state Medicaid agency.
Parents exempt from the work-or-school rules would include people with disabilities, pregnant women, and new mothers, who qualify at higher income levels anyway. Children qualify as long as their parents’ income is no more than 208% above the poverty level.
South Carolina’s pending application is similar to one approved in December 2019, during President Donald Trump’s first term. But the pandemic hit before it could be implemented, and the Biden administration revoked the permission.
There’s one big difference: Unlike the previous version, people who already qualify for Medicaid won’t have to meet the work-or-school rules. Those would apply only to people newly eligible because their incomes fall between 67% and 100% of the poverty level, Leieritz said.
“Granting South Carolina the authorities necessary to reinstitute this initiative will strengthen the Medicaid program’s dual missions of financing health services and improving opportunities for independence, self-reliance, and prosperity for the state’s citizens,” McMaster wrote in his letter.
The state’s Medicaid agency is working to determine how many people would be affected by the change, Leieritz said. When officials initially applied for the waiver in 2018, the agency predicted roughly 32,000 parents in the coverage gap would be newly eligible for Medicaid.
Under Trump, many states might pursue Medicaid work requirements
The work requirements would be similar to those required by the federal government for people receiving grocery benefits through the Supplemental Nutrition Assistance Program, or SNAP, which is often called food stamps.
Under those rules, people under 55 who can work — what the government calls “able-bodied adults” — are limited to three months of food benefits over a three-year period unless they can prove they work, volunteer or attend job training at least 80 hours each month, according to the U.S. Department of Agriculture.
Because people can qualify for SNAP while making up to 100% of the federal poverty level, it’s likely many who would apply for Medicaid under the proposed eligibility expansion are already meeting its work requirements.
That was intentional, Leieritz said.
“This is an important step in reducing the administrative burden on accessing services for those who qualify,” he said in an email.
State Medicaid officials are working to put together the state’s official application for the program, which will follow McMaster’s plea to give it expedited consideration. There’s no timeline yet for submission, but officials are hoping to put in their application as soon as possible, Leieritz said.