Feds OK SC's request to mandate work, volunteer requirements for Medicaid recipients

Dec. 12--COLUMBIA, S.C. -- South Carolina got the green light Thursday from the federal government to require some Medicaid recipients to work or volunteer in order to qualify for their health care benefits.

On Thursday, Republican Gov. Henry McMaster said the state has been granted two waivers it requested last year allowing the state to require able-bodied S.C. adults on Medicaid to work or volunteer in order to continue receiving coverage under the federal health care program. The waivers were approved despite court challenges over similar proposals in two other states: Arkansas and Kentucky.

McMaster said Thursday that there is "no excuse" for adults not to be working given the state's low unemployment rate.

"South Carolina's economy is booming, wages are up, and our unemployment rate is at an all-time low at 2.6%," McMaster said in a statement. "Competition for workers is fierce and businesses are struggling to fill vacancies. ... 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."

But critics of the state's new plan say that those requirements will only hurt South Carolinians facing poverty, particularly women with children and residents in some of the state's rural counties where hospitals have vanished and access to services is slim.

"This is more than cruel, it's going backwards," said Sue Berkowitz, who head's South Carolina Appleseed Legal Justice Center, slamming the waiver as going too far since it denied provisions that Appleseed supported, including continuing coverage for women months after they have given birth. "This is just a really cruel, cruel effort on behalf of the feds to hurt low-income people."

Under South Carolina's new waiver, able-bodied adults who get their health benefits through Medicaid, the joint federal-state health insurance program for the poor, would have to work at least 80 hours a month, or take part in job or education training, or participate community service.

In South Carolina, about 1 million people get their health care through Medicaid, which the state chose not to expand under the Affordable Care Act.

More than 80% of the state's Medicaid beneficiaries are children, senior citizens or disabled. The waiver would exclude those patients from work and volunteer requirements.

Eleven of the state's counties -- Allendale, Bamberg, Barnwell, Chester, Clarendon, Fairfield, Lee, Marion, Marlboro, Orangeburg and Williamsburg -- have some of the highest rates of Medicaid use in the state, according to a 2018 analysis by Georgetown University's Center for Children and Families and S.C. Appleseed. That study estimated that between 5,000 and 14,000 S.C. parents could lose their coverage in the first year of the state's enforcing work requirements.

Berkowitz called the waiver Thursday "ill-advised." More than 80% of the adults who could be affected by this new waiver are mothers, and 35% of them are already working, Berkowitz added.

The other mothers, she said, are not working because "they are taking care of someone who has an illness or they might be ill or disabled themselves," Berkowitz said.

"What this is going to do is put the burden on them to ask for an exemption, which means many of them will lose their health care."

The American Cancer Society Cancer Action Network also expressed concerns about the new requirements.

The group said in a release Thursday the state has nearly 280,900 cancer survivors who get health benefits through Medicaid.

"While we appreciate the department's carve-out for cancer patients who are undergoing treatment, we are concerned about the negative impact this policy could have on cancer survivors and people at risk for cancer," Beth Johnson, the state's government relations director, said in a statement. "Community engagement guidelines have the potential to inhibit a patient's access to lifesaving care and treatment services provided by the state's Medicaid program."

It's unclear whether anyone will challenge the requirements in the courts.

But Berkowitz said, "We are going to do a full analysis of all the administrative and legal remedies that are available ... and seriously consider them."

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