Thousands of SC parents would lose health insurance in Medicaid plan, study says

Medicaid mix-up: Governor debate heats up over federal aid questions

Henry McMaster and James Smith state their views on Medicaid expansion during the governor debate on October 17 in Florence, S.C.
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Henry McMaster and James Smith state their views on Medicaid expansion during the governor debate on October 17 in Florence, S.C.

Thousands of South Carolina’s poorest parents will lose health insurance under a state proposal to impose work requirements on Medicaid recipients, a new study says.

Between 5,000 and 14,000 S.C. parents would lose their Medicaid coverage in the first year such a policy is in force, according to a report released Friday by S.C. Appleseed Legal Justice Center and Georgetown University’s Center for Children and Families.

When parents lose insurance, their children are at greater risk of losing coverage, too, the report’s authors said, noting the recent increase in the percentage of S.C. children who are uninsured.

“These are struggling families, mostly moms, and we know that when there is a lack of health care among parents, we know that ultimately harms children,” said Sue Berkowitz, executive director of S.C. Appleseed.

South Carolina is seeking permission from the federal government to require able-bodied Medicaid recipients to prove they are working at least 80 hours a month, seeking work, going to school or volunteering, in order to keep receiving benefits.

Gov. Henry McMaster, a Richland Republican, decided to seek the work requirements last January, after President Donald Trump said he would make it easier for states to impose work requirements for Medicaid, the federal health insurance program for the poor and disabled.

Supporters of Medicaid work requirements say they will encourage able-bodied Medicaid recipients to find work. Working, they add, will improve the health and financial status of those residents while lowering the state’s health care costs.

Defending the proposal Friday, McMaster’s spokesperson Brian Symmes said the governor “believes that the path to a healthy and stable home life begins with gainful employment and that temporary government assistance should be exactly that — temporary.”

The state’s Health and Human Services agency, which oversees its Medicaid program, has included exemptions for residents in the Medicaid proposal for beneficiaries who cannot fulfill work requirements, Symmes added.

But critics of the plan say the work requirements will only create barriers to health care for families that need it most.

According to the report, by the fifth year of the policy being in place, the number of low-income S.C. parents losing coverage would rise to between 9,000 and 26,000. Families impacted by the policy would be among the state’s most vulnerable with incomes of $1,160 a month for a family of three. Of the affected families, 86 percent are mothers, 51 percent are African American, and 35 percent say they already are working.

Encouraging people to work is a “worthy goal,” said Joan Akler, executive director of the Georgetown Center for Children and Families.

However, she added, some Medicaid recipients, even those who qualify under the state’s new plan, “likely will lose coverage because they can’t meet the new rule or don’t know about the rule.”

Take Arkansas, for example.

In Arkansas, the first state to enforce work requirements for Medicaid, nearly 17,000 people, or 22 percent of Medicaid recipients affected by that state’s new rules, lost coverage “often because of administrative hurdles in reporting their work hours,” the report released Friday by Georgetown and Appleseed says.

“Arkansas is the canary in the coal mine on what will happen when you do this,” said Phyllis Jordan, a spokesperson for the Center for Children and Families. “The more administrative hurdles that you put up, the fewer people enroll or the fewer people stay enrolled.”

S.C. Health and Human Services spokesperson Colleen Mullis expressed confidence in the state’s analysis of who might lose coverage. The report, which the agency just received Friday, compared similar work programs in “Medicaid expansion states to South Carolina’s proposal in order to make the number of individuals who may possibly lose coverage due to noncompliance appear larger.”

The state is accepting public comment on the proposal through 5 p.m. Jan. 22.

Jamie Self is a projects reporter writing about health care, education, criminal justice and more. An alum of The State’s politics and State House team, Jamie has won several first place awards for education and government beat reporting and has contributed to wins for political and public service journalism. @jamiemself