Medicaid enrollment surged during COVID then fell after. Here’s why and what SC did about it. | Opinion

The South Carolina Healthy Connections Medicaid program administered by the South Carolina Department of Health and Human Services provides healthcare coverage to more than 1 million South Carolinians, 60% of whom are children.

Here’s what we’re doing to ensure Medicaid eligible members remain covered.

Generally, people qualify for Medicaid because they have a disability or meet guidelines based on household income and other qualifying reasons (such as being pregnant, being a child or having a child). Medicaid programs are operated by both a state agency and the federal government’s Centers for Medicare and Medicaid Services.

Federal law requires all state Medicaid agencies to check the eligibility status of Medicaid members annually, but Congress paused this requirement at the start of the COVID-19 public health emergency when it passed the Families First Coronavirus Response Act. This essentially prohibited states from disenrolling Medicaid members.

Congress reinstated the requirement to check Medicaid members’ eligibility status last year, requiring states to begin the process of disenrolling members whose Medicaid eligibility status could not be confirmed beginning April 1, 2023. The Centers for Medicare and Medicaid Services refers to this as the “unwinding.”

Before the COVID-19 pandemic, about 1.1 million South Carolinians were typically enrolled in Medicaid. Enrollment surged during the prohibition on Medicaid disenrollment. South Carolina’s Medicaid enrollment increased by about 30% from February 2020 to May 2023. This increase in enrollment occurred across the country where Medicaid enrollment grew nationally by 32% from February 2020 to May 2023.

While checking the eligibility status of Medicaid members annually is a regular process, it was not done for more than three years. To help ease the restart of this process, Centers for Medicare and Medicaid Services offered states temporary flexibilities that allowed policy changes to reduce the burden on both agency employees and Medicaid members.

The South Carolina Department of Health and Human Services adopted 13 temporary flexibilities, nearly double the national average of seven. Many have allowed the agency to more easily reach Medicaid members through more accurate contact information and to renew more members’ coverage with information already available without needing to request additional information from families of Medicaid members.

The agency also launched an outreach and marketing campaign to inform Medicaid members and the public about the return of annual eligibility reviews. We partnered with community organizations, other state agencies and the health care provider community, participating in more than 150 community and stakeholder events across the state. These efforts are in addition to direct communication with Medicaid members via multiple mailings, text messages, phone calls and emails.

Using the slogan, “Submit your review when it’s time to renew,” the South Carolina Department of Health and Human Services also added paid advertising and worked with school districts, health care providers and others to reach families.

The culmination of these flexibilities, the process improvements and the marketing and outreach campaign have led to 94.67% of annual review forms being successfully delivered through the mail and an increase of new Medicaid applications of 80% from April 2023 to April 2024.

As we continue processing Medicaid annual eligibility reviews, South Carolina’s Medicaid members who think they may have missed their deadline can still return their annual review.

Members can visit apply.scdhhs.gov to submit their annual review, check their annual review status, update their contact information and more.