South Carolina becomes the 11th state with similar requirements approved by the federal Centers for Medicare and Medicaid Services since its administrator, Seema Verma, announced nearly two years ago that she would welcome proposals from states that wanted to compel Medicaid recipients to work as part of what she described as an effort to give them “the right incentives to live healthier, independent lives.” Critics contend that most Medicaid recipients who are able to work already do so and that health insurance is a prerequisite to building a better life.
A federal judge based in the District blocked the requirements in Kentucky and New Hampshire — and ruled that Arkansas must suspend its requirements after several months in which about 18,000 people had lost insurance under the rules. Other states that have won CMS approval recently have decided on their own not to follow through, at least for now, in some instances citing the ongoing litigation.
Against that backdrop, the CMS’s approval of the South Carolina plan is distinctive. All but two other states would compel people to work or prepare for a job only if they became eligible for Medicaid under a state expansion of the program through the Affordable Care Act.
The CMS’s written approval also emphasizes that South Carolina’s approach fulfilled fundamental objectives. In rejecting the three other states’ plans, U.S. District Judge James Boasberg of the U.S. District Court for the District of Columbia held that federal health officials had failed to hold states to that standard — especially with the enrollment drop in Arkansas, the only state to put the rules into practice.
South Carolina is planning to impose its work rules on two groups of low-income people who did not qualify before under that state’s stringent eligibility rules. Specifically, those groups are parents or other caretakers with incomes slightly higher than the state’s threshold of 67 percent of the federal poverty level, plus certain adults who are homeless, need drug treatment or are involved with the criminal justice system.
For this reason, the CMS says that the program will add an estimated 45,000 additional South Carolinians to the rolls, even if some of the newly eligible people fail to meet the requirements. Under a separate approval, the state can also apply the requirements to current recipients who are very low-income parents. Most will be exempt, but documents acknowledge that perhaps 7,100 could lose coverage.
Unlike any other states’ plans, where recipients will be given time to comply, South Carolina is requiring that the newly eligible applicants must prove they are already working or performing other types of “community engagement” at least 80 hours per month to be admitted to Medicaid.
A coalition of 21 patient and consumer groups issued a denunciation of the administration’s decision, saying they are “gravely concerned.” Emily Stewart, executive director of Community Catalyst, a health-care advocacy group, called the approval “a new low in the Trump administration’s quest to strip away health coverage for our nation’s low-income residents.”
Officials of the National Health Law Program, which has brought lawsuits against other states, said they were exploring legal action involving South Carolina. “We are looking at all administration and litigation options that are out there . . . to protect the Medicaid recipients of South Carolina,” Sue Berkowitz, director of the South Carolina Appleseed Legal Justice Center, said in an interview. “Just because you’re pretending to offer something, but then you’re taking it away [through] these work requirements and administrative barriers, how is this opening up?”
On Thursday, Verma stood alongside South Carolina Gov. Henry McMaster (R) to announce the approval. Verma flew to Greeneville after a White House meeting the evening before during which President Trump’s acting chief of staff, Mick Mulvaney, sought to end a series of public clashes between her and Health and Human Services Secretary Alex Azar.