Governor Henry McMaster of South Carolina has formally requested the U.S. Department of Health and Human Services (HHS) to collaborate with the South Carolina Department of Health and Human Services (SCDHHS) in reinstating the state’s Healthy Connections Community Engagement Initiative, commonly referred to as Medicaid Work Requirements. This initiative aims to improve health outcomes and encourage financial independence by mandating community engagement activities such as 80 hours of monthly work, job training, education, or community service for qualifying Medicaid members.
“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,” Governor McMaster stated in a letter addressed to Acting HHS Secretary Dorothy Fink.
The governor further explained: “South Carolina pursued the Section 1115 waivers that made up its Healthy Connections Community Engagement Initiative to close the health care coverage gap created by the Patient Protection and Affordable Care Act (ACA) and incentivize employment among its citizens. Under the ACA, adults are eligible for subsidized health care coverage on the federal exchange when their earnings reach the federal poverty level. However, Medicaid coverage ends for many working parents at a threshold that is below the federal poverty level. This flawed structure created a health care coverage gap that disincentivizes many low-income families from earning additional income. This presents working families with an undesirable choice: earn additional income to support their family or lose their healthcare coverage.”
Initially directed by Governor McMaster in January 2018, SCDHHS sought federal waivers to establish work requirements for qualifying Medicaid recipients. The Trump Administration approved South Carolina’s application in December 2019; however, it was paused during the COVID-19 pandemic due to compliance with federal mandates under the Families First Coronavirus Response Act. The Biden Administration later withdrew approval of this initiative in August 2021.
The governor’s current request focuses on restoring elements related to New Coverage for Parents and Community Engagement within the Palmetto Pathways to Independence section 1115 waiver previously approved by Centers for Medicare and Medicaid Services in December 2019.
