Gov. Henry McMaster directed the South Carolina Medicaid agency on Thursday to seek permission from the federal government to impose work requirements on beneficiaries of the public health insurance program.
McMaster's push coincides with a decision made by the Trump administration to offer an easier path for states to impose such work requirements.
“Whenever possible, we should always endeavor to help South Carolinians in need find their path to gainful employment and away from the temporary assistance of government,” McMaster said in a press release.
“A good, steady job makes everything better, it creates a better home life, results in healthier lifestyles, and provides financial independence and opportunity,” he added.
More than 1 million people in this state are covered by Medicaid.
According to enrollment numbers provided by the state agency last year, nearly 83 percent of those beneficiaries are children, disabled adults or elderly.
Sue Berkowitz, executive director of Appleseed Legal Justice, which advocates for low-income residents, viewed McMaster’s announcement as primarily political.
"I wish he understood who Medicaid beneficiaries are,” she said. “We’re just following the pack for the sake of following the pack.”
The state’s Democratic Party chairman was quick to criticize the plan, too.
“There are several truths to this act, the first being that Republicans in South Carolina do not embody the Christian values of compassion and empathy. They may preach it, but they certainly do not practice it,” party Chairman Trav Robertson said in a statement.
Robertson said he thinks McMaster's plan violates the federal Medicaid statue and that it should be legally challenged.
"This is nothing more than a cheap and callous measure by the governor," he said. "He went after school buses and endangered our children. Now he’s going after their parents' insurance. It is as typical as it is mean-spirited.”
One former Medicaid director said he believes McMaster’s plan has merit.
“The best way to build support for covering more people in Medicaid is to make sure taxpayers feel their money is being well spent,” said Tony Keck, who served as the state's Medicaid director for four years under former Gov. Nikki Haley.
Work requirements, he pointed out, are already part of other federal programs, including Temporary Assistance for Needy Families. These requirements often provide exceptions to beneficiaries who are caregivers, students or disabled, he said.
“Few of us wouldn't argue that those who can work, should work,” said Keck, now a hospital executive in Tennessee. “The governor’s proposal could eventually help broaden support for a program that reaches more people deserving of help.”
Across the country, 70 million people, or about 1 in 5 Americans, are enrolled in Medicaid, making it the government's largest health insurance program. In South Carolina alone, the Medicaid agency's budget tops $7 billion a year, most of which comes from the federal government.
The Affordable Care Act allows states to expand eligibility for Medicaid to cover millions more low-income adults. But when the U.S. Supreme Court made Medicaid expansion optional in 2012, South Carolina declined to participate.
People are not legally required to hold a job to be on Medicaid, but states traditionally can seek federal waivers to test new ideas for the program.
The administration's latest action spells out safeguards that states should consider to obtain federal approval for waivers imposing work requirements on "able-bodied" adults. States can also require alternatives to work, including volunteering, caregiving, education, job training and even treatment for a substance abuse problem.
Technically, the federal waivers would be "demonstration projects." In practical terms, they would represent new requirements for beneficiaries in those states.
The administration said 10 states have applied for waivers involving work requirements or community involvement. They are Arizona, Arkansas, Indiana, Kansas, Kentucky, Maine, New Hampshire, North Carolina, Utah and Wisconsin. Advocates for low-income people expect Kentucky's waiver to be approved shortly.
Seema Verma, head of the federal Centers for Medicare & Medicaid Services, said the goal is to help people move from public assistance into jobs that provide health insurance.
"We see people moving off of Medicaid as a good outcome," she said.
A spokesman for the S.C. Medicaid agency said department leaders received McMaster's directive "in the past day," and they plan to meet internally and with other state agencies to discuss what a Medicaid Work Requirement for SC Medicaid recipients may look like.
If approved by the federal government, it's unclear when work requirements might be imposed in South Carolina or how the state would enforce them.