Make Medicaid expansion in S.C. another state-federal success story (copy)

Gov. Henry McMaster wants to impose work requirements on Medicaid beneficiaries in South Carolina. File/Grace Beahm Alford/Staff

COLUMBIA — South Carolinians covered by Medicaid would have to get or search for a job, volunteer or go to school to keep their government health insurance under a proposal pushed by Gov. Henry McMaster.

The state Medicaid agency plans to seek permission from the Trump administration to implement the rules on an estimated 180,000 adults, Joshua Baker, director of the Department of Health and Human Services, told The Post and Courier on Friday.

Children, people with disabilities and the elderly make up most of the 1.3 million South Carolinians covered by Medicaid. Others exempt from the proposed rules include single parents, two-parent households where one parent is disabled, and people in a drug-abuse treatment program, Baker said.

The rules are part of an effort to help people become independent and break generational poverty, he said.  

"We're not going to allow people to continue to get Medicaid benefits without making an attempt to be self-sufficient," said McMaster spokesman Brian Symmes. Getting a job "lifts that family up." 

The rules would be similar to what South Carolina requires for poor people to stay on the Supplemental Nutrition Assistance Program, SNAP, commonly referred to as food stamps.  

They're also similar to what the Centers for Medicare and Medicaid Services first approved for Kentucky in January. The announcement marked an unprecedented change to the nation's largest health insurance program and invited other states to apply.  

Sue Berkowitz, an advocate for the poor, said the proposal is politically driven as "the latest, greatest way to blame people for being poor." 

"There's a fallacy out there that people are getting benefits and not working because they don't want to work. It shows a true lack of understanding of what people need," said Berkowitz, director of Appleseed Legal Justice Center. "All he's trying to do with this is put up one more barrier and kick people off Medicaid." 

The timing, amid the governor's campaign, shows he's "making politics more important than policy," she said. 

McMaster, who took office in January 2017 after Nikki Haley became U.S. ambassador, is seeking his first full term. He faces four GOP challengers in the June primary. A new ad promoting McMaster includes the proposed work rules for Medicaid patients.  

Many of the details are expected to be hashed out over the coming year. The state agency must hold public hearings and take public comment before it can even submit its proposal to the federal government. The rules likely couldn't be implemented until at least July 2019. 

They would include requiring "able-bodied adults" between the ages of 19 and 64 to work or volunteer for 80 hours a month, prove they're looking for work, go to school, or take a job-training course. The state would pay for some costs toward getting a GED, Baker said.

"A good, steady job makes everything better," McMaster said in January, when he directed the Cabinet agency to seek federal permission for work rules. "It creates a better home life, results in healthier lifestyles and provides financial independence and opportunity." 

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Follow Seanna Adcox on Twitter at @seannaadcox_pc.

Assistant Columbia bureau chief

Adcox returned to The Post and Courier in October 2017 after 12 years covering the Statehouse for The Associated Press. She previously covered education for The P&C. She has also worked for The AP in Albany, N.Y., and for The Herald in Rock Hill.