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Medicaid Work Rules Approved for South Carolina

Michael Rainey

The Trump administration on Thursday approved South Carolina’s request to impose work requirements on Medicaid recipients. Seema Verma, administrator of the Centers for Medicare & Medicaid Services, said the new rules “will lift South Carolinians out of poverty by encouraging as many as possible to participate in the booming Trump economy.”

South Carolina is the 10th state to receive permission to impose work requirements in its Medicaid program. The new rules will require beneficiaries to work, train or volunteer at least 80 hours per month in order to maintain eligibility. Those who fail to do so for three consecutive months will have their benefits suspended, though the benefits can be restored once the requirements are met. The plan also extends coverage to 14,000 state residents who are homeless or addicted to drugs, though they too will have to satisfy the work requirements.

Legal challenges: A federal judge has ruled against work requirements in Arkansas, Kentucky and New Hampshire, and several other states have suspended their requirements pending final resolution of the issue. The judge said that work requirements violate the purpose of Medicaid and will result in thousands of people losing health coverage.

Losses expected in South Carolina: Sue Berkowitz of the South Carolina Appleseed Legal Justice Center told the Greenville News that the work requirements will result in 14,000 people losing Medicaid coverage in the state over the next five years. The state’s estimate puts that number at 7,100.

Joan Alker of the Georgetown University Health Policy Institute said Thursday that the South Carolina plan will disproportionately affect African-American women who are single mothers living in rural areas.

Partisan ping-pong: There’s little agreement about the benefits of work requirements for Medicaid beneficiaries, and the differences are starkly partisan. Echoing Verma’s comments, the Republican governor of South Carolina, Henry McMaster, said they are designed to help the poor, both economically and spiritually. "There is no reason for anyone who can work not to be working, especially if that person is able-bodied and is receiving public assistance," McMaster said at a press conference Thursday. “Without meaningful work, life loses its joy and meaning."

Presidential candidate Joe Biden expressed the typical Democratic response to such efforts: “Simply put, Medicaid work requirements are nothing but a vicious attempt at stripping low-income South Carolinians of access to affordable health care," Biden said in a statement. "Donald Trump is working side-by-side with governors and state legislatures across the country to play politics with people’s health care."

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