South Carolina is the latest state to seek permission to implement work requirements in its Medicaid program.
Gov. Henry McMaster submitted a Section 1115 waiver to the Centers for Medicare & Medicaid Services (CMS) in May, and the agency opened a comment period on the application Monday. CMS will accept comments through July 10.
Under South Carolina’s proposal, some adults enrolled in full Medicaid benefits would be required to work 80 hours per month to remain eligible for coverage. Pregnant women, people with disabilities, those with children or those receiving substance abuse treatment through Medicaid are among the exemptions, according to the waiver request.
“Foundational to this demonstration is the hypothesis that employment leads to the economic and social mobility necessary to attain independence, while recognizing that, first and foremost, a person who is penalized for finding work by losing their health coverage may choose to remain unemployed," South Carolina health officials wrote in the request.
If Medicaid enrollees fail to prove they are exempt from the requirements or are not reporting their work status for more than three months, their benefits will be revoked, according to the request.
Should CMS approve the waiver, South Carolina is planning to roll out a five-year demonstration as soon as July 2020.
CMS first rolled out guidance on using Section 1115 waivers for Medicaid work requirements in January 2018, and since then several states have requested and been approved to implement them. Several others, like South Carolina, are awaiting a response from the feds.
Though a number of states have sought to test work requirements, they have been controversial and have faced significant legal challenges. In March, a federal judge struck down work requirements in Kentucky and Arkansas, arguing that CMS had failed to fully weigh the impact of such programs on coverage before approving them.
Other legal challenges, such as one in New Hampshire, are pending. CMS has argued that the waivers promote employment, which in turn promotes health. But the judge said that the goal of Medicaid is to offer health coverage, so approving work requirements skirts that goal.
Despite the legal battles, experts said that states actively seeking work requirements are likely to stay the course and charge ahead with such programs.