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CMS Approves Medicaid Work Requirements in S.C.

The Centers for Medicare & Medicaid Services (CMS) approved South Carolina’s Section 1115 demonstration waiver, which makes work requirements a condition of eligibility for certain Medicaid beneficiaries in the state. The waiver runs through Nov. 30, 2024.

South Carolina did not expand Medicaid under the Affordable Care Act (ACA). However, through this waiver, the state raises the eligibility threshold for parents and other caregivers from 62 percent to 100 percent of the federal poverty level (FPL). This newly eligible population must complete and report work or other community engagement activities for a minimum of 80 hours per month to qualify for Medicaid coverage.

Several other states have received approval to implement work requirements, but South Carolina is the first to apply the requirements primarily to parents and caregivers. Certain groups are excluded from the requirements, including:

  • individuals receiving supplemental security income;
  • individuals in institutional placements;
  • primary caregivers of a child up to age 18 or an adult with a disability;
  • medically frail individuals;
  • members of recognized tribes;
  • individuals diagnosed with acute medical conditions that prevent compliance;
  • individuals exempted from similar requirements in the Supplemental Nutrition Assistance Program or Temporary Assistance for Needy Families; and
  • individuals up to one year postpartum.

Courts have struck down waivers with work requirements in Arkansas, Kentucky, and New Hampshire. Appeals in these cases, as well as legal challenges of other states’ waivers, are pending.

Contact Senior Director of Policy Erin O’Malley at or 202.585.0127 with questions.


About the Author

Rachel Schwartz is a former policy associate at America's Essential Hospitals.

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