South Carolina’s new Medicaid work requirement will force recipients to file a monthly report stating that they have been employed, searched for a job, attended training or classes, or volunteered.

The Trump administration approved South Carolina’s request to mandate a work requirement in order to qualify for Medicaid. The Dec. 12 decision will make the state the tenth to attempt imposing such conditions requiring Medicaid recipients to either work 80 hours per month, be a full-time student, or volunteer their time with charities. While South Carolina’s Medicaid work requirement received approval and would become the most restrictive state in the union, a court battle is likely to ensue over the issue as has become custom.

Established Pattern

Thus far, none of the Trump administration’s attempts to link Medicaid eligibility with work requirements have been upheld in federal court. In the nine states that introduced similar changes, only three of them implemented the new rules before Judge James E. Boasber of the Federal District Court for the District of Columbia ruled against them on the basis that federal officials had not fully considered the impact on Medicaid recipients.

Although Medicaid work requirements were struck down in Arkansas, Kentucky, and New Hampshire, appeals were immediately filed in each case with conservatives hoping to push the issue to the Supreme Court, much like the Republican Party is doing with abortion restrictions. If the highest court takes up the case, Republicans are hoping the two Trump-appointed judges will swing the court and rule definitively on the matter in their favor – hence, the reason why the Trump administration keeps approving a regulation that is continually struck down.

Previous states that have attempted to link Medicaid eligibility with work requirements did so by coupling it with an expansion of Medicaid eligibility through the Affordable Care Act (ACA). Under the ACA, which passed in 2010, states have the option to extend Medicaid eligibility for adults of all ages to 133 percent of the federal poverty level or below. South Carolina opted not to expand program eligibility through this method and instead chose to raise the income level requirement from 67 percent of the poverty line to 100 percent thereby allowing an estimated 32,000 more parents to qualify.

Unlike expanding Medicaid per the ACA provision, South Carolina will still limit Medicaid to only low-income families while excluding childless adults. However, even though more low-income parents will qualify, they will still be beholden to the work requirement barring several exceptions including medically frail or disabled persons and primary caregivers of children.

The state will also include 14,000 adults who are either chronically homeless, in need of substance abuse treatment, or in the criminal justice system. The decision to include the group will likely be of little benefit, however, as they too will be required to satisfy the work component.

Justification For Medicaid Work Requirement

South Carolina Governor Henry McMaster justified South Carolina’s Medicaid work requirement by citing economic benefits.

“South Carolina’s economy is booming, wages are up, and our unemployment rate is at an all-time low at 2.6%,” said McMaster. “Competition for workers is fierce, and businesses are struggling to fill vacancies. In this economy, there is no excuse for the able-bodied not to be working.”

Under the new requirement, Medicaid recipients will have to file a monthly report with the state that they have been employed, searched for a job, attended training or classes, or volunteered. Seema Verma, administrator of the Centers for Medicare and Medicaid, traveled to South Carolina to stand alongside McMaster while announcing the change. She argued the prerequisites will not be a burden but instead will help improve people’s lives and allow them to “rise out of poverty and government dependence.”

“South Carolina’s requirements – complete with appropriate protections – will lift South Carolinians out of poverty by encouraging as many as possible to participate in the booming Trump economy,” Verma wrote in a Dec. 12 statement for the governor’s office.

Criticism of Medicaid Work Requirements

The reality is that data from Arkansas’ attempt at curtailing Medicaid eligibility resulted in more people being kicked from the program due to the complexity of reporting requirements than from general ineligibility. A coalition of groups including the American Academy of Pediatrics, the Georgetown University Center for Children and Families, the March of Dimes, and the Children’s Defense Fund criticized the cumbersome bureaucracy of monthly reporting stipulations.

“Medicaid work reporting requirements just don’t work,” they wrote in a Dec. 12 condemnation of the work requirement. “The requirements are burdensome for individuals, do not lead to increases in employment, and instead cause people to lose their health insurance coverage. We are disheartened and alarmed that the administration has once again approved a policy that has been proven to lead to fewer people getting the care they need.”

In Arkansas, less than 1 percent of Medicaid recipients charged with meeting work requirements actually became gainfully employed while 25 percent lost their Medicaid coverage according to Joan Alker, executive director of the Georgetown Center for Children and Families.

Despite data like Arkansas’ experience with Medicaid work requirements showing such requirements do not work and harm families, South Carolina and the Trump administration are set on going forward and the state will not be the last to try the measure. There are currently applications for eight more states to impose similar work requirements pending approval as the court cases continue to pile up, which may be part of the GOP plan to force the Supreme Court to establish a federal precedent for the issue.