Hundreds of thousands of South Carolinians may lose access to Medicaid coverage over the next year, according to state insurance professionals.
“Out of the 1.2 million people who are covered by Medicaid right now [in South Carolina], more than 600,000 people’s coverage is going to be in jeopardy over the next 12 months,” said Shelli Quenga of Summerville, chief innovation officer for statewide social service nonprofit the Palmetto Project that helps residents navigate the insurance marketplace.
The United States government extended the ability to retain Medicaid without renewing in the traditional time period during the Covid-19 pandemic public emergency, which ended May 11. Now, those who benefited from extended coverage, such as pregnant women and young people, may lose their Medicaid coverage permanently or temporarily.
“There’s about 300,000 people that are going to lose coverage because they’re no longer eligible for Medicaid — primarily people over the age of 19 and women who have been pregnant sometime during the pandemic and now exceed the 12-month postpartum coverage,” Quenga told the Charleston City Paper.
An additional 300,000 or more are expected to lose coverage temporarily due to failure to return a renewal form, failure to receive the form or submission of inaccurate information, she said.
South Carolina is one of the 10 states that did not extend Medicaid qualifications under the Affordable Care Act in 2022, said former S.C. Sen. Joel Lourie of Columbia, president and CEO of Lourie Life & Health, which recruits and trains insurance agents, agencies and other groups throughout the Southeast, including the Palmetto Project.
“The states that did not expand Medicaid are going to get impacted worse than those that did,” Lourie told the City Paper.
The largest groups in the Medicaid population of South Carolina are children from lower income families, seniors and women who have lower incomes or are pregnant, Lourie said.
“We’re now going back to pre-pandemic Medicaid requirements,” he said.
Lourie served in the legislature as a Democrat for 18 years, and he said one of his last attempts at passing legislation was to expand Medicaid eligibility.
“We just don’t have the votes to do it,” he said. “The governor could do this with a swipe of a pen, but we don’t have a governor who wants to do that nor the majority of the legislature that wants to do that.”
The state is currently carrying out the first round of redeterminations, Lourie said, and people could lose Medicaid coverage as early as June 1.
Band-Aid health care
“Palmetto Project believes strongly in [health care] access — for every South Carolinian to be [insured and] able to walk in the front door of a hospital,” Quenga said. “Right now, everybody in South Carolina has the ability to access health care through the emergency room. And that’s just a Band-Aid.”
Since 2010, the Palmetto Project has helped about 10,000 people secure Medicaid coverage, Quenga said. She illustrated how South Carolina’s refusal to participate in the 2022 federal Medicaid expansion affected people negatively. Quenga recently was unable to transfer an Ohio woman’s Medicaid status to South Carolina, instead recommending a patchwork of resources such as free clinics, community health centers and prescription assistance programs.
“It’s almost a full-time job to manage all of these different pieces in order to put together some kind of [health care] access,” she said.
A lot of U.S. colleges stopped offering students coverage in 2013 when the Affordable Care Act enrollment allowed young people to remain on their parent’s coverage until turning 26 years of age, she said. Some students who are transitioning off Medicaid will not have these options if they can’t join their parents’ plans or because they are not working or not earning enough to meet the income requirements.
“If their parents had coverage, they’d be able to stay on it until they’re 26, but not everybody’s parents are offered coverage from their employer — especially in a poor state like South Carolina [with an] economy [that] runs on tourism. If a parent works at a hotel or a restaurant or as a tour operator, that business is seasonal and they can’t get insurance that way.”
Within the Medicaid system, there are coverage gaps that affect low income individuals and families, Quenga said. Although it’s only a small percentage of people, those who are in the Medicaid coverage gap are individuals who earn too much to qualify for Medicaid but work below the hours required by the Affordable Care Act. There is also no Medicaid coverage for generally healthy, childless adults with no or low income.
“The word ‘gap’ sounds kind of innocuous,” Quenga said. “But really, this is like a chasm. This is a place where people go to die.”
Lourie added, “Everyone knows somebody who’s going to be affected by this,” so he emphasized how important it is for the public to be aware of rollbacks.
“Our health care system operates better and more efficiently, both from a service and a cost standpoint, when more people have coverage,” he said. “This is not only an issue that affects the people who are losing coverage — it affects our state as a whole.”
Lourie said his agency can help individuals and families navigate Medicaid changes as well as the health insurance marketplace, including spreading awareness that renewal paperwork is required to be submitted this year. For more information, visit lourielifeandhealth.com or palmettoproject.org.
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