COLUMBIA, S.C. – Governor Henry McMaster today formally requested the U.S. Department of Health and Human Services (HHS) work with the South Carolina Department of Health and Human Services (SCDHHS) to reinstate the state’s Healthy Connections Community Engagement Initiative, also known as Medicaid Work Requirements. The initiative promotes healthier outcomes and incentivizes financial independence by adding community engagement requirements for qualifying Medicaid members that would include 80 hours of monthly work, job training, education, or community service. 

"Granting South Carolina the authorities necessary to reinstitute this initiative will strengthen the Medicaid program's dual missions of financing health services and improving opportunities for independence, self-reliance, and prosperity for the state's citizens," Governor McMaster wrote in the letter to Acting HHS Secretary Dorothy Fink.

The governor's letter added: "South Carolina pursued the Section 1115 waivers that made up its Healthy Connections Community Engagement Initiative to close the health care coverage gap created by the Patient Protection and Affordable Care Act (ACA) and incentivize employment among its citizens. Under the ACA, adults are eligible for subsidized health care coverage on the federal exchange when their earnings reach the federal poverty level. However, Medicaid coverage ends for many working parents at a threshold that is below the federal poverty level. This flawed structure created a health care coverage gap that disincentivizes many low-income families from earning additional income. This presents working families with an undesirable choice: earn additional income to support their family or lose their healthcare coverage."

In January 2018, Governor McMaster directed SCDHHS to seek federal waivers to establish work requirements for qualifying Medicaid recipients. South Carolina’s application was approved by the Trump Administration in December 2019 but it was paused during the COVID-19 pandemic to comply with federal requirements under the Families First Coronavirus Response Act. The Biden Administration then withdrew approval of the initiative in August 2021. 

The governor's request for reinstatement is centered around restoring the New Coverage for Parents and Community Engagementcomponents of the Palmetto Pathways to Independence section 1115 waiver that was approved by the Centers for Medicare and Medicaid Services in December 2019.