Up to 300K people could lose Medicaid coverage when SC reviews eligibility

COLUMBIA, S.C. (WCSC) - South Carolina will soon begin reviewing who is eligible for Medicaid for the first time in three years, and the state agency that oversees the program says up to around 300,000 people could lose their coverage in the next year.

Before the pandemic, the South Carolina Department of Health and Human Services reviewed Medicaid eligibility annually to determine who still qualifies.

For the last three years, people could be added to Medicaid but generally not removed — unless they asked to be removed, moved out of state, or died — because of the federal COVID public health emergency.

But that is coming to an end, and starting April 1, states can resume disenrolling people again.

“For our Medicaid members who have been enrolled in Medicaid for a while, this is going back to the process that existed in 2019 and before. We have a lot of members who have joined Medicaid and been enrolled in Medicaid for the first time during that period, so that’ll be a bit of a new process,” South Carolina Department of Health and Human Services Communications Director Jeff Leieritz said.

The Department of Health and Human Services will take a full year to carry that process out, from April 2023 to March 2024, following the guidance of its stakeholders and the federal government.

It estimates Medicaid enrollment will drop from about 1.3 million South Carolinians to just over a million, where it was before the pandemic.

“There shouldn’t be many who are currently under 19 [years old] who are losing coverage,” Leieritz said. “Nothing about our enrollment process or application process or eligibility process for those individuals has changed.”

A lot of the South Carolinians who will be disenrolled are those who previously qualified as children because their family’s income was below a certain level, according to DHHS.

Now they are adults and have aged out of that coverage eligibility but have remained on Medicaid the last three years because federal law prohibited removing them.

Starting April 1, the department of health and human services will mail out review forms to everyone currently on Medicaid in South Carolina.

Because the state is doing this in batches instead of all at once, some people will receive their forms in early April while others could get it as late as just over a year from now, or any time in between.

They have 60 days after the form is mailed to fill it out and return it.

“If somebody receives the annual review form and does not return it within 60 days, they’ll likely lose their coverage,” Leieritz said, adding people who miss the deadline should contact DHHS and return the completed form out late, as they may still be able to be retroactively enrolled if they are eligible.

If the department of health and human services is able to determine on its own that someone is still eligible for Medicaid, those people will receive a continuation of benefits notice in the mail, so they will not need to fill out the review form.

While DHHS does not expect many children to lose coverage, unless their family’s eligibility changed, the potential for kids to be dropped because a parent or guardian failed to return the review form is what concerns Healthy Learners.

The Columbia-based nonprofit works in more than a dozen counties across South Carolina, in the Upstate, Midlands, Pee Dee, and Lowcountry.

Last year, it provided more than 2,000 children from low-income households with healthcare, including dental, vision, and mental health.

“Our fear is that we take a child to an appointment, think they’re on Medicaid, and come to find out that maybe they have been disenrolled or might no longer be eligible, or probably more typically, they just haven’t done the paperwork to make sure they have continuous coverage,” Healthy Learners Executive Director Amy Splittgerber said.

Most of the children they serve are on Medicaid, so if they lose coverage, it could affect how much care Healthy Learners is able to provide other kids who aren’t Medicaid-eligible but are uninsured.

“We will probably do some mass mailings to all of our families to make sure that they have filled out the paperwork, that they have that continuation of coverage so that they can get the care they need and we can minimize our costs of out-of-pocket medical fees,” Splittgerber said.

People can visit the DHHS “Annual Review” webpage to find sample review forms and fact sheets in both English and Spanish.

They can also update their contact information by clicking here, to add phone numbers and email addresses to receive notifications when their review form has been sent.

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