South Carolina is set to become the first state to apply a Medicaid work requirement to the parents of minor children with incomes under 100% of the federal poverty level. Other states are also considering similar legislation.

The potential impact for Head Start programs may be two-fold. One: there may be an impact on the families possibly available to volunteer within the program. And, two: under the Head Start Program Performance Standards 1302.46 (b)(2)(i) A program must provide ongoing support to assist parents’ navigation through health systems to meet the general health and specifically identified needs of the children and must assist parents in understanding how to access health insurance for themselves and their families, including information about private and public health insurance and designated enrollment periods. This means that in states where work requirements are enacted on Medicaid, Head Start staff need to understand and explain these requirements to parents of Head Start children impacted by this change.

In South Carolina, the Healthy Connections Community Engagement Initiative for Medicaid Beneficiaries requires beneficiaries to fulfill 80 hours of community engagement activities per month through employment or other community engagement activities.  At the official announcement as reported in the Charleston (SC) Post and Courier on December 12, 2019, Medicaid spokeswoman Colleen Mullis estimated that 20,000 adults in South Carolina will need to complete qualifying activities under the new rules.  The state will grant exceptions to certain people, including primary caregiver of a child, up to age 18, and/or a disabled adult, and individuals identified as medically frail.

Head Start parents (and potentially their children) in South Carolina may lose Medicaid coverage if they do not make sure their compliance is confirmed with the state’s records. In order to be compliant with Head Start regulations, Head Start staff members need to understand the new program’s rules and know how to help Head Start families navigate the process of confirming compliance or exemption status, and reporting employment or other community engagement activities. Examples of other community engagement activities include participating in adult GED programs, pursuing a degree at a higher education institution, or being in compliance with the work requirements of Supplemental Nutrition Assistance Program (SNAP).

As reported in the Washington Post, the work rules will be imposed on two groups of low-income people who previously did not qualify before under South Carolina’s stringent eligibility rules. One of those groups are parents or other caretakers with incomes slightly higher than the state’s threshold of 67 percent of the federal poverty level.

Joan Alker, executive director of the Georgetown Center for Children and Families, has extensively studied Medicaid work requirements, and in a December 13th interview with National Public Radio, says the state’s new work requirements will disproportionately impact African Americans, women, and people who live in rural areas.

Research has also shown that when people lost coverage, it wasn't because they were not working or trying to skirt the requirements.

"We now have good data indicating that tens of thousands of people were kicked off of Medicaid, not because they were ineligible under the work requirement program, but because they had trouble actually following through on the reporting requirements — dealing with websites, trying to figure out how to report hours effectively, and all the rest," Nicholas Bagley, a law professor at the University of Michigan, told NPR in October.

The complete South Carolina Healthy Connections Works document can be found here. Find South Carolina Healthy Connections Medicaid on the web here.

_________________________

J. Christopher Watkins, Executive Director
Training & Technical Assistance Services (T/TAS)
Western Kentucky University

800.882.7482
www.ttas.org
ttas.info@wku.edu
Advancing knowledge within early learning communities

Connect with T/TAS on Facebook and Twitter