B. Medicaid Coverage Groups in South Carolina

• Library: A Practical Guide to Elder and Special Needs Law in South Carolina (SCBar) (2021 Ed.)

B. MEDICAID COVERAGE GROUPS IN SOUTH CAROLINA

In South Carolina Medicaid is not a single program. Instead, depending upon what definition you use for "program," South Carolina has as many as 18 separate programs or coverage groups. Different rules apply to the different coverage groups. The MPPM divides the groups into two categories: Modified Adjusted Gross Income (MAGI) Related Programs and Supplemental Security Income (SSI) Related Programs-Strict and Liberalized. MAGI is a methodology defined in the Patient Protection and Affordable Care Act (ACA), which simplifies the counting of income by eliminating income disregards. See MPPM, Chapter 201, available at http://www1.scdhhs.gov/mppm/ (last viewed Oct. 23, 2020). The MAGI programs do not include an asset test or resource limit for eligibility for these groups. Effective January 1, 2014, the ACA imposed the MAGI methodology for families, pregnant women, and children.

While the ACA permitted states to expand Medicaid to healthy adults without children, the U.S. Supreme Court decision of National Federation of Independent Businesses v. Sebelius made the additional coverage optional for the states. 567 U.S. 519 (2012) (In a plurality opinion: "As for the Medicaid expansion, that portion of the Affordable Care Act violates the Constitution by threatening existing Medicaid funding. Congress has no authority to order the States to regulate according to its instructions. Congress may offer the States grants and require the States to comply with accompanying conditions, but the States must have a genuine choice whether to accept the offer. The States are given no such choice in this case: They must either accept a basic change in the nature of Medicaid, or risk losing all Medicaid funding. The remedy for that constitutional violation is to preclude the Federal Government from imposing such a sanction. That remedy does not require striking down other portions of the Affordable Care Act."). While South Carolina has frequently expanded Medicaid to cover groups in addition to those mandated by the original Medicaid plan, South Carolina has not expanded Medicaid to add the additional coverage groups allowed under the ACA.⁶

MAGI Groups are as follows:

• Pregnant Women and Infants (PW) - For coverage, women must be pregnant and have income less than 194% of the Federal Poverty Level (FPL).⁷ The benefit is all Medicaid covered services during the pregnancy and a 60-day postpartum period. MPPM, Chapter 204.02, available at http://www1.scdhhs.gov/mppm/ (last viewed Oct. 23, 2020).
• Parent/Caretaker Relative, formerly known as Low Income Families (LIF) - This program provides basic health care coverage for low income parents and caregivers of at least one child under age 19. Currently, income must be below 62% of the FPL. MPPM, Chapter 204.04, available at http://www1.scdhhs.gov/mppm/ (last viewed Oct. 23, 2020).
• Healthy Connections Family Planning - Family planning services are available to individuals (men and women) whose family income is at or below 194% of the FPL. This program only provides family planning services and does not provide other health care services. MPPM, Chapter 204.05, available at http://www1.scdhhs.gov/mppm/ (last viewed Oct. 23, 2020).
• Children, also known as Partners for Healthy Children - Children, up to age 19, who live in households with income at or below 208% of the FPL may qualify for this comprehensive health program. Children are eligible to receive all medically necessary Medicaid services, whether covered under the State Plan or not. MPPM, Chapter 204.03, available at http://www1.scdhhs.gov/mppm/ (last viewed Oct. 23, 2020). For more information on children's Medicaid and children's right to medically necessary services review the EPSDT section later in this Chapter.
• Regular Foster Care - Full Medicaid coverage is available for foster children with income at or below 62% of the FPL. For purposes of this category, only the child's income is counted and not the household income. MPPM, Chapter 204.06, available at http://www1.scdhhs.gov/mppm/ (last viewed Oct. 23, 2020).
• Subsidized Adoption - Full Medicaid coverage is available for adopted children, if the adoption was subsidized and if the child's income is at or below 62% of the FPL. MPPM, Chapter 204.08, available at http://www1.scdhhs.gov/mppm/ (last viewed Oct. 23, 2020).
• Former Foster Care up to Age 26 - This is the only category

...