SCDHHS Submits 1115 Community Engagement Waiver

The South Carolina Department of Health and Human Services (SCDHHS) has submitted an application for a Medicaid Section 1115 Demonstration Waiver to implement the following changes to Medicaid in South Carolina:

  • Identify individuals eligible for community engagement activities and assist them with accessing necessary employment and community engagement support programs.
  • Seek a state-specific solution to mitigate financial disincentives for employment created by the ACA Medicaid expansion.
  • Modernize eligibility thresholds for children participating in Medicaid and CHIP.
  • Combat the ongoing opioid crisis by providing medically necessary addiction treatment services to the state’s lowest-income individuals, including creating a pathway to treatment and employment for the justice-involved population.
  • Improve customer service and reduce artificial administrative barriers to benefit coordination among social service agencies by updating legacy information systems and improving data sharing between Medicaid and other programs such as the Supplemental Nutrition Assistance Program (SNAP), Temporary Assistance for Needy Families (TANF), Unemployment Insurance (UI), and other programs.

The community engagement portion of the waiver applies to beneficiaries who are enrolled in Medicaid in the Parent Caretaker Relative (PCR) and Transitional Medicaid Assistance (TMA) groups. Once approved, PCR and TMA individuals will be required to participate in community activities to maintain an active Medicaid enrollment status. Requirements will be similar to TANF and SNAP benefits. For those individuals required to participate in a community engagement program, the state intends to align with work-search, education and training programs available through publicly-funded programs. Examples of compliant activities include:

  • Participation in an adult secondary education program through a public-school district or technical college.
  • Full-time participation in a degree or certificate- seeking program in an accredited institution of higher education.
  • Compliance with unemployment insurance (UI) work-search requirements (first 16 weeks of UI benefits)
  • For dual Medicaid-SNAP/TANF beneficiaries, demonstrated compliance with SNAP community engagement standards.
  • Full-time employment or part-time employment for not less than 80 hours per month
  • Community or public service.

Community engagement requirements will not be applicable to the following:

  • Children enrolled in Medicaid or the Children’s Health Insurance Program (CHIP);
  • Pregnant women;
  • Disabled individuals, including individuals who have a medical condition that would prevent them from participation in this project;
  • Individuals over the age of 65;
  • Individuals receiving Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI)
  • Individuals who are the primary caregiver of a child or someone who is disabled;
  • Individuals participating in a Medicaid covered treatment program for alcohol or substance abuse addiction, including opioid addiction;
  • Individuals receiving treatment through Medicaid’s Breast and Cervical Cancer Program;
  • Individuals compliant with or exempt from the SNAP/TANF requirements related to employment; and
  • Individuals who are determined by SCDHHS to be exempt on a case specific basis.

The demonstration waiver will not change the current health care delivery system, benefit coverage or cost sharing for individuals participating in the waiver from those provided under the current Medicaid State Plan. If approved, the 5-year waiver would be implemented by July 1, 2020. The federal comment period will be open from June 10 through July 10, 2019.

Filing Memo to Issuers for Network Adequacy Standards

Click here to view the memo.