Medicaid expansion by the back door

By Ashley Landess and Robert Ariail

Many South Carolinians are starting to realize that, despite the promises of our governor and many legislative leaders to the contrary, Obamacare is already being implemented in our state. It isn’t happening because of one vote on one law to comply, but rather through the quiet taking of federal dollars attached to Affordable Care Act (ACA) programs.

Medicaid is, for all practical purposes, already being expanded under provisions of the ACA even though the state hasn’t officially opted in to the ACA Medicaid expansion. Programs such as “express lane” eligibility would automatically enroll children who meet certain criteria, and hospitals would be allowed to enroll a patient in Medicaid through “presumptive eligibility,” which permits hospital personnel trained by the S.C. Department of Health and Human Services (SCDHHS) to apply a simplified set of requirements to declare a patient Medicaid-eligible. In addition, SCDHHS is changing our state’s Medicaid formula to broaden eligibility by altering income requirements through a methodology contained in the ACA.

So Medicaid expands, and likely will continue to expand until the lines blur so much that South Carolina finds itself complying with the Medicaid expansion terms.