SC Medicaid is at grave risk, say experts

SC Medicaid is at a grave risk, say advocates

Linda Cale advises families on long-term care options for their aging loved ones.

She is worried that cuts to Medicaid resulting from President Donald Trump’s budget legislation will make her job more difficult and leave South Carolina’s low-income seniors in a bind.

Here’s why: There is a growing number of seniors needing assisted living support, and the availability of beds for those on Medicaid is scarce, according to Cale.

That’s in part because reimbursement rates, or the amount of money care facilities receive per resident, are low for those on Medicaid.

If cuts to the program result in even skimpier reimbursement rates, it could mean that fewer care facilities will be willing to serve those on Medicaid.

“It’s only going to make an already challenging situation in South Carolina more challenging,” said Cale, whose Greenville-based company, Senior Care Authority, works with families across the Upstate.

South Carolina will be hit hard, says hospital association

Meanwhile, health policy advocates predict that the legislation – the “Big Beautiful Bill,” as Trump has dubbed it – will result in cuts to services and access to care throughout South Carolina, particularly in rural communities.

Medicaid is a federally funded program that provides coverage for low-income people and those with disabilities.

Supporters of Trump's legislation celebrate its promised tax cuts and increased spending to deport illegal immigrants.

USA Today reports that the bill will divert $1 trillion from Medicaid, leading the nonpartisan Congressional Budget Office to project a loss of insurance coverage for 11.8 million Americans over the next 10 years.

When the cuts are fully phased in, South Carolina hospitals will lose approximately $2.4 billion annually, according to Schipp Ames, Vice President for Strategic Marketing and Communications at the South Carolina Hospital Association.

“The likely result is layoffs, service reductions, and, in the worst-case scenario, closures,” Ames said in an email.

The South Carolina Hospital Association is a nonprofit organization that represents about 100 hospitals and healthcare systems in the state.

Spartanburg Regional Healthcare System is a member of its organization.

A spokesperson with SRHS declined to comment on the potential impact of Medicaid cuts, but said in an email, “Like organizations across the country, Spartanburg Regional Healthcare System monitors how state and federal legislation might impact patients.”

An attempt to contact Prisma Health was unsuccessful, and a representative with Bon Secours declined to comment.

According to the SC Hospital Association, Medicaid is an essential piece of the healthcare puzzle in South Carolina:

• More than one million South Carolinians rely on Medicaid.

• Sixty percent of children in the state have Medicaid coverage.

• Medicaid provides coverage for more than half of all nursing home residents.

• Fifty percent of Medicaid spending in South Carolina supports elderly and disabled residents.

GOP lawmakers say don't worry, rooting out waste will 'strengthen the program'

These numbers didn’t deter Republican lawmakers from South Carolina, where Trump won nearly 60 percent of the vote in the 2024 presidential election.

Supporters of Trump’s legislation have argued that those in need of Medicaid won’t be affected by the cuts – in fact, Rep. William Timmons (R-4th District) claims that they will benefit.

In an email, Timmons’ communications director, Liz Willis, said:

“Congressman Timmons recognizes how critical Medicaid is to families across South Carolina — especially children, seniors, and people with disabilities. That is exactly why he voted to strengthen the program through the One Big Beautiful Bill.”

Timmons and other Republicans have argued that savings will be found by targeting waste and taking coverage away from those who shouldn’t be in the program in the first place, not patients who are genuinely in need.  

“The only people that will potentially lose their health benefits are able-bodied adults with no dependents that choose to not work or volunteer 20 hours a week,” Willis said. “It’s simple, if you are able to contribute and choose not to, the American taxpayers are done giving you a free ride.”

In a news release, Sen. Lindsey Graham took a similar line: “(The bill) eliminates waste, fraud, and abuse – and requires able-bodied Medicaid recipients to work.”

Willis also touted the bill’s creation of the Rural Health Transformation Program – a $50 billion fund to support rural hospitals and clinics.

Claims of waste are overblown, say rural health analysts

All this may help to lessen the blow to care providers and low-income patients – but not by much – said Kevin Bennett, who serves as Director of the Center for Rural and Primary Healthcare at the University of South Carolina School of Medicine.

“It’s going to be messy for a lot of folks,” Bennett predicted.

In addition to Medicaid cuts, he noted that Trump’s legislation also reduces subsidies for plans under the Affordable Care Act. This is likely to mean even more South Carolinians will eventually go without coverage, he said.

Bennett thinks the SC Hospital Association’s projections about revenue loss among the state’s providers may be a little high – it’s too soon to know the full impact of the bill. But it will far outweigh the share South Carolina is likely to receive from the $50 billion allocated by Congress, he said.

Meanwhile, Bennett disputed the claim that rampant Medicaid abuse is a significant factor in the program’s overall cost.

“It’s really not,” he said.

“Most estimates are that about half a percent to three percent" of Medicaid recipients shouldn’t be in the program," he said.

“That’s more than you want, but you’ll spend more than you save trying to get them off the rolls.”

Work requirements might weed out recipients who are undeserving – or at least motivate them to look for a job – but Clemson professor Amanda Stover says it isn’t always that simple.

Some face barriers, such as a lack of transportation, especially in rural areas. Others may spend their days caring for aging family members or others with chronic needs, said Stover, who teaches courses and conducts research on rural healthcare.

“To make a general statement that they’re lazy or taking advantage of the system – I don’t think that is an accurate assessment,” she said.

Overall, Bennett believes the outlook for many is grim: “I think you’re going to see a lot of stories about single moms getting kicked off the rolls, kids kicked off the rolls.”

Rural hospitals may close or cut services, affecting entire communities

If the financial cuts are as deep as Bennett predicts, he believes the impact will be felt throughout entire communities.

He explained that for most rural hospitals, “margins are razor thin. Some have negative margins but are kept afloat by county government or philanthropic contributions. But if you take insurance away from even five percent of their patients, then they’re not going to be able to sustain that for long.”

To save money, hospital administrators might reduce the operating hours of emergency rooms.

“Maternity care is one that goes away quickly” when healthcare systems face a financial crunch, Bennett added.

Losing access to these or other programs would affect all residents, not just the uninsured.

Stover worries that if people in poor communities lose coverage, they’ll skip preventative and primary care. “And then you can see greater spread of infectious disease, affecting other populations,” she said.

Broader implications: 'Hospitals are huge economic engines'

There are broader economic implications as well when hospitals are forced to close or significantly reduce services, Bennett said.

“Hospitals are huge economic engines,” he said. “In most rural counties, that’s their largest employer. If they close or cut back, then doctors don’t move there, and other people might lose their jobs.”

Bennett said the Affordable Care Act (ACA) helped stabilize rural hospitals in South Carolina as more patients enrolled in the government’s health insurance marketplace.

“We had been trending upward,” he said. “But I think we’re going to go backward.”

For the elderly, 'need is only going to grow'

As Cale considers the possible impact of Medicaid cuts on her clientele, she said the loss of government funds for assisted living programs “would affect everyone” – residents in rural and more urban communities alike.

Cale pointed to a statistic that weighs on her mind: 10,000 people in America turn 65 each day.

“The need is only going to grow,” she said.