The Palmetto Pathways to Independence waiver seeks to provide a health care coverage pathway for families whose income is currently too high to qualify for full-benefit South Carolina Healthy Connections Medicaid coverage but too low to qualify for federal subsidies in the federal marketplace.
The demonstration seeks to build a state-specific solution to eliminate the financial disincentives for employment that currently exist due to the all or nothing approach to Medicaid expansion as authorized under the Patient Protection and Affordable Care Act (ACA). Individuals eligible for the demonstration will be required to participate in 80 hours per month of community engagement activities to gain and maintain Medicaid coverage through the demonstration.
Specifically, the Palmetto Pathways to Independence waiver program will establish a new eligibility pathway for adults aged 19-64 who otherwise meet eligibility criteria under the parent caretaker relative (PCR) coverage group and have an income that is at or above 67% and below 95% FPL with a 5% disregard, effectively including individuals with income between 67%-100% FPL.
South Carolina's goals for the demonstration are to incentivize employment and close the health care coverage gap created by ACA. The demonstration will support strategies to:
- Remove health-related barriers to employment;
- Promote member transition to commercial health insurance; and
- Support the long-term, fiscal sustainability of the Healthy Connections Medicaid program.
In accordance with federal regulation (42 CFR § 431.408), the South Carolina Department of Health and Human Services (SCDHHS) will provide the public and other interested parties with the opportunity to review and provide input on the waiver through a formal, 30-day public notice and comment process which will run from April 30, 2025, to May 31, 2025. The draft of the Palmetto Pathways to Independence waiver can be found below.
The state will also hold two public hearings for interested parties to learn more about the waiver renewal application, ask questions, and provide public comments. The public hearings will be held at the following dates, times, and locations. Individuals with disabilities who require special accommodation in order to attend these public meetings, should contact Kira Ramseur at (803) 898-4134 or email at CEWaiver@scdhhs.gov to ensure that any necessary accommodation can be provided.
| Public Hearing #1 (In Person and Virtual) | Public hearing #2 (Medicaid Advisory Committee Meeting - Virtual) |
|---|---|
May 6, 2025, 9:30 a.m. South Carolina Department of Health and Human Services 1801 Main Street, Multipurpose Room A/B Columbia, SC 29201 | May 13, 2025, 10 a.m. |
Palmetto pathways to independence Waiver
April 30, 2025 – South Carolina Department of Health and Human Services Palmetto Pathways to Independence Demonstration Waiver Public Notice
April 29, 2025 – Palmetto Pathways to Independence proposed waiver application
January 21, 2025 – Governor McMaster's letter requesting the U.S. Department of Health and Human Services expedite approval of SCDHHS' waiver