South Carolina H 3109: Medicaid Expansion

Bill Text

2025-2026 Bill 3109 Text of Previous Version (Dec. 06, 2024) - South Carolina Legislature Online 

South Carolina General Assembly
126th Session, 2025-2026

Bill 3109

Indicates Matter Stricken
Indicates New Matter

(Text matches printed bills. Document has been reformatted to meet World Wide Web specifications.)

A bill

TO AMEND THE SOUTH CAROLINA CODE OF LAWS BY ADDING SECTION 
44-6-120 SO AS TO PROVIDE THAT BEGINNING JANUARY 1, 2026, AN ADULT SIXTY-FIVE 
YEARS OF AGE OR YOUNGER WHOSE INCOME IS AT OR BELOW ONE HUNDRED THIRTY-THREE 
PERCENT OF THE FEDERAL POVERTY LEVEL, WITH A FIVE PERCENT INCOME DISREGARD, IS 
ELIGIBLE FOR MEDICAID AS PROVIDED FOR IN THE PATIENT PROTECTION AND AFFORABLE 
CARE ACT, AND AMENDMENTS TO THAT ACT.

Whereas, in March 2010, 
Congress enacted the Patient Protection and Affordable Care Act (ACA), the 
constitutionality of which was upheld by the United States Supreme Court in 
June of 2012, with the exception of certain aspects of Medicaid Expansion; and

Whereas, the Court 
found unconstitutional the ACA withholding all of a state's existing federal 
Medicaid funding if the state does not expand Medicaid eligibility to 
individuals sixty-five years of age or younger whose income is at or below one 
hundred thirty-three percent of the federal poverty level, with a five percent 
income disregard; and

Whereas, while the 
Court struck down the Medicaid expansion penalty, it maintained the expansion 
and gave states the option of participating in the expansion as provided for in 
the ACA; and

Whereas, to fund this 
expansion, the ACA required the federal government to fund one hundred percent 
of a state's Medicaid costs for newly eligible beneficiaries through 2016, and 
would gradually decrease the federal match to ninety percent, with a ten 
percent state match, in 2020 and thereafter; and

Whereas, based on an 
April 2012 independent Medicaid expansion study prepared for the South Carolina 
Department of Health and Human Services, approximately 333,000 uninsured and 
underinsured South Carolinians would have become newly eligible for Medicaid under 
the expansion, increasing to roughly 354,000 by 2020, resulting in an $11.2 
billion net increase in federal funding to the State between 2014 and 2020; and

Whereas, the study 
found further that these increased federal funds would not exist but for 
Medicaid expansion and would lead to a net gain of nearly 44,000 jobs over 
these seven years, which, due to the multiplier effect, would result in $1.5 
million in labor income by 2020; and

Whereas, even though 
South Carolina has not yet chosen to participate in Medicaid expansion, the 
State has the authority to do so at any time and, in making this decision, 
should consider the economic impact of enhanced federal funds coming into the 
State, the cost to the State to implement the expansion, the impact on 
uncompensated health care costs, and the impact on uninsured South Carolinians, 
whom the expansion was designed to reach; and

Whereas, the rise of 
income levels that would occur under Medicaid expansion would translate into 
additional spending both from individuals and households, creating substantial 
increases in tax revenue statewide. These increases in tax revenue would offset 
much, if not all, of the State match requirements and administrative costs 
associated with Medicaid expansion; and

Whereas, regardless of 
whether the State chooses to participate in Medicaid expansion, under the ACA 
there has been and will continue to be a reduction in federal disproportionate 
share payments to hospitals serving larger numbers of Medicaid and uninsured 
low-income patients, placing a much greater financial burden on these 
hospitals, the State, and ultimately all health care consumers by increased 
insurance premiums and health care costs; and

Whereas, not only does 
opting into Medicaid expansion significantly impact and improve the State's 
economic welfare, with a return far greater than could be achieved with our 
existing Medicaid state match, but exercising this option also is a moral 
imperative; and

Whereas, to do other 
than participate in Medicaid expansion denigrates the worth of hundreds of 
thousands of uninsured South Carolinians by denying them the opportunity to 
improve their individual health, and accordingly the health of the State, to 
improve their quality of life, to improve their chances of entering, 
maintaining, and advancing in the workforce, and to improve their individual, 
as well as collective, productivity and contributions to their communities and 
the State of South Carolina. Now, therefore,

Be it enacted by the 
General Assembly of the State of South Carolina:

SECTION 1. Article 1, Chapter 6, Title 44 of the S.C. Code is 
amended by adding:

 Section 
44-6-120. Beginning January 1, 2026, an adult sixty-five years of age and 
younger whose income is at or below one hundred thirty-three percent of the 
federal poverty level, with a five per