Who is in the Gap?
The Medicaid Program Today in South Carolina
1.1 million people, mostly children, are covered by Medicaid insurance.
44%
of children are covered by Medicaid
49%
of births are covered by Medicaid
63%
of nursing home residents are covered by Medicaid
Source: Kaiser Family Foundation, Medicaid State Fact Sheets, August, 2024
Who is in the Gap in South Carolina? Working Age Adults (Ages 19 – 64)
- 58% of South Carolinians in the gap have a worker in the family
- 79% of small employers in SC do not offer health insurance. Only 38% of employees in the bottom 25% of income nationwide have an offer of health insurance from their employer.
- 16% of those in the gap have a major functional disability or illness (National Data)
- 10% of South Carolinians in the gap are parents who may be caring for a child full-time
- 19% of South Carolinians in the gap are over the age of 55
General Data Source: Kaiser Family Foundation, How Many Uninsured Are in the Coverage Gap and How Many Could Be Eligible if All States Adopted Medicaid Expansion, February 2025.
Small Employer Source: Kaiser Family Foundation, Percent of Private Sector Establishments That Offer Health Insurance to Employees by Firm Size, 2022, US Bureau of Labor Statistics, Coverage in Employer Medical Care Plans Among Workers in Different Wage Groups, March 2023
Major Occupations in the Gap
Construction
Food Service
Retail
Custodial Service
Caregivers
Today the number of people in the gap in South Carolina is at a low point. An expiring federal law will leave thousands of South Carolinians in the gap in 2026.
Currently a federal law subsidizes premiums on the exchange for people under 150% of poverty to $0 or a small amount monthly. The SC exchange grew from 200,000 enrollees to over 600,000 in the last several years under this provision. That law will likely expire at the end of 2025 unless Congress renews it. Learn More
This Insurance Gap Contributes to SC’s Poor Health Outcomes Among States
The Solution to Close the Insurance Coverage Gap:
Adopt Provisions of the Affordable Care Act To Cover All Very Low Income Adults
The Affordable Care Act provides 90% of the cost of closing the gap vs. only ~70% for the SC Medicaid program today. In 2021, the American Recovery Act provided an additional bonus to states that had not closed the gap if they did so, including South Carolina.
The Benefits of Closing the Gap in South Carolina
340,000 South Carolinians would gain affordable health insurance coverage. This includes people who are uninsured with no health insurance option, people who have an option from their employer or people on the market exchange but cannot afford it.
- The federal government would pay 90% of the cost of closing the gap vs. 70% for the SC Medicaid program today. In addition, South Carolina would get a $904 million bonus.
- South Carolina is leaving over $2.5 billion every year in Federal investment on the table
- South Carolina taxpayers and providers are already paying for the expansion in 40 other states. Closing the gap would help keep South Carolina dollars in South Carolina.
- South Carolina is walking away from a 9 to 1 investment return that would generate 29,000 new jobs, almost $4 billion in new economic output and over $100 million in new tax revenue
- South Carolina is refusing a research documented program in 40 other states to improve its poor health outcomes. See our two page information sheet for more details.
Interested in getting involved with Cover SC and closing the Coverage Gap?