Who is in the Health Insurance Gap


Wh
o is in the Gap?

The Medicaid Program Today in South Carolina

1.1 million people, mostly children, are covered by Medicaid insurance.

of children are covered by Medicaid

of births are covered by Medicaid

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

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

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.