South Carolina Medicaid Barriers
for Moms and Babies
This report was drafted based on available information and data sourced throughout this document. The Southern Alliance for Public Health Leadership (SAPHL) convened a series of sessions over from May of 2026 through September of 2026 with subject matter experts and stakeholders across the state of South Carolina to collect their feedback and ideas on both where the system was breaking down and how it could work better.
1 Policy Landscape and Changes
In South Carolina, Medicaid is a crucial and foundational safety net. Despite its vital role, significant administrative and procedural barriers continue to hinder eligible families from accessing and maintaining coverage. The recent Medicaid "unwinding" period underscored these systemic vulnerabilities, as tens of thousands of South Carolinians lost their health coverage.
Total Coverage Loss
South Carolina Medicaid members disenrolled during unwinding (April 2023 - August 2024).
Procedural Terminations
Disenrollments that occurred for purely procedural reasons—paperwork bottlenecks—rather than a change in actual eligibility.
While user-side barriers like limited digital literacy and rural broadband access are significant, state-side administrative systems are a primary driver of this coverage loss. Families frequently navigate glitchy mobile interfaces and face critical notification failures when address changes are not properly processed. Digital enrollment portals in South Carolina also increasingly rely on third-party verification services (like ID.me) for identity verification, which can come with additional challenges. Consequently, families often lose their maternal and pediatric coverage due to systemic administrative errors rather than a genuine change in their eligibility status.
1.1 New Laws Disrupting Medicaid Access for Families
New federal requirements and bureaucratic layers around eligibility, verification, and reporting compound the existing workload pressures and staffing vacancies that are already overwhelming local South Carolina Department of Health and Human Services (SCDHHS) offices. Beyond these general administrative burdens, these procedural bottlenecks prevent effective enrollment and retention across the board.
Furthermore, while South Carolina took the vital step of extending postpartum Medicaid coverage to 12 months in 2022, a severe "postpartum cliff" remains at the one-year mark. Because South Carolina is a non-Medicaid expansion state, transitioning from pregnancy-related Medicaid to caregiver Medicaid (which has extremely low income limits) or the federal ACA Marketplace is incredibly complex, frequently leaving mothers to fall entirely into the coverage gap. Babies face parallel risks; although they are automatically covered as "deemed newborns" for their first year, families frequently miss the procedural redetermination steps required to maintain the child's coverage at their first birthday.
1.2 Crisis in Maternal Care
For moms and babies, this represents a breakdown in the essential continuous care required during their most vulnerable stages. It is also a barrier to creating a sustainable healthcare system; every dollar not covered by Medicaid translates into both a health and economic cost for families, for providers, and for healthcare systems. It’s particularly noteworthy for local health departments, which primarily serve women and children and where Medicaid is often the primary insurer for their clients.
This report, developed through a series of collaborative working sessions with regional leaders and advocates, aims to map these bottlenecks and challenges in exhaustive detail. By identifying the specific barriers—from the heavy reliance on Medicaid for births to the nuances of presumptive eligibility—we provide a roadmap for Southern policymakers. The following sections will explore these challenges in depth, highlighting successful regional programs and offering actionable solutions to remove the red tape and ensure every eligible family in South Carolina remains covered.
2 Understanding the Healthcare Landscape for Moms and Babies
2.1 The Coverage Landscape: Eligibility Versus Enrollment
A significant disparity exists between Medicaid or CHIPChildren's Health Insurance Program eligibility and active enrollment across South Carolina, demonstrating that income limits are not the sole driver of uninsurance. The chart below shows representative counties across South Carolina.
| County ↕ | Uninsured Women at 200% FPL (PW limit: 194%) ↕ | CHIP ↕ | Uninsured Children at 200% FPL (CHIP limit: 208%) ↕ | Medicaid ↕ |
|---|---|---|---|---|
| Horry | 25.6% | 46.7% | 8.3% | 18.8% |
| Jasper | 25.4% | 50.6% | 10.1% | 22.2% |
| Beaufort | 25.2% | 43.5% | 11.0% | 17.3% |
| Saluda | 24.0% | 48.6% | 11.4% | 23.2% |
| Lancaster | 22.1% | 42.6% | 7.2% | 19.1% |
Across a diverse cross-section of South Carolina—spanning affluent coastal enclaves like Beaufort, tourism-driven hubs like Horry, and rural or rapidly suburbanizing areas like Jasper, Saluda, and Lancaster—a striking similarity emerges: high uninsurance among moms and children who meet the income requirements for Medicaid. Roughly one in four women (22.1% to 25.6%) living at 200% of the Federal Poverty Level in these counties remain uninsured, even though the state's Medicaid threshold for pregnant women is 194%. Similarly, between 7.2% and 11.4% of children at 200% FPL in these areas lack coverage, despite the CHIP income threshold extending to 208%.
What makes these communities stand out is how their shared data exposes a systemic flaw rather than a localized one. Instead, administrative friction acts as the great equalizer. Whether families are navigating the service economy of the Lowcountry or agricultural work in the Midlands, the same localized bottlenecks—lack of program awareness, complex application procedures, social stigma, and confusing verification requests—prevent thousands of eligible mothers and babies from receiving crucial preventive and perinatal care.
2.3 Access, Workforce Gaps, and the Fragility of Pediatric Care
Structural provider shortages further exacerbate the impact of administrative barriers. When a county lacks essential healthcare infrastructure, any lapse in insurance coverage can completely sever a family's access to maternal and pediatric care.
| County ↕ | March of Dimes Profile ↕ | Inadequate Prenatal Care ↕ | Pediatricians ↕ | Uninsured Women (200% FPL) ↕ | Uninsured Children (200% FPL) ↕ |
|---|---|---|---|---|---|
| Chester | Maternity Care Desert | 23.8% | 2 | 17.5% | 7.6% |
| Saluda | Maternity Care Desert | 44.0% | 0 | 24.0% | 11.4% |
| Hampton | Maternity Care Desert | 41.5% | 0 | 19.0% | 7.7% |
| Bamberg | Maternity Care Desert | 37.5% | 0 | 15.9% | 7.4% |
| Calhoun | Maternity Care Desert | 26.4% | 1 | 16.1% | 7.3% |
In high-poverty rural counties like those highlighted above, many children and moms are currently enrolled in Medicaid. Yet many more qualify based on income. This massive dependency and discrepancy highlights the extreme fragility of pediatric healthcare access in these areas. Because the majority of children rely on the state for their care, any administrative bottleneck—such as a delayed renewal notice, a glitchy online portal, or a missed deadline—has the potential to trigger a pediatric public health crisis across an entire county. For these communities, procedural red tape is not just an inconvenience; it is a systemic threat to infant and child development.
2.4 Administrative Chokepoints and Procedural Disenrollments in Medicaid
To understand what keeps eligible South Carolinians from accessing Medicaid, it is critical to evaluate how the state manages applications and renewals. To their credit, the South Carolina Department of Health and Human Services (SCDHHS) proactively publishes a Medicaid Annual Eligibility Review Dashboard. The comprehensive unwinding data from April 2023 through August 2024 provides clear evidence of systemic operational strain, where administrative hurdles drive massive coverage losses.
Coverage loss in the renewal process largely falls into two distinct categories: "determined ineligible" and "procedural disenrollments." Disenrollments based on actual eligibility reviews represent instances where the state has verified a member no longer qualifies for Medicaid. Procedural disenrollments, by contrast, denote situations where individuals lose their coverage not because their income or status changed, but simply because they failed to navigate the state's administrative requirements—meaning thousands of eligible applicants are routinely locked out of the healthcare safety net.
A high-level review of South Carolina’s dashboard highlights how heavily the state's process relies on procedural terminations that needlessly disrupt coverage. Of the 443,993 Medicaid members disenrolled during the unwinding period, only 173,323 (39%) were actually reviewed and determined to be ineligible. More concerning for health equity is the state's procedural action data: 270,532 individuals—nearly 61% of all disenrollments—were dropped from coverage simply for failing to return their review form. Another 138 members were disenrolled for procedural reasons like filling out the form inaccurately or incompletely. Just as in neighboring states, these statistics show that coverage loss is often symptomatic of a deeply flawed infrastructure where families are separated from their benefits due to paperwork friction rather than a change in actual need.
The South Carolina data explicitly details the scale of these administrative chokepoints, showing a massive breakdown in beneficiary engagement and documentation protocols. While the state reported a 95.28% successful mail delivery rate for annual review forms and an 86% text message delivery rate, only 33.91% of reviews were returned within the standard 90-day window. Even with an extended 90-day grace period, the return rate only climbed to 40.43%.
Macro Context: Structural Failure vs. The "Applicant Apathy" Narrative
From an advocacy perspective, the South Carolina findings reinforce a frustrating systemic imbalance. State agencies and federal oversight mandates remain intensely hyper-focused on preventing consumer-level fraud and ensuring those who no longer qualify are quickly removed. However, South Carolina’s own data explicitly proves that the primary driver of coverage loss is not intentional deception by applicants, but rather a rigid administrative framework that relies heavily on manual paperwork returns.
Rather than acknowledging these deep infrastructural failures, state agencies frequently issue a standard rhetorical "cop-out," framing low return rates as localized issues of applicant apathy or a failure of personal responsibility. This explanation completely ignores the reality that vulnerable populations are universally navigating complex lives while relying on convoluted, inaccessible state systems. Forcing minor communication tweaks onto a collapsing, paper-reliant eligibility infrastructure will never fix the underlying structural flaws embedded within South Carolina’s Medicaid system, routinely leaving eligible moms and babies without vital care.
2.5 A Profile of Medicaid Recipients and Uninsured but Eligible
Profile 1: The Bureaucratic Bottlenecks
Horry, Jasper, Beaufort, Saluda, Lancaster
Roughly 1 in 4 pregnant women (22.1% to 25.6%) and 7.2% to 11.4% of children at 200% FPL are uninsured despite meeting eligibility thresholds. Statewide, nearly 61% of all Medicaid disenrollments (270,532 individuals) were purely procedural—driven by unreturned review forms rather than confirmed ineligibility.
Profile 2: The Social Services Paradox
Williamsburg, Chesterfield, Barnwell, Allendale, Marion
These counties exhibit severe MVI scores ranging from 94 to 99, but paradoxically maintain lower uninsurance rates (11.9% to 16.7% for women) than wealthier counties. Deep poverty leads to continuous touchpoints with caseworkers across programs (WIC, SNAP, TANF) which trigger automatic renewal prompts.
Profile 3: The Healthcare Ghost Towns
Saluda, Hampton, Bamberg, Chester, Calhoun
Classified as March of Dimes Maternity Care Deserts with severe workforce gaps (0 pediatricians in Saluda, Hampton, and Bamberg). Inadequate prenatal care reaches up to 44% in Saluda. In these rural deserts, an insurance card fails to translate into care because local providers simply do not exist.
3 Medicaid Communications and Awareness of Eligibility
The first step in applying for Medicaid is becoming aware that you are eligible. However, identifying eligibility remains a significant challenge for mothers and children due to a blend of systemic, financial, and communications hurdles. This daunting application process quickly discourages applicants, often finding folks giving up entirely after a single rejection.
The complexity of the system is further exacerbated by the language used to describe eligibility. The current terminology in state notices is often too technical for the average person to understand—relying heavily on bureaucratic jargon like "MAGI" (Modified Adjusted Gross Income), "redetermination," or "spend-down." This lack of clarity is particularly dangerous for vulnerable populations, especially those with Limited English Proficiency (LEP). Furthermore, specific demographic groups—notably Latina, immigrant, and refugee communities—experience heightened fear regarding government interactions. Misinformation and concerns surrounding the "public charge" rule deter eligible families from enrolling in or maintaining their required benefits.
Finally, the method by which information is disseminated often limits who gets coverage. In rural areas where internet access is unreliable, families rely heavily on word-of-mouth. If a community's collective knowledge is outdated, or if the state's messaging fails to communicate clearly with the target audience, many remain unaware that they qualify.
3.1 Presumptive Eligibility Awareness and Limitations
Awareness of Presumptive Eligibility (PE) remains functionally low among the general public despite the fact that it could help ensure short-term healthcare coverage for pregnant women. Typically acting as a placeholder, patients only discover they qualify when they arrive at a clinic seeking care and are informed by staff that they need coverage to proceed.
However, PE in South Carolina is heavily restricted to hospitals, Federally Qualified Health Centers (FQHCs), and health departments—all of whom face penalties if a patient is ultimately deemed ineligible. Furthermore, the timeframe for retroactive coverage is smaller post-HR 1.
Because there is no sustainable, proactive statewide outreach, the burden of discovery falls heavily on the patient at a highly vulnerable moment and the providers serving them. For pregnant women seeking regular Medicaid, a sharp decline in available Navigators over the last five years has shifted this administrative burden to other clinical staff. Because current application methods—such as calling the Medicaid office directly—frequently require 45 to 60 minutes on hold, many staff avoid the process entirely due to time constraints. If a mother does not successfully navigate the standard Medicaid application before her brief PE window closes, she is left uninsured mid-pregnancy, turning PE into a reactive "band-aid" rather than a cohesive safety net.
3.2 Newborn Enrollment, the Postpartum Cliff, and Administrative Hurdles
In contrast to adult applications, Newborn Medicaid Enrollment is relatively straightforward, typically requiring only a simple form and boasting a one-to-two-week turnaround (provided there are no clerical errors like name misspellings). However, another critical vulnerability in the system occurs at the "postpartum cliff," when a mother hits the end of her 12-month postpartum coverage window.
When mothers lose their coverage once this period expires, it triggers widespread confusion. National data suggests that families and children are often incorrectly assumed to be ineligible at this stage as well, leading to a premature cessation of pediatric care. This drop-off is largely attributed to poor communication from the Medicaid agency regarding continued child eligibility and the confusing terminology used as families transition from one Medicaid category to another.
This coverage cliff is worsened by an inflexible reliance on physical mail for eligibility renewals, which frequently leads to critical notification failures when families experience a routine change in address. Because of these rigid administrative burdens and structural communication flaws, a massive percentage of Medicaid terminations are driven by procedural errors—such as flawed state-generated notices or failing to return mailed documents—rather than actual ineligibility. Consequently, families lose access to essential, continuous care not because their financial situation has improved, but due to institutional communication breakdowns.
For those attempting to manage their cases online, severe infrastructure gaps remain. Families are largely unaware of how to effectively use the state's electronic benefit portal to verify identity, update cases, or submit documents. Additionally, online enrollment systems often rely on third-party credit bureaus for identity verification. This fundamentally disadvantages low-income applicants who lack established credit histories, effectively barring them from digital enrollment and forcing them back into backlogged phone or in-person systems.
3.3 Navigating Managed Care and Plan Selection
Even after successfully enrolling, recipients face the immediate administrative hurdle of understanding the state's Managed Care system. New enrollees must navigate selecting a Managed Care Organization (MCO) or risk being auto-assigned to a health plan that their established providers do not accept. The complexities of understanding in-network versus out-of-network providers present a secondary barrier that prevents individuals from utilizing their coverage effectively, often disrupting continuity of care right as a mother establishes a relationship with an OB-GYN or pediatrician.
3.4 Program Complexity and Workforce Bottlenecks
The overarching complexity of the Medicaid system acts as a substantial barrier to both enrollment and retention. This complexity is exacerbated by severe workforce challenges across South Carolina's state agencies. Frontline human services staff and caseworkers are chronically overworked, underpaid, and subject to high turnover rates.
Consequently, applicants often encounter inconsistent guidance, massive processing backlogs, and widespread confusion. Overworked frontline staff are frequently hindered by flawed or highly-automated eligibility determination systems that routinely ignore or fail to assess available data, compounding the workforce bottlenecks with severe systemic friction.
4 Operational Challenges and Medicaid Application Bottlenecks
For pregnant people and new mothers in South Carolina, securing timely prenatal and pediatric care is consistently hindered by a fragmented health coverage landscape and chronically obsolete technology. Expectant mothers must navigate overlapping programs, eligibility cliffs, and a notoriously unstable digital infrastructure. Because the system is deeply unintuitive and plagued by technical failures, low-income families are forced into a confusing maze of bureaucratic requirements. Many rely entirely on the limited bandwidth of local health clinics or underfunded nonprofit groups like SC Thrive to file applications. This complexity leaves eligible individuals uninsured because they either abandon the process in frustration, assume they do not qualify, or fall victim to severe communication gaps regarding their children's ongoing eligibility.
4.1 The Complexity of Eligibility Pathways
South Carolina offers multiple pathways for maternal and infant coverage, but navigating them requires overcoming distinct eligibility hurdles and structural cliffs that threaten continuous care:
Standard Medicaid (Healthy Connections)
Provides comprehensive maternity and 12-month postpartum coverage for women under expanded income thresholds (194% FPL for pregnant women). While critical during pregnancy, long-term structure creates severe continuity issues at the one-year mark.
The Postpartum Coverage Cliff
Exactly one year postpartum, mothers must transition to caregiver Medicaid, which carries much lower income limits. Lacking proactive communication that children remain eligible for Medicaid/CHIP (208% FPL), mothers frequently assume their child loses coverage too.
Emergency Medicaid
Undocumented mothers and marginalized groups are limited to Emergency Medicaid. This covers only acute events like active labor and delivery, providing zero prenatal or ongoing postpartum care, driving costly reliance on emergency rooms.
4.2 Logistical and Technical Friction
Even when mothers identify the correct coverage pathway, South Carolina’s infrastructure imposes an unreasonable administrative burden on both families and healthcare providers. The state's primary Medicaid computer infrastructure dates back to approximately 2000, creating immediate digital barriers for vulnerable applicants.
The online portal is notoriously unstable, frequently timing out mid-application, actively kicking users off the system, and exhibiting severe incompatibility issues with standard web browsers. A standard application requires a minimum of one hour to complete. When digital avenues fail, applicants are forced into telephonic queues with Healthy Connections or SC Thrive, routinely facing 30- to 45-minute wait times due to chronic lack of funding and staffing.
These bottlenecks are rooted in a broader workforce crisis within the Department of Social Services (DSS). Low wages and pervasive burnout have fueled severe staff turnover and chronic understaffing. The resulting processing backlogs and eligibility determination errors are frequently written off as "training problems," when they actually reflect systemic funding failures that leave vulnerable mothers waiting weeks for critical coverage decisions.
4.3 Infrastructure Gaps and Regulatory Disconnect
Efforts to modernize South Carolina's enrollment infrastructure have been repeatedly stalled by political stagnation. Historically, state Medicaid directors and legislators have actively avoided upgrading these legacy IT systems due to ideological apprehensions about appearing to "grow government." This resistance to infrastructure spending has locked the state into a technological bottleneck that systematically excludes eligible individuals simply by virtue of digital failure.
Compounding this is a deeply misaligned auditing framework. State and federal audits prioritize policing beneficiary fraud—which is exceedingly small—over ensuring healthcare access. By focusing almost exclusively on duplicate enrollments and provider billing abuse, the state maintains a glaring regulatory blind spot: it completely fails to track eligible individuals who are wrongfully missed or dropped by the system due to agency errors or technical glitches.
4.4 Provider-Side Constraints Impacting Physical Access
The friction of the Medicaid enrollment process bleeds directly into South Carolina's clinical infrastructure, severely disrupting physical access to care. Because the digital systems are so unreliable and community hub grants have been stalled by institutional red tape, patients frequently arrive at local pediatric and women's health clinics entirely uninsured.
Attempting to facilitate these complex, hour-long Medicaid applications in clinical waiting rooms backs up patient appointments by 30 minutes or more. To maintain any semblance of operational flow, desperate clinic staff are forced to abandon the digital portals entirely and revert to highly inefficient paper applications. Furthermore, as vulnerable populations lose standard eligibility and shift toward Emergency Medicaid, the financial burden on local hospitals increases, as uncompensated ER treatments for routine or preventative issues are substantially more expensive and strain an already fragile rural healthcare network.
5 Recommendations
5.1 Communications
- Modernize Communications: South Carolina Healthy Connections must move beyond the reliance on physical mail, which disproportionately fails families in transient housing or rural areas. Invest in better multi-lingual communications and SMS text messaging to ensure renewal notices and updates actually reach mothers. This doesn’t mean physical mail outreach ends; it needs to be supplemented.
- Clarify Naming Conventions & Demystify the Cliff: Healthy Connections must address program jargon that confuses applicants. Clearly distinguish between Healthy Connections, CHIP, Emergency Medicaid, and Presumptive Eligibility so families understand exactly what they are enrolling in, what is covered, how to stay enrolled, and what their status is. Immediate operational improvements include creating clear, bulleted educational flyers distributed in clinics and WIC offices to demystify the postpartum cliff.
- Educate Health Professionals: Implement annual informational webinars for health professionals to update them on fluctuating poverty rates and eligibility rules so they can better guide their patients.
- Enhance Healthcare Cost Literacy: Develop transparent, accessible tools like a localized healthcare cost calculator. Equipping families with clear information about out-of-pocket expectations demystifies the system and encourages continuous engagement with care and coverage for care.
- Target Communities where Enrollment is Lagging: Gaps in enrollment are not evenly distributed across the state; Healthy Connections should invest in local efforts in counties with high uninsured but eligible populations.
- Making Medicaid Consumer Friendly: Public engagement with Medicaid should be grounded in the real-life stories and experiences of those who use it. Understanding exactly how administrative barriers directly impact the physical and mental health of South Carolina mothers and babies instead of a focus on bureaucratic process provides the urgency needed to drive systemic change.
5.2 Operations
- Deploy Community Health Workers (CHWs) and Navigators: Private philanthropy and Healthy Connections should provide funding to support CHWs and navigators who work in Federally Qualified Health Centers (FQHCs) and local clinics. This is sparking discussions around a potential solution: having community health workers trigger outreach at the nine-month mark to educate mothers on maintaining their children’s coverage. These navigators should "walk alongside" mothers through the entire process—including scheduling return visits for document uploads—so families do not get lost in the administrative shuffle or experience coverage gaps.
- Grow Evidence-Based Home Visiting: The legislature should build upon the success of South Carolina's Evidence-Based Home Visiting Programs. By further funding and cross-training local health department care coordinators and home visiting staff in Healthy Connections eligibility and renewal processes, they can effectively act as administrative buffers against procedural exhaustion and bridge the enrollment gap.
- Stabilize the Workforce: Sustainable long-term progress will require targeted advocacy to secure livable wages for DSS personnel to stabilize the workforce that processes these vital applications.
- Managed Care Organizations and Families: Managed Care Organizations should transition to a family-centered enrollment and renewal model that automatically aligns all household members within the same Managed Care Organization (MCO) by default. Additionally, eligibility and data systems must be modernized to process redeterminations at the household level, ensuring changes in a parent's status do not inadvertently trigger coverage drop-offs or separate plan assignments for their children.
- Facilitate a "Warm Handoff" at the Postpartum Cliff: Healthy Connections should treat the end of the 12-month postpartum extension as a managed transition rather than a cliff. Deploy dedicated navigators to actively transition mothers to the ACA Marketplace or Caregiver Medicaid rather than simply mailing a termination notice.
- Redesign Automated Notices: Conduct an immediate operational audit and redesign of all automated Medicaid renewal and termination notices. Healthy Connections must ensure all generated communications are legally sound, comprehensible, and provide enrollees with the exact information essential for the maintenance of their coverage, stopping the distribution of defective notices.
5.3 Policy
- Maximize Automatic (Ex Parte) Renewals: Eliminate the procedural paperwork burden by fully integrating cross-agency data. If a mother or child is already deemed financially eligible for SNAP or WIC, the state should utilize that existing data to automatically renew their Healthy Connections coverage at the household level.
- Implement Multi-Year Continuous Eligibility for Children: Provide uninterrupted pediatric coverage from birth to age six. This eliminates the "deemed newborn" cliff at age one and annual redetermination churn during a child's most critical developmental years, simultaneously reducing the state's administrative workload.
- Expand Presumptive Eligibility Authority: Stop treating PE as a hospital-centric "band-aid." Grant PE determination authority to trusted Community-Based Organizations (CBOs), WIC clinics, and FQHCs so the organizations mothers already trust can proactively capture uninsured pregnant women before a crisis point.
- Enable Direct Address Updates by Providers and MCOs: Address the root cause of notification failures by legally authorizing Managed Care Organizations (MCOs) and contracted healthcare providers to update a patient’s contact information directly within the Healthy Connections system.
- Modernize the State's Infrastructure: The state must overcome political pushback to heavily fund the modernization of the state's 20-year-old computer infrastructure. The system must be updated to ensure it effectively evaluates all available data already on file and accurately screens applicants for disability-related coverage, directly addressing systemic vulnerabilities.
- Mandate Data Transparency: Require the state to proactively publish granular, case-level Medicaid Eligibility Quality Control data in a consumer-friendly format. Publicly tracking deficiency and error rates is necessary to identify structural chokepoints and hold the state accountable for systemic administrative failures.
6 Conclusion
The administrative complexities of South Carolina's Medicaid system currently act as a significant barrier, separating vulnerable mothers and children from access to the continuous care they need. Whether in high-poverty rural communities or wealthier suburbs, these procedural hurdles exacerbate severe health disparities and directly contribute to the state's maternal and infant health crisis.
By shifting agency protocols from a defensive posture of fraud prevention to a proactive model of enrollment optimization, South Carolina can bridge these severe coverage gaps. Adopting the targeted policy and operational shifts outlined in this report allows state leaders to effectively dismantle this red tape. Transforming Healthy Connections into an accessible, consumer-centered safety net is an urgent necessity to ensure that every eligible family maintains their health coverage without falling off preventable bureaucratic cliffs.
2.2 Social Drivers of Maternal Vulnerability
By cross-referencing enrollment data with the Surgo Maternal Vulnerability Index (MVI), we can pinpoint which communities face the steepest barriers to maternal and child health and how that might compare to the eligible but unenrolled population. High MVI scores reflect systemic community-level stressors that compound the difficulty of navigating Medicaid enrollment.
When drivers such as physical environment, general healthcare access, and physical health are severely compromised, the bureaucratic requirements of maintaining health coverage become exponentially more challenging for expecting and new mothers. Importantly we also find that counties that have a greater risk for maternal vulnerability typically have lower uninsurance rates than wealthier communities with less risks for pregnant women.