Medicaid work requirements · South Carolina

Medicaid work requirements in South Carolina: who is subject and who loses coverage (2027)

Data snapshot 2026-06-03 · part of These 5 Million People Are About to Lose Their Medicaid — But They Don't Have To

South Carolina has not expanded Medicaid, so the federal work requirement that takes effect January 1, 2027 does not apply to a state expansion population. This model counts no South Carolina adults as subject.

The requirement matters for South Carolina in a different way: if the state expanded Medicaid later, its expansion adults would report from day one. The American Community Survey counts about 555,959 uninsured South Carolina adults with household income at or below 138% of the poverty line, the population an expansion would cover and the requirement would then reach.

Key figures

Model v2-2026-06-03. "Strict" counts adults whose ACS record shows them subject with no observable exemption; "permissive" allows the broader exemption reading.
MeasureSouth Carolina
Expansion stateNo
Subject to the requirement via waiverNo
Expansion pool (adults 19 to 64)0
Adults subject, strict definition0
Adults subject, permissive definition0
Share of expansion pool subject0.0%
Projected coverage loss by 20340
Hardship exception statusNon expansion
Early implementerNo
Ex parte capability score (0 to 100)n/a

Counties in South Carolina: uninsured adults below 138% of poverty

Greenville County (58,398), Richland County (47,220), and Charleston County (46,524) hold the most uninsured low-income adults in South Carolina.

ACS 5-year estimates by county. These adults are not subject to the 2027 requirement because South Carolina has not expanded Medicaid.
CountyUninsured adults at or below 138% FPLPoverty rateWorking-age population
Greenville County58,39811.0%324,434
Richland County47,22017.0%262,336
Charleston County46,52412.0%258,468
Horry County38,02713.0%211,262
Spartanburg County36,95214.0%205,288
Lexington County32,33212.0%179,625
York County31,5928.0%175,512
Berkeley County26,77711.0%148,763
Anderson County21,87514.0%121,526
Beaufort County18,50710.0%102,818
Dorchester County17,96312.0%99,796
Aiken County17,78414.0%98,798
Pickens County14,64017.0%81,335
Florence County14,12118.0%78,448
Sumter County10,81016.0%60,055
Lancaster County10,48812.0%58,269
Orangeburg County8,33625.0%46,313
Oconee County7,95016.0%44,169
Laurens County7,14419.0%39,688
Greenwood County7,09517.0%39,416
Kershaw County6,97414.0%38,746
Darlington County6,37120.0%35,394
Georgetown County5,98516.0%33,251
Cherokee County5,95618.0%33,088
Chesterfield County4,57020.0%25,390
Newberry County3,91616.0%21,756
Colleton County3,91117.0%21,730
Jasper County3,35118.0%18,616
Chester County3,33119.0%18,508
Williamsburg County3,10724.0%17,262
Clarendon County3,10420.0%17,245
Edgefield County3,07117.0%17,060
Marion County2,86027.0%15,888
Marlboro County2,83028.0%15,720
Dillon County2,79432.0%15,524
Union County2,73221.0%15,178
Abbeville County2,43916.0%13,552
Fairfield County2,11519.0%11,750
Barnwell County2,06525.0%11,474
Saluda County1,93218.0%10,731
Hampton County1,89620.0%10,534
Lee County1,70528.0%9,472
Calhoun County1,43019.0%7,946
Bamberg County1,29722.0%7,203
McCormick County87517.0%4,860
Allendale County80727.0%4,484

State brief and methodology

Estimates, not counts. The model rakes to CBO's national subject total and allocates by ACS microdata; state agencies hold the administrative data that would replace these figures.

Sources

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