News Health Systems

Thousands of Medicaid Applications Go Unprocessed in South Carolina

Nina Liss-Schultz

In South Carolina, tens of thousands of Medicaid applications are stuck in processing backlog, leaving residents wondering whether they qualify for the government health insurance.

In South Carolina, tens of thousands of Medicaid applications are stuck in processing backlog, leaving residents wondering whether they qualify for the program.

According to the Post and Courier, between the beginning of October 2013—when the first open enrollment period of the Affordable Care Act began—and mid-July, some 43,000 South Carolina residents applied for the government insurance program designed for low-income people. Only 25 percent of those applications have been processed by the state’s Department of Health and Human Services.

South Carolina is one of 24 states that decided not to expand Medicaid under the Affordable Care Act. Under the health-care overhaul, states that expand Medicaid eligibility to individuals with incomes up to 133 percent of the federal poverty level will have their programs completely funded by the federal government until 2017.

Still, since the rollout of the HealthCare.gov website, South Carolina has seen a barrage of applications for its Medicaid program. The Post and Courier says that the state’s Department of Health and Human Services has pledged to get through the backlogged applications within 20 business days, and that it has increased personnel assigned to the applications in order to meet the goal.

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South Carolina is only one of many states struggling to keep up with increased Medicaid enrollment. The Obama administration last month sent letters to six states warning them that they are not complying with federal rules related to Medicaid application processing, and asking them to come up with plans to get rid of the backlog. Tennessee, one of the recipients of the White House letter, is the subject of a class-action lawsuit whose plaintiffs argue that the state has created bureaucratic hurdles with the intention to limit enrollment. At one point this year, there were almost a million applications backlogged in California. The state has since come up with a plan to cut that number down to 350,000 in the coming weeks.

As of the end of May, Medicaid enrollment under Obamacare had reached 6.7 million. At the same time, some 1.7 million of those were still waiting to be processed.

Commentary Sexual Health

South Carolina Mom Shows Homophobic Sex Education Isn’t a Thing of the Past

Martha Kempner

A mom in South Carolina was shocked to learn that what young people in her state hear about homosexuality in schools is biased, intolerant, and downright homophobic. But her state is not alone: At least eight states have laws that require teachers to present biased information about same-sex relationships.

This summer, the country made great strides in the fight for LGBTQ rights as the U.S. Supreme Court declared state same-sex marriage bans unconstitutional. Yet as the school year started, one mother in South Carolina was shocked to learn that what young people in her state hear about homosexuality in public schools is biased, intolerant, and downright prejudiced. She is now working with advocates to overturn the decades-old law that requires teachers to present this skewed information. But South Carolina is not alone: At least eight states have similar laws.

While we celebrate all the progress we’ve made in securing marriage equality for same-sex couples, we can’t let ourselves believe that the struggle for LGBTQ rights is over or that homophobia is a thing of the past, including in our school systems. Parents and advocates need to take a close look at what children in their states will be learning this year and work both to remove these outdated and unfair laws, and to help their children learn accurate and unbiased information in the meantime. 

Such was the case with Marie-Louise Ramsdale, whose daughter attends Wando High School in Mount Pleasant, South Carolina. According to the Post and Courier, like other high school students scheduled to receive sexuality education, she brought home a letter at the start of the academic year from a health teacher designed to inform parents of what was going to be taught and let them know that they could “opt out” of the class if they objected to its content. The letter explained:

The program of instruction for this unit may not include discussion of alternate sexual lifestyles from heterosexual relationships including, but not limited to, homosexual relationships except in the context of instruction concerning sexually transmitted infections.

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Ramsdale, who is an attorney, told the Post and Courier: “I’m very concerned about the message it sends to children in the schools who may be gay, not by choice, but by birth. I’m concerned that it promotes homophobia, and I’m equally as concerned that they’re teaching a curriculum that violates the U.S. Constitution,” in the sense that the state is attempting to restrict individuals’ First Amendment rights.

The letter actually quotes the state law regarding sexuality education. South Carolina requires that between ninth and 12th grade, students receive at least 750 minutes of “reproductive health education” and pregnancy prevention education. The law defines this as instruction in human physiology, conception, prenatal care and development, childbirth, and postnatal care. According to the law, however, such education does not include “instruction concerning sexual practices outside marriage or practices unrelated to reproduction, except within the context of the risk of disease. Abstinence and the risks associated with sexual activity outside of marriage must be strongly emphasized.”

When the law was written in 1988, only heterosexual couples could get married—so all abstinence-until-marriage messages would have, by nature, excluded gay or lesbian students and suggested by extension that all same-sex behavior was wrong because those couples could never get married. But the message in South Carolina is worse than just exclusion. By leaving same-sex couples out of discussions of healthy sexual relationships but including them in the discussion on sexually transmitted infections (STIs), young people are essentially being told that gay people are nothing more than disease vectors: a false and dangerous stereotype that arose during the height of the HIV epidemic. This biased message could have a devastating impact on students who are gay, lesbian, bisexual, or questioning their orientation, as well as students who are being raised by parents in a same-sex relationship.

Ramsdale has taken her concerns to the State Board of Education. In addition, she has also contacted Colleen Condon, a Mount Pleasant city council member who successfully challenged South Carolina’s same-sex marriage ban as a plaintiff in 2014. Condon agreed the law is troubling, asking the Post and Courier: “Are we trying to encourage young gay teens to believe there is something aberrant about their decisions?”

The two have since been working with the South Carolina Equality Litigation Post-DOMA Task Force, which was formed after the Supreme Court struck down the Defense of Marriage Act. The task force is now launching an investigation into what districts across the state are teaching in the hopes of overturning South Carolina’s law.

Unfortunately, students in South Carolina are not the only ones who will hear such information in school. In Arizona, schools are not required to teach about sexuality at all. If they choose to address it, however, the instruction must be medically accurate but cannot promote a “homosexual lifestyle,” portray “homosexuality as a positive alternative lifestyle,” or “suggest that some methods of sex are safe methods of homosexual sex.”

Of course, this is impossible: A medically accurate course would actually explain that when it comes to HIV transmission, certain behaviors carry more risks than others. Unprotected anal sex, for example, is very risky for the receptive partner; performing oral sex on a woman, by contrast, is less risky. The genders involved do not make a difference.

Alabama’s law is even more inflammatory. It requires sexuality education to “emphasize, in a factual manner and from a public health perspective, that homosexuality is not a lifestyle acceptable to the general public and that homosexual conduct is a criminal offense under the laws of the state.”

This statement is horrifyingly wrong from a number of angles. First, public health experts do not tend to use “acceptable” as a test as to whether something is likely to keep a population safe. Second, there is no difference from a public health perspective between same-sex and opposite-sex couples, as long as everyone takes precautions to prevent STIs and unintended pregnancy. Moreover, though it once might have been unfortunately true that homosexuality was not “accepted” by the general public—and, as these laws demonstrate, pockets of discrimination linger throughout the country—this is thankfully no longer the case. A Gallup poll conducted in May 2015 found that 60 percent of adults thought marriages between individuals of the same sex should be valid and have the same rights as those between opposite-sex couples. And, finally, laws criminalizing homosexual behavior were declared unconstitutional over a decade ago in the 2003 Supreme Court case Lawrence v. Texas.

Policies like these, which propagate fears and damaging stereotypes, are a vital reminder that the struggle for LGBTQ rights and equality did not end with this summer’s Supreme Court decision. Young people—whether they are gay or not—should not be told that homosexuality is unacceptable, dangerous, and illegal. And the effect of these laws extend beyond sex-ed curricula: In fact, the Gay, Lesbian, and Straight Education Network’s 2009 National School Climate Survey found that LGBTQ students in states with stigmatizing laws were more likely to hear homophobic remarks from school staff, less likely to report incidents of harassment and assault to school staff, and less likely to report having support from educators.

These classes also represent a tremendous missed opportunity. Ideally, sex-ed classrooms should be a place in which students can learn what sexual orientation is, how individuals come to understand their own sexual orientation, and what we can all do to respect each other’s choices and identities. This kind of critical thinking about sexual orientation is necessary, not just to help those students who are LGBTQ or questioning their sexuality, but to help us all move toward a future free of homophobia and discrimination.  

To combat this continuing campaign of misinformation, parents should find out what is being taught in their child’s school and, like Ramsdale, should fight if the curriculum is biased. States and localities have made strides when challenged—the Anoka-Hennepin school district in Minnesota, for example, changed its Sexual Orientation Curriculum Policy after being sued by several students who claimed it fostered an unsafe environment.

In the meantime, while educators’ hands are still tied in certain states and they are forced to provide misinformation, parents should remain invested in the lessons their children are learning. If those lessons are propagating homophobia, it’s up to parents to correct that inaccuracy at home.

News Law and Policy

As Confederate Flag Comes Down, Race Remains Central to South Carolina’s Health-Care Woes

Nina Liss-Schultz

South Carolina Gov. Nikki Haley’s denunciation of the Confederate flag last week has in some ways overshadowed her refusal to act in other areas related to structural inequality, such as refusing to expand health-care access to low-income communities across the state.

South Carolina Gov. Nikki Haley’s denunciation of the Confederate flag last week has in some ways overshadowed her refusal to act in other areas related to structural inequality, such as refusing to expand health-care access to low-income communities across the state.

Haley has decried the racist terrorist attack on Black Americans at the Emmanuel AME Church in Charleston and announced her intentions to take down the Confederate flag waving on capitol grounds. But activists and political observers in South Carolina have charged that if Haley truly supported Black South Carolinians, she would push to expand access to Medicaid.

Haley and South Carolina Republicans will reject about $12 billion in federal Medicaid expansion funds from 2014-2020, Rozalynn Goodwin, vice president for community engagement for the S.C. Hospital Association, told the Post Courier.

In 2013, nearly a quarter of Black Americans in the United States had no health insurance, compared to 14 percent of white people. Even with the Affordable Care Act (ACA), which has drastically increased the number of insured Americans, states that have opted to not expand Medicaid continue to have a massive “coverage gap”—people who don’t qualify for Medicaid but are too poor to pay for private insurance.

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South Carolina has the country’s 33rd most restrictive Medicaid program. A family of three with a total annual income of $12,271 makes too much for Medicaid, and adults without children don’t qualify. An estimated 194,000 South Carolina residents fall into the coverage gap, forcing them to pay out of pocket for health-care services.

People of color make up 36 percent of the South Carolina population, but 57 percent of its uninsured.

Access to health care is a matter of life and death for many caught in the gap. Medicaid expansion in South Carolina would save the lives of 190 people every year, according to a recent White House report.

“The Columbia, South Carolina zip code has the highest incidence of diabetes-related amputations in the nation, and many of the working poor have spiraled into poor health because of lack of access” Sue Berkowitz, director of South Carolina Appleseed, a legal justice organization, told Rewire. “A lot of these cases could be avoided and quality of life could be improved if there was access to quality, affordable care.”

Despite evidence that expanding Medicaid would save lives, Haley and the state’s GOP-majority legislature have opposed the ACA and its potential for helping low-income families receive medical care.

“We will not expand Medicaid on President Obama’s watch. We will not expand Medicaid ever,” Haley said at the 2013 Conservative Political Action Conference. Haley, in her 2014 State of the State address, once again pledged to “fight Obamacare every step of the way.”

Medicaid expansion would mean cholesterol screenings for more than 23,000 state residents, according to White House projections. About 6,500 more women would gain access to a mammogram and 9,700 women would be able to access cervical cancer screenings.

There have been race-based overturns in the way South Carolina policymakers discuss the expansion of Medicaid, or any effort to improve health care in Black communities. Back in 2009, Lindsey Graham (R), the U.S. Senator from South Carolina, said Medicaid expansion was a particularly bad idea for his state because of the Black population.

“We’ve got it tough. We’re on our knees,” Graham said. “Twelve percent of our people are unemployed and 31 percent of our people are Black.”

“The reason we have such high minority poverty rate is due to historical racism,” Berkowitz said. “The fact that the southeastern states are all refusing to expand Medicaid, it’s not an accident. It’s also where voter ID law are happening, and where insensitivity to the immigrant community is greatest.”

The uphill battle toward Medicaid expansion is one that the late state Sen. Clementa Pinckney—who was killed by the right-wing gunman who fired on Emmanuel AME Church—fought for during his time in the deeply-Republican legislature. Pinckney’s colleagues eulogized him on Friday as tenaciously advocating for Medicaid expansion, demanding education funding, and fighting the GOP’s voter ID laws and discriminatory lending practices.

Haley told CBS News last week that she hopes residents of her state will come together to have a dialogue about racism and the flag.

“What we hope is that we do the things South Carolinians do, which is have the conversation, allow some thoughtful words to be exchanged, be kind about it, come together on what we’re trying to achieve and how we’re trying to do it,” she said.

But Berkowitz said that the real test will be whether Haley will open up a dialogue about Medicaid and other public benefit programs that have been cut off or restricted in the state.

“The proof is really going to be, when we’re looking at programs that will really help to improve the lives of communities of color, whether Haley will even let us have a dialogue. Don’t shut down the ability to expand Medicaid,” she said. “Close the health care gap.”