State HHS seeks $55M maintenance funding, behavioral‑health and home‑and‑community increases

Eunice Medina, director of the South Carolina Department of Health and Human Services, presented the agency’s FY‑26 decision packages to the Senate Finance subcommittee on March 5, describing several maintenance and targeted requests tied to Medicaid enrollment changes and program operations.

Medina said Medicaid enrollment fell from roughly 1,300,000 during the federal public‑health emergency to about 1,100,000 after redeterminations, a drop of roughly 200,000 members. “A couple of the other slides…show that those in Medicaid that we serve are truly the most vulnerable: majority children, pregnant mothers, the disabled and the elderly,” Medina told the committee.

Medina described a maintenance‑of‑effort request of approximately $55,000,000 to “keep our lights on,” noting the agency has historically requested $70–90 million but is reducing the current ask after cost‑saving work. She said consolidating pharmacy preferred drug lists under state management increased federal rebate capture and saved about $21,000,000 per year.

On behavioral health, Medina requested $5,700,000 to consolidate and increase reimbursement for community‑based rehabilitative behavioral‑health services, with a priority on raising rates for lower‑paid private providers and addressing substance‑use disorder services. She also proposed adding Medicaid coverage for partial hospitalization and intensive outpatient programs —“a step‑down option from inpatient” — with a relatively small initial request intended to seed capacity statewide.

Medicaid asked to raise opioid‑treatment program reimbursement to parity with Medicare (a request described as roughly $5,400,000) to expand capacity and address substance‑use disorder treatment shortages.

Medina outlined a proposed change to graduate medical education (GME) payments, moving from cost‑report based reimbursement to a per‑resident payment model to allow targeted incentives for specialties and areas of greatest need. She said the agency has completed the supply‑and‑demand portion of a GME study, is finalizing Medicaid network mapping and expects to present a recommended methodology for possible implementation July 1.

On home‑and‑community‑based services (HCBS), Medina said the program is not an entitlement and is constrained by appropriations and federally approved slots. She said many intellectual‑disability waivers carry long waitlists (DDSN‑managed programs include substantial waits) and asked the committee to authorize funding to release roughly 1,000 individuals from wait lists — a request Medina tied to a $10,000,000 appropriation for slots and support.

Medina signaled the department will monitor the new partial‑hospitalization/intensive‑outpatient line and adjust future requests as hospitals build capacity. She also committed to returning to the legislature with a report next year on outcomes from GME payment changes and other policy moves. The subcommittee requested additional follow‑up materials, including the Kaiser report referenced on wait lists and periodic updates on program rollouts. No formal votes were taken during the presentation.

Medina’s presentation identified internal colleagues (CFO Brad Livingston, communications director Jeff Lauretz and legislative aide Jackson Wilkins) and reflected a portfolio‑level approach combining cost‑savings and targeted investments to expand capacity for behavioral health, opioid treatment and home‑based supports.