Trump’s ‘One Big Beautiful Bill’ cuts Medicaid for SC hospitals, what about nursing homes?
Editor's note: Per a 2002 South Carolina law on state-directed payments, a franchise fee was established for nursing home reimbursements, meaning South Carolina nursing facilities are not impacted by changes to state-directed payment programs under the “One Big Beautiful Bill,” according to Jeff Leieritz, spokesperson for the SC Department of Health and Human Services. Still, many nursing home residents in South Carolina rely on Medicaid coverage to assist paying for nursing home care.
Eight South Carolina nursing homes are listed as being at risk of shutting down pending budget cuts laid out under President Donald Trump’s “One Big Beautiful Bill Act” through a study by Brown University School of Public Health.
This bill is intended to provide tax deductions and spending cuts to government-funded programs. Democrats and Republicans were largely divided, but it ultimately passed and became law on July 4, 2025.
One of the major impacts this bill brings involves Medicaid funding, which could force some hospitals and nursing homes to close across the Palmetto State.
South Carolina ranks as the sixth-worst state for health care in the U.S., according to data from the U.S. Census Bureau, Centers for Disease Control and Prevention and The Kaiser Family Foundation, an independent health policy research center.
In addition, an Aug. 11 report by the Congressional Budget Office estimates 10% of households in the lowest income bracket will lose approximately $1,200 per year in combined benefits from programs like Medicaid and the Supplemental Nutrition Assistance Program, while the top 10% of earners are projected to gain around $13,600 annually from tax cuts as a result of the bill.
How does this bill impact SC nursing homes?
A report from the Brown University School of Public Health on June 23 identified 579 nursing homes across the country, including eight South Carolina facilities, that face risk of closure from Medicaid cuts.
The report found the following three factors made nursing homes more vulnerable to this risk under Medicaid cuts:
- A high amount (85% or more) of residents are on Medicaid
- Occupancy rates below 80%
- Ratings of 1- or 2-stars from the Centers for Medicare & Medicaid Services Five-Star Quality Rating System
“More than 60% of nursing home residents rely on Medicaid to cover their care,” said Sen. Mark Warner, D-Va, one of the senators who requested the report, in a response to the report. “We’re going to see facilities close, staffing levels drop, and quality of care decline – endangering lives and leaving families scrambling.”
Nursing home care is a required state benefit under Medicaid, so it will continue in all states, but other services, including home and community-based service waiver programs, are not mandatory, researchers at Brown University School of Public Health stated in the report.
Medicaid cuts in SC
According to recent data from the South Carolina Department of Health and Human Services, 1.03 million residents are enrolled in Medicaid across the state.
According to The Kaiser Family Foundation, South Carolina will start losing its ability to pay hospitals for treating Medicaid patients at similar rates as private insurance by 2028 through a program known as state-directed payment.
Collectively, these cuts translate to a loss of roughly $2.4 billion annually, according to the South Carolina Hospital Association.
Even though hospitals will see cuts, Jeff Leieritz, spokesperson for the SC Department of Health and Human Services, states that a reimbursement increase for nursing homes that’s going into effect Oct. 1, is a mixture of 70% federal money and 30% state money.
“30% of the funds pay for medical services or Medicaid members in South Carolina through state dollars and the remaining 70% are federal dollars,” he said.
Which SC nursing homes are at risk?
Here’s a list of the South Carolina nursing home facilities the Brown University researchers listed at risk and their scores in each category from the report:
1. PruittHealth - North Augusta in Aiken County
- Percentage of residents on Medicaid: 94%
- Facility occupancy rate: 73%
- CMS star rating (out of 5): 2 at the time of study, currently rated 4
2. PruittHealth - Aiken in Aiken County
- Percentage of residents on Medicaid: 95%
- Facility occupancy rate: 73%
- CMS star rating (out of 5): 1 at the time of study, currently rated 2 and cited for abuse.
3. Bayview Manor/Resorts at Beaufort in Beaufort County
- Percentage of residents on Medicaid: 94%
- Facility occupancy rate: 47%
- CMS star rating (out of 5): 1
4. PruittHealth - Moncks Corner in Berkeley County
- Percentage of residents on Medicaid: 100%
- Facility occupancy rate: 61%
- CMS star rating (out of 5): 2 at the time of study, currently rated 1 and cited for abuse.
5. PruittHealth - Ridgeway in Fairfield County
- Percentage of residents on Medicaid: 91%
- Facility occupancy rate: 74%
- CMS star rating (out of 5): 1 at the time of study, currently rated 2
6. PruittHealth - Columbia in Richland County
- Percentage of residents on Medicaid: 91%
- Facility occupancy rate: 50%
- CMS star rating (out of 5): 2 at the time of study, currently rated 1
7. Mountain View Nursing Home in Spartanburg County
- Percentage of residents on Medicaid: 100%
- Facility occupancy rate: 72%
- CMS star rating (out of 5): 2
8. Dr. Ronald E. McNair Nursing & Rehabilitation Center in Williamsburg County
- Percentage of residents on Medicaid: 93%
- Facility occupancy rate: 68%
- CMS star rating (out of 5): 1 at the time of study, currently rated 2
This story was updated at 1 p.m. on Friday to include additional information on nursing home reimbursements from the SC Department of Health and Human Services.
This story was originally published August 21, 2025 at 6:00 AM.
