2025 South Carolina Legislative Session Preview

State Capitol of South Carolina, Columbia

South Carolina’s 2025 legislative session began on Jan. 14 and is scheduled to adjourn in early May. Recognizing that health policy remains a top priority for lawmakers, HCA Healthcare is sharing this legislative preview to keep colleagues informed about key developments that could impact care and access in the communities we serve.

Under the all-Republican leadership of Senate President Thomas Alexander (R-District 1) and House Speaker Murrell Smith (R-District 67), and in conjunction with Governor Henry McMaster (R), this session will address a range of issues, including the state budget, healthcare policy, and education.

Below is an overview of significant policy proposals lawmakers will likely consider during the 2025 session:

Medicaid

Several bills have been pre-filed regarding Medicaid. These include:

HB 3109 would expand Medicaid eligibility starting January 1, 2026, to adults aged 65 or younger with incomes up to 138% of the federal poverty level, as outlined in the Affordable Care Act.
HB 3377 would direct the State Election Commission to conduct a statewide advisory referendum during the 2026 general election to ask voters whether South Carolina should participate in Medicaid expansion.
HB 3611 would establish a study committee to evaluate the potential impacts of Medicaid expansion in South Carolina and address related matters.
HB 3108 would provide for reimbursement and insurance coverage of doula services through private insurance and Medicaid under specified conditions. The bill establishes criteria for Medicaid coverage, creates a scope of practice for doulas, and requires the creation of a certification organization and a statewide registry for certified doulas. The bill also mandates insurance utilization reporting for perinatal doula services.

Women’s Healthcare

Women’s healthcare, specifically maternal healthcare, has long been a concern in South Carolina, which ranks 8th highest for maternal mortality in the nation. Several bills address women’s health, including:

HB 3202 would require health insurance policies to cover diagnostic and supplemental breast examinations without cost-sharing requirements such as copayments, deductibles, or coinsurance.
HB 3243 would require the State Health Plan to provide coverage for lactation care and services starting with the 2027 plan year. The bill specifies the scope of coverage, prohibits cost-sharing requirements such as copayments or deductibles for these services, and defines relevant terms. SB 42 is similar to this House bill.
HB 3249 would enact the “South Carolina Dependent Maternity Coverage Act,” requiring all health insurers in the state that provide coverage for dependents up to age 26 to include maternity care coverage for those dependents.
SB 27 would allow abortion before fetal viability and under specific conditions after viability, establish a process for minors seeking an abortion, and ensure access to reproductive healthcare, including assistive reproductive technologies and contraceptives. The bill mandates coverage for abortions and sterilization procedures in health insurance plans that cover pregnancy, and expands Medicaid for prenatal and postnatal care. It also permits telemedicine prescriptions for abortion-inducing drugs and redefines reproductive health education to include comprehensive, medically accurate instruction, with abstinence as one option.
SB 41 would update definitions within the Comprehensive Health Education Program. It would require reproductive health education to be age-appropriate, comprehensive, and medically accurate, while ensuring that abstinence is not taught as the sole or primary method of preventing pregnancy and sexually transmitted diseases. The bill also includes the benefits of abstinence until marriage in pregnancy prevention education and adds domestic violence and pregnancy prevention education to the curriculum for grades six through eight.

Healthcare Workforce

HB 3093 and HB 3392 would expand protections for healthcare workers. Specifically, the bills provide that injuring a healthcare worker or emergency response employee related to their official duties would come under the definition of assault and battery of a high and aggravated nature.Several bills have been pre-filed addressing loan forgiveness for healthcare workers, including:

SB 19 would establish the “Health Care Professional Loan Forgiveness Program” to assist eligible healthcare professionals with loan repayment. The bill outlines eligibility criteria, program administration, and funding mechanisms, and creates an advisory committee to oversee the program.

HB 3025 would expand the scope and impact of the Geriatric Physician Loan Forgiveness Program. The legislation would broaden the pool of healthcare professionals eligible to participate in the program, making loan forgiveness accessible to a wider range of practitioners involved in geriatric care. Additionally, the bill would ncrease the total amount of loans that can be reimbursed under the program, aiming to further incentivize healthcare professionals to serve the state’s aging population. These changes are intended to address workforce shortages in geriatric care and improve access to medical services for older South Carolinians.

Parental Rights to Child Healthcare

HB 3011, the “Parental Rights in Education Act,” would codify parental authority over their children’s upbringing, education, healthcare, and mental health. The bill would prevent the state from substantially burdening these rights and require parental consent in specific circumstances. It also would provide a legal avenue for parents to seek remedies if they believe their rights under the law have been violated. If enacted, the legislation would establish clearer parameters for parental involvement in education and healthcare decisions while outlining the state’s responsibilities and limitations. HB 3118, called the Parental Bill of Rights, and HB 3638 are similar bills.

Mental Health

HB 3088 aims to address behavioral health needs within the justice system, proposing a pilot program in select South Carolina counties to provide an alternative to incarceration for certain offenders with behavioral health disorders. The program would offer treatment, vocational training, and support services, with eligibility determined by established criteria. It also mandates data collection and reporting to assess effectiveness and creates an advisory council and trust fund to support implementation.

HB 3478 would enact the “Mental Health in Schools Act,” aiming to establish annual mental health screenings for students in grades 6 through 12 to address unmet mental and behavioral health needs and improve outcomes for young people. The bill would create a Mental Health Screening Program within the state Department of Education, outline its responsibilities, and mandate additional services and requirements related to student mental and behavioral health.

Other Healthcare Bills

Restructuring Departments

HB 3613 would create the Executive Office of Health Policy to oversee and coordinate the work of several health-related departments, including Health Financing, Public Health, Aging, Intellectual and Related Disabilities, and Behavioral Health. It outlines the responsibilities of the office and its secretary and includes provisions for service contracts, technical corrections, and the reorganization of certain departments to streamline health policy and administration in South Carolina.
SB 2 would create the Department of Behavioral Health and Developmental Disabilities, consolidating the Offices of Intellectual Disabilities, Mental Health, and Substance Abuse Services. The bill would transfer duties from existing departments to the new entity, update public health powers and emergency procedures, and make related changes to streamline health services administration in South Carolina.

Insurance

HB 3089 would require hospitals and medical providers to file insurance claims with a patient’s health insurer for reimbursement of medical costs and expenses.
HB 3302 would enact the “Stop Surprise Bills Act,” prohibiting insurers and healthcare providers in South Carolina from engaging in surprise billing practices.
HB 3566 would enact the “Fair Claims Accountability Act,” creating the Healthcare Claims Consumer Assistance Program. The bill would prohibit health plans and insurers in South Carolina from wrongfully denying or inadequately covering valid consumer insurance claims.

Children’s Healthcare

HB 3586 would require issuers of individual health insurance in South Carolina to provide coverage for minor children, regardless of their dependent status. It would also mandate that individual and group health insurance policies include coverage for maternity care, which the bill explicitly defines.

Studies

HB 3610 would establish the Healthcare Market Reform Measures Study Committee to evaluate and recommend improvements to the healthcare market in the state.
HB 3568 would establish the South Carolina Minority Health Disparities Study Committee to identify and address health disparities among racial and ethnic populations in the state.

Healthcare Policies on Patient Communication and Advocacy

HB 3615 would prohibit healthcare facilities from initiating discussions about ”Do Not Resuscitate” orders with patients or their family members, except under specified circumstances.
HB 3623 would require hospitals to provide patients’ families a list of agencies where complaints about a healthcare provider or facility can be reported.
HB 3657 would require hospital attending physicians to consult with a specialist physician treating a patient if requested by the patient, their family, or another authorized healthcare decision-maker.

Vaccines

SB 54 would enact the “Medical Informed Consent Act,” banning vaccine mandates, protecting employees from penalties for vaccine refusal, and allowing pharmacists to refuse prescriptions under certain conditions. The bill would update quarantine rules, limit asymptomatic quarantines to 21 days, require monitoring of vaccine safety, and remove licensure requirements for healthcare providers to administer vaccinations.

State Budget

Gov. McMaster has proposed a $41.6 billion state budget for the upcoming fiscal year, representing a $1.7 billion increase from the previous year’s proposal as a result of South Carolina’s booming economy, which has generated a significant budget surplus. Some specific allocations in the governor’s proposal, which will be reviewed and likely revised by lawmakers, include:

Healthcare

$100 million for a neurological hospital to be operated by the University of South Carolina

Workforce Development

$95 million for scholarships for students at technical colleges

Disaster Relief

$50 million for Hurricane Helene-related costs$40 million to replenish disaster relief funds
$150 million for a new South Carolina Public Assistance program

Income Tax Cut