The South Carolina General Assembly’s 2026 session will convene January 13. Under the leadership of President of the Senate Thomas Alexander and Speaker of the House Murrell Smith, Jr., in conjunction with Governor Henry McMaster, lawmakers are expected to take up a broad agenda including tax policy, education, public safety, governance reforms, and infrastructure needs amid rapid population and economic growth.
2026 is a major election year, and campaigning will dominate much of the year. Unfinished business from 2025 will also carry over into the 2026 session.
Below is an overview of key policy proposals that lawmakers will likely consider during the 2026 session.
Budget
Governor McMaster will submit an executive budget shortly after the legislative session begins in January. South Carolina’s official general appropriations bill will be introduced following the governor’s budget.
The South Carolina Policy Council’s 2027 South Carolina Responsible Budget highlights continued revenue growth but cautions against expanding recurring spending faster than long-term revenues can support. The report urges lawmakers to prioritize core services, limit reliance on one-time funds, and align tax relief with sustainable budget capacity.
Rural Health Transformation Program
The Rural Health Transformation Program (RHTP), a program created under the One Big Beautiful Bill Act (OBBBA), will award $50 billion in state grants between 2026 and 2030. The program is designed to support rural healthcare access, workforce capacity, technology modernization, and infrastructure investment.
South Carolina Department of Health and Human Services (SCDHHS) submitted the state’s application in November 2025, and CMS announced first-year grant awards for all 50 states. South Carolina will receive more than $200 millionfor the remainder of federal fiscal year 2026. Additional details on implementation are expected from SCDHHS.
South Carolina’s proposed RHTP initiatives focus on strengthening rural health systems through several key efforts:
- Connections to Care: Utilizing technology to connect providers and patients
- Wellness Within Reach: Bringing care directly to communities
- Leveling Up: Taking successful pilot projects statewide
- Shoring Up to Sustainability: Investing in infrastructure and workforce
- Tech Catalyst Fund: Seed funding for innovative, startup health companies
Healthcare Workforce
Several healthcare-focused proposals introduced in 2025 align closely with provider operations, workforce stability, and facility compliance.
H 3480, the Healthcare Workplace Security Act, would expand assault-and-battery provisions and definitions tied to offenses committed within healthcare facilities against healthcare workers.
H 3875, the Perinatal Integration Act of 2025, would require the Department of Public Health to promulgate regulations integrating midwives and birthing centers into the organization of perinatal levels of care. If the bill advances, much of the practical impact will shift to rulemaking and licensure compliance expectations.
Scope of practice and care delivery model bills that remain active include:
- H 3580 would grant full practice authority to advanced practice registered nurses (APRNs) who meet certain criteria
- H 3579 would modernize physician assistant (PA) practice authority, supervision, and board representation, including attestation-based practice for experienced PAs.
- S 669 would create a team-based healthcare framework for PAs, APRNs, and anesthesiologist assistants (AAs), and directs development of incentives to support collaborative care.
Surgical Smoke
S 170 would require licensed facilities to adopt policies requiring the use of surgical smoke evacuation systems during applicable procedures and includes a July 1, 2026 effective date framework with delayed compliance for certain hospitals.
Tax Policy and Affordability
Income tax reform will be a main focus in the 2026 session. The primary House bill is H 4216, an income tax restructuring bill that would begin changes in tax year 2026 and establish standards for future reductions. The bill is a major restructuring of the tax base and rate structure.
Because the Senate did not take up H 4216 in 2025, a central question for 2026 is whether House and Senate leaders can align on timing and impacts while maintaining recurring budget capacity.
Tort Reform and Medical Malpractice
Tort reform is expected to return as a dominant 2026 issue, with medical malpractice policy positioned for renewed attention.
- S 244, Tort Reform, a broad package that touches multiple civil liability concepts and is expected to remain a focal point in the tort reform conversation.
- H 4544, a more targeted malpractice-related option, would amend provisions tied to noneconomic damages and related liability concepts.
Education
Education will remain a high-interest topic in 2026 as lawmakers continue implementing and expanding school choice programs while addressing public school funding pressures.
The South Carolina Department of Education reported that the Education Scholarship Trust Fund program reached the 10,000-student milestone for the 2025-26 year. Related legislation, S 692, proposes changes to Education Scholarship Trust Fund definitions and the application and certification process. Continued refinement of program guardrails and administration are expected in 2026.
