MUSC Health is the dominant health system in the market, leaving Trident Health and Roper St. Francis Healthcare to vie for the No. 2 spot. And for the moment, Trident Health has jumped ahead of RSFH for the second position. Health systems in Charleston are scrambling to build facilities in the medically underserved Berkeley and Dorchester counties in order to drive growth in patient volume and gain favor with payers, and they are targeting lucrative and needed service lines. Renovations and new facilities include MUSC Health’s $355 million MUSC Shawn Jenkins Children’s Hospital and Pear Tourville Women’s Pavilion, Trident Health’s $24 million emergency room expansion at Summerville Medical Center and its new freestanding emergency room in Summerville, and Roper St. Francis Berkeley Hospital, which opened in 2019. BlueCross BlueShield of South Carolina is the dominant insurer in the market and state and relies on its clout and size when doing business, leaving it to health systems to drive change. The Centers for Medicare & Medicaid Services has approved the state’s Medicaid work requirement. If implemented, the work requirement could result in some recipients losing Medicaid benefits and decreased enrollment for Medicaid MCOs.


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