Georgia, like all other states, is asking everyone who is on Medicaid to re-apply for benefits under the government’s safety net health insurance program. Everyone on Medicaid was automatically extended for three years during the federal pandemic emergency, but the annual verification system is about to start back up.
Most Medicaid enrollees will either reapply and continue their Medicaid insurance, or switch to another kind of insurance. But some, as many as 128,000 by one estimate, will be dropped off Medicaid and wind up uninsured. Experts expect a substantial number to drop off who are actually eligible for coverage, just because of mistakes or bureaucracy. One of the most common destinations for new insurance, the Affordable Care Act’s marketplace exchange, requires individuals to proactively apply.
Here are some tips, phone numbers and resources to help through the process.
The overall process of Medicaid reapplications, technically called “redetermination,” is expected to get rolling in large numbers on April 1. It will happen in spurts and last for 14 months. (There are reports that a few Medicaid enrollees have gotten their letters early, but those are outliers.)
Georgia has more than 2 million people on Medicaid now, and the agencies in charge of the process plan to go through them in batches, taking up batch after batch over the course of 14 months.
Whenever each person is notified that it’s their time, they will have just over a month to submit their paperwork.
To know when their reapplication date is, Medicaid enrollees should go to their Gateway accounts. When a person has been put in a batch and assigned a reapplication deadline, the date should be posted there.
Georgia has 2.7 million Medicaid enrollees, according to Department of Community Health Commissioner Caylee Noggle. All of them must be re-verified. The state usually does this annually, but during the national pandemic Public Health Emergency, everyone who got on Medicaid was allowed to stay on, no matter what. Georgia’s Medicaid rolls grew by 41%.
The redetermination process will be administered by the Georgia Department of Human Services, through its Division of Family and Children Services. Another state agency, the Department of Community Health, actually oversees Medicaid, but DFCS caseworkers run the eligibility services under contract to DCH. So paperwork and emails for reapplications will be coming from the DHS and DFCS. If they say “redetermination,” they’re talking about this application process.
Each person should check their Gateway account to make sure it has their correct contact information.
People going through the process must make sure that DHS or DFCS can communicate with them. Some advocates are really worried about people with changed addresses, phones or emails falling through the cracks.
Just because patients have been able to use their Medicaid insurance to see doctors, that doesn’t mean it’s in their Gateway account. Their doctor’s office may have received their new phone number or new email address or change of mailing address, but that doesn’t mean the doctor sent it to the Medicaid insurance company or that the insurance company sent it to Medicaid’s eligibility caseworkers at DFCS.
The patient’s Gateway account, online on the internet, is the enrollee’s place to update and be updated.
If you don’t have internet to manage your Gateway account, or you’re helping someone who doesn’t:
- Call DHS/DFCS at 1-877-GA-DHS-GO (1-877-423-4746)
If you are hard of hearing, deaf-blind or have difficulty speaking:
- Call that number above by dialing 711 (Georgia Relay)
If you don’t have a phone or internet, or you’re helping someone who doesn’t:
DFCS will accept a “point of contact,” another person besides the enrollee who can communicate on their behalf. But the enrollee must establish that person as their point of contact. In metro Atlanta, for example, the health care charity Mercy Care acts sometimes as a point of contact for its own patients.
When the process gets going, the enrollee should receive a letter or email or both — whichever method of communication they have designated as preferred in their Gateway account — with instructions.
The applicant will probably have to submit paperwork, including paperwork related to their income. Even if they have no income, they will have to submit proof that they have no income. There are expected to be instructions about that.
If the person is told they no longer qualify for Medicaid, they’ll have the opportunity to appeal.
One quirk: If they’re found to no longer be eligible this spring, there’s a possibility they might be eligible starting July 1. The state of Georgia might open up a new Medicaid program July 1 for people who perform certain activities like working at least 80 hours a month. That hasn’t been confirmed yet, though.
On the internet:
- The Medicaid member’s Gateway account is ground zero for all this activity.
- In addition, the state has set up a special website for the process, with sections for help and frequently asked questions: https://staycovered.ga.gov
Every county but one, Spalding, has a DFCS office. Not every office is open every day. To find a location and its hours, go to this link: https://dfcs.georgia.gov/locations
However, if you want to just walk in, it depends on what you want to do.
DFCS offices accept paperwork being dropped off.
But to get in-person help on a case or get questions answered, the applicant must make an appointment before going to the office, according to DFCS. For people who work unpredictable shift jobs, getting help by phone instead may be better.
WHAT ELSE? THE ACA
If the person loses their Medicaid, they may be eligible for health insurance at no cost or low cost on the Affordable Care Act’s marketplace exchange, also known as Obamacare. The ACA usually allows people to enroll only in the fall, but people who are made to drop their health insurance are eligible for a special enrollment period.
ACA plans are only for people who make more than the federal poverty level. That’s at least $14,580 per year for an individual, for example, or $30,000 per year for a family of four. For these plans, the government steps in and subsidizes the coverage depending on the person’s income level so that the monthly premium and the copays are affordable.
The state is hoping to do a good job of letting people who get dropped from Medicaid know about the ACA resources, but it still helps to ask.
Here are some resources.
- Healthcare.gov is the federal website where people can go to input their income level and household information, see the plans they would qualify for, and sign up for one. It also has a phone number with navigators: 1-800-318-2596. For the hearing-impaired TTY: 1-855-889-4325.
- Healthsherpa.com is a privately run version of the federal marketplace. It only shows federally qualified ACA plans, and some ACA agents say it is easier to use than the federal site. They also have phone customer service at 1-855-772-2663.
“Navigator” is a special term for guides who are certified to help people sign up for ACA plans as well as to figure out if they qualify for something else like Medicare or Medicaid. Georgia has a number of offices for Navigators.
- The Georgia Association for Primary Health Care (GAPHC, statewide): 1-844-442-7421
- Georgia Legal Services Program (Georgia ENROLL, only in 45 rural Georgia counties): 1-866-442-3676
- Mercy Care (Fulton and DeKalb counties): 678-843-8527