On April 1, the clock starts ticking for hundreds of thousands of poor, disabled or elderly Georgians who face the loss of their Medicaid health insurance. The majority are children.
For three years, no one enrolled in the government program has had to renew their paperwork to prove that they still qualified. Existing cases automatically stayed on, and new enrollees were added in droves during the pandemic. The Medicaid rolls in Georgia swelled by 41%, according to the Georgia Budget and Policy Institute.
That is about to change. The emergency pandemic protections that were first enacted in March 2020 for Medicaid enrollees all across the country are now starting to expire. In Georgia, starting April 1, all who are currently insured by Medicaid must reapply to continue receiving benefits — a population totaling 2.7 million, according to Department of Community Health Commissioner Caylee Noggle.
Those who don’t update their papers — or who no longer qualify — will be dropped from the program. Estimates of those at risk in Georgia range from 240,000 to 560,000.
Those could include poor kids who have now turned 19 and aged out, and poor moms who had Medicaid because they were less than a year out from giving birth, but have passed that time boundary.
Others, perhaps 45% of the total disenrolled, according to federal predictions, will lose coverage for procedural reasons even though they’re still eligible. That could mean they didn’t reapply, or that they or Medicaid workers made a mistake, like using an outdated address to communicate.
Analysts at the University of Chicago working with AHIP, the national advocacy group for insurance companies, estimated that 128,000 Georgians will be removed from Medicaid and simply wind up uninsured.
AHIP predicted that the most common destination, for 49% of those disenrolled, would be to an employer-sponsored health plan. Others might enroll in plans on the Affordable Care Act marketplace, or in military plans.
Federal analysts expect as many as 17% of enrollees nationwide will no longer qualify. Many of those will find alternate coverage, for example in the subsidized ACA plans. But in Georgia, there is more risk than in other states that a disenrollee who makes less than the poverty level won’t have options for new coverage. Georgia is among a small number of states that do not offer Medicaid to all poor adults — only adults in certain circumstances.
“A huge undertaking”
The looming process of re-certifying coverage for Georgia’s 2.7 million enrollees promises to be a formidable challenge for state officials.
“This is going to be a huge undertaking,” Caylee Noggle, commissioner of the Department of Community Health, told legislators earlier this year. Her agency oversees Medicaid in Georgia.
Some enrollees may lose coverage through bureaucratic snafus.
“I’m nervous,” said Laura Colbert, executive director of Georgians for a Healthy Future, a health care advocacy nonprofit.
“This is going to be the biggest coverage event since the implementation of the Affordable Care Act,” she said. “Our state agencies are historically not well resourced and can struggle to fulfill their mission... I’m concerned for Georgia families that policymakers have not invested enough resources, and as a result won’t be successful.”
However, Colbert added, “I’ve also seen evidence that people with the state are being thoughtful, so that gives me some optimism as well.”
Two state agencies have been preparing for months —The Department of Community Health, which oversees Medicaid, and the Division of Family and Children Services, whose staffers process eligibility cases under contract to DCH and make eligibility determinations.
While some enrollees will become uninsured, others won’t lose all hope of coverage, but will need to transition to something different if they make enough money. Those whose income exceeds the federal poverty level, $14,580 for an individual or $30,000 for a family of four, for example, can be referred to subsidized health plans under the Affordable Care Act that can be low-cost or free.
A spokeswoman for the agency that oversees DFCS, Kylie Winton, said the state is planning to spend “tens of millions” of dollars on the redetermination effort, perhaps $26 million in state and federal funds, when all is accounted for. That’s in addition to more funding that has been allocated to hire new eligibility caseworkers.
The state has begun telling Medicaid enrollees to update their addresses in their online Medicaid account, called Gateway. There they may see the deadline date they’ve been assigned, which could be any time over 14 months. If they follow prompts and go to the state’s website, they’ll see messages about the coming need to re-apply. Just over a month before their date, they should receive a letter or email with details.
The state has prepared emails and letters to send to all enrollees, regardless of circumstances. It has spent money on new computer software, and has established a website with tips. It plans to take on the cases in batches, through March 2024. It has received state funding for 450 new caseworkers to help handle the load. It has hired more than 270 new workers since January. “We would love any help amplifying our postings,” the department said in a statement, providing a link.
In addition to starting redeterminations this year, the state tentatively hopes to open up its new, limited expansion of Medicaid on July 1. If the program launches, those workers will have to administer a new set of eligibility requirements the state has never used before, including work and engagement requirements. The new program could end up adding 90,000 people to the Medicaid rolls, state officials have said.
What concerns Cynthia Gibson most in her job as an independent advocate is the possibility that people who should be on Medicaid will get kicked off because of a mistake either they make, or that the state makes in trying to reach them or process their casework.
Gibson is an attorney who oversees help for Medicaid enrollees at the nonprofit Georgia Legal Services Program. When people get knocked off Medicaid, they get a notice that has her program’s phone number, among others. They call her staff, and her staff tries to resolve the problem. She’s been doing such work for years.
For about a year, Gibson said, she hasn’t been able to get a DFCS manager on the phone to resolve problems. DFCS has been hit with both a caseworker staff shortage and resignations among management, she said.
A heightened risk
Georgians will first be advised by a DFCS notice of the need to be re-certified — if DFCS is able to reach them.
DFCS has sent notices and planned a publicity campaign to ask people to update their current preferred address, U.S. mail or email or both, in their Gateway account.
The risk of not having a current address for an enrollee “is particularly heightened because the Medicaid population is relatively transient with less stable housing, and some Medicaid enrollees may have had no contact with DHS since the beginning” of the pandemic in March of 2020, said a state auditor’s report.
Ashley McKenzie, who works to get poor people enrolled in Medicaid for the Atlanta charity clinic Mercy Care, says contacting enrollees will be complicated because Medicaid serves a vulnerable population.
“Everybody doesn’t have a phone,” she said.
Jack Grote, an attorney who works with low-income people, said he expects there will be a lot of Medicaid recipients who are unfairly cut from the health coverage over the next couple of months.
“We’re going to be seeing a lot of people who are on Medicaid for the first time, who haven’t been through this process before,” said Grote, who works with Atlanta Legal Aid, a nonprofit law firm that serves low-income people in the metro Atlanta area. “We anticipate that there’s going to be some errors.”
AJC reporter Katherine Landergan contributed to this story.
EDITOR’S NOTE: This story has been updated to note that the state’s latest budget funds 450 new caseworkers for the extra Medicaid work.
MEDICAID RENEWAL TIPS
All Medicaid recipients must renew their eligibility status every year in Georgia. That requirement was suspended during the pandemic. But now it’s back.
- The state has established a website with tips for enrollees: https://staycovered.ga.gov/
- Enrollees should start by logging into their Gateway accounts to manage the redetermination process.
- If you’re on Medicaid, make sure that the state has your updated mailing address.
- Make sure to check your mail and keep an eye out for any letters from the state.
About the Author