On the department’s websites, on its phone lines, at its offices, many people like Jackson report a broken customer service system. They cite conflicting or confusing information, lost paperwork, full voicemail boxes. The last-ditch solution offered — coming in person to the agency’s office — often ends with a face-to-face plea for a call from a caseworker, or would-be enrollees encountering a locked door.
And yet this system has never been more important. Jackson is at the center of a once-in-a-generation shift in Georgia Medicaid, the state’s health coverage for low-income families and individuals. It affects one-quarter of the state’s population.
Up until this past April, Americans who signed up for Medicaid during the pandemic were allowed to keep the medical coverage without an annual review of their situation. But that federal amnesty has ended, and states have resumed their yearly evaluations.
In Georgia that means determining if 2.8 million enrollees still qualify, or if they will be kicked off the Medicaid rolls. The state plans to catch some of those people who don’t qualify in a safety net by offering new Medicaid coverage, with different requirements.
Spearheaded by Gov. Brian Kemp and launched July 1, the long-awaited program is called Georgia Pathways to Coverage. It offers Medicaid to working-age adults who file monthly reports showing they are employed at least 80 hours a month, or perform other specific activities, such as attending higher education and volunteering at a registered nonprofit.
Between those newly kicked off and those who never had Medicaid in the first place, the state says its new program is an option for 370,000 uninsured adults.
So far, however, the state’s efforts to evaluate eligibility while launching Georgia Pathways have produced grim results. Medicaid coverage for more than 320,000 Georgians has been dropped. Most of those terminations happened because the state believes enrollees never sent the required paperwork for reevaluation. Meanwhile, the Pathways program has enrolled fewer than 2,000 people. Many people don’t even know about the program because it hasn’t been well publicized.
State officials say they’re doing everything they can.
“We must follow federal and state rules to deny someone whose eligibility cannot be verified,” a spokeswoman for the Department of Human Services said in a written statement. “But we are working tirelessly to help all eligible Georgians keep their coverage. The state is notifying members in as many ways as possible and enhancing its systems to prevent avoidable denials.” She noted the state has created an additional website to guide people through the Medicaid changes, staycovered.ga.gov.
But some advocates fear that the significant loss in coverage is due to numerous roadblocks in the system, which average consumers are ill equipped to navigate, and that some of the new requirements are harder to fulfill than officials realize.
“We’re seeing ... lots of people being terminated from Medicaid when they are still eligible” — people who have filed the correct paperwork as required, said Cynthia Gibson, an attorney for Georgia Legal Services Program.
Women who are pregnant have been dropped. Families have seen one child disenrolled while another child is declared eligible. “I’ve no idea how it’s happening,” said Gibson.
And that’s with Georgia Legal Services assisting would-be enrollees.
Jack Grote, another attorney who helps people navigate Georgia Medicaid, said he took a long time to learn the system and has clear thoughts on what navigating it must be like for average people.
“I think it’s a nightmare,” Grote said.
Who qualifies for Medicaid?
Medicaid helps Jackson manage a long list of conditions. She says she has a blood disorder and has suffered life-threatening pulmonary embolisms. She’s had knee surgeries to repair a meniscus and an ACL. Those left her with arthritis and other pain. And very slowly, she is losing her sight due to an eye ailment that eventually reshapes the eyeball into a cone, a condition visible to anyone sitting to her side.
Income-wise, she says, her family scrapes by on Social Security survivor benefits, which not just fall below the $24,860 per year federal poverty level for a household of three, but also below $14,580 per year that would classify an individual as impoverished.
In most states, that low income would qualify her for Medicaid. But Georgia is among 10 states that opted out of expanding Medicaid coverage for all poor adults.
Rather than expand Medicaid to all low-income adults, the state has created about 30 categories of eligibility. Pregnant women whose income minus 5% of the federal poverty level is less than 220% of the federal poverty level, for example. Or widows between the age of 50 and 59 who receive Retirement, Survivors, and Disability Insurance benefits; or being the main caretaker for one child between 2 and 18 years old whose entire household income is a much smaller percent of the federal poverty level, amounting to no more than $5,484 annually in 2023.
Deciphering the criteria is no easy task. There is no simple list, outlining all eligibility requirements using plain language. Asked for one, the state offered an Atlanta Journal-Constitution reporter a list of 13 websites to peruse.
The search for answers
Georgia has spent millions alerting Medicaid enrollees about the reevaluations. It communicates with enrollees through email, snail mail or text messages, whichever they select. But, over the three pandemic years when reevaluations were suspended, people may have moved and changed addresses. Doctors say many Medicaid patients are learning they were disenrolled when they show up for services and are turned away because they’re not covered.
Jackson said her first tip that something was up came when she saw her food stamps account not getting refilled with the same amount. Food stamps, also called SNAP, help Jackson feed herself and her two sons at home, ages 16 and 10. Caseworkers at the Department of Human Services’ Division of Family and Children Services, or DFCS, run both SNAP and Medicaid enrollment. When it comes to Medicaid, DHS and DFCS are overseen by the state Department of Community Health.
Sifting closely through her online account on DFCS’ main internet portal, Jackson saw conflicting messages about SNAP and Medicaid. To navigate the internet, she has just a cell phone, not a personal computer.
Because Jackson has only her cell phone, she couldn’t get full instructions on what to do next. Equally important: She didn’t know it, but the word “approved” next to her name didn’t necessarily apply to her Medicaid. It could apply to her children’s.
In a statement to the AJC, a spokeswoman for the Department of Human Services apologized for Jackson’s confusing experience, but said that the mobile version of the website is intended to let users check their benefits quickly. For people who have families or multiple benefits, it’s important to use a desktop or laptop computer, she said.
It became clear to Jackson that she would need help to figure out her situation. She’d already tried speaking to someone on the phone. And appointments at DFCS are difficult to get. When people show up, they sometimes encounter a locked door. And no DFCS office in the state sees walk-ins during evening hours or on weekends.
Sharpening the impact for customers, advocates say, is that the state’s deadline for filing the needed paperwork is relatively tight — at most, 45 days.
Outside the locked glass doors at one metro Atlanta office at 4:30 p.m. this week, a handful of the thwarted people milled about reading the posted notices. One called a number listed in bold print and reached a voicemail saying walk-ins were welcomed until 5 p.m.
Dozens of people who’d made it before 4 p.m. were still waiting inside to see someone. Some who’d done their business occasionally emerged from the door. They’d waited inside for hours, they recounted, but their problems still weren’t solved.
One person said she’d been called to a window and sat with someone who listened to her complaint. But it turns out that worker was not someone who could solve issues. Instead, that worker listened, sent an email to a caseworker and told the person to give it a couple days for the caseworker to respond.
A security guard gave the frustrated crowd gathered outside candid advice. They could show up at 5 a.m. to take a numbered ticket, she said. But, even if they make it to an intake worker, they were told, most of the actual caseworkers aren’t there; they work remotely.
Seeking help 15 miles away
Jackson knew the score and didn’t go to DFCS. Instead, she headed somewhere else. Though she doesn’t have a car, she takes buses and occasionally gets rides from a friend. She went to a church parking lot near the DeKalb County line. There, the nonprofit Intown Cares runs food pantry and has a person, Tanya Davenport, who specializes in navigating the safety net programs. Once a week, Davenport sets up a folding table to give free advice. It’s 15 miles away from Jackson’s apartment in south Fulton County.
That day, Jackson needed answers: Was she still covered by Medicaid or not? If not, what changed, and what requirement did she need to meet? What paperwork did she need to send to prove it?
Davenport was once on public assistance herself and views the job as a mission.
Credit: HYOSUB SHIN / AJC
Credit: HYOSUB SHIN / AJC
But she couldn’t help Jackson, she said. Looking at Jackson’s phone, Davenport said her reading of the mobile website was just as good as Jackson’s. Like some attorneys, Davenport did not know the mobile site presents information differently than the desktop website.
After a brief conversation, her conclusion was that Jackson needed to keep trying to reach a state caseworker.
She and an exasperated Jackson stared at each other.
Davenport knew what that meant.
“You’re not getting anybody. You’re just basically getting the runaround,” Davenport explained. “Then when you do catch somebody with (space to leave) a message, what happens then is that person never calls you back.”
Others waiting in line for Davenport’s help, or for the food pantry, chimed in. Jessica Redmond said she’d been rejected from Medicaid but didn’t understand precisely why or what to do next. To demonstrate, she put her phone on speaker and dialed her caseworker and got his voicemail. Then the voicemail was full. It gave suggestions like trying for two more days, then calling his supervisor. But the supervisor’s voicemail was full too, Redmond said.
Grote, the attorney with Atlanta Legal Aid, said that, in seven years of dealing with Medicaid, he can count on two hands the number of times he’s reached an actual caseworker on the phone. He’s had clients denied for lack of paperwork after twice sending the required paperwork.
The real value of hiring a lawyer to appeal a denial, Grote said, is that the case moves up the ladder and gets someone at DFCS or above them to pay attention. But most people who are denied never appeal.
“I mean, I very much feel for the caseworkers. There’s one caseworker doing the job of five or six because the system is just so underfunded,” he said. “But, if you can’t leave a voicemail, that simply defeats the purpose.”
While it’s well known that DFCS is understaffed, the spokeswoman for the agency did not provide the number of open positions it is still trying to fill. She said DFCS currently has 2,000 employees working on enrollments, more than half having been hired this year. Forty-two are working on Pathways. “Making sure our agency is properly staffed continues to be a top priority,” she said in a written statement.
Georgia’s marquee program
After visiting Intown Cares, Jackson went back to the internet on her phone. She focused on bringing up the desktop site, and the next day her phone finally did. Sifting through the pages, she found a notice that she is approved — but only until Nov. 30. Another notice says her Medicaid will be terminated Dec. 1.
The notice referred her to the Federally Facilitated Marketplace, the official name of the Obamacare exchange, which is for people who make more than the federal poverty level.
By the state’s reasoning, if Jackson does lose her Medicaid coverage, and if her income remains below the poverty level, the new Pathways program would be exactly the thing she needs.
She didn’t know about the program. In spite of the fact the state is months into disenrollment, DHS and DCH have no contract to publicize the Pathways yet.
Pathways is for those hundreds of thousands of adults who are too old for childhood Medicaid and too young for Medicare, and who make too little money to qualify for subsidized insurance on the Obamacare exchange. The idea is if they fall in that age group, they can get a job or perform specific activities.
To qualify for Pathways, a person must file monthly documents with the state showing that the 80 hours of work, volunteering or education has been fulfilled.
But some find the state’s requirements too demanding. Miguel Clark said he had several chronic illnesses, including HIV and a mental condition. All of that and a schedule overrun by doctor’s appointments make it difficult for him to work a regular job, he said. He could be covered if he was on disability, and he was for 10 years. But his disability declaration was revoked, he said, for reasons he doesn’t understand.
Jackson has chronic pain. In addition, she isn’t sure if her illnesses allow her to qualify for the Pathways program.
She also goes to some doctor’s appointments during the day. The pain from her chronic conditions makes it hard for her to sit for long periods, so she sometimes spends hours lying in bed. Other times, she does what she called her “community service” — activities such as gathering groceries from free charities, then bringing them back to her apartment complex to set up a donation table and share with neighbors.
She says another complication is that, by 3 p.m. on school days, and on weekends, she must be home to be with her children.
They live in the only apartment she says she can afford, a complex that has been the site of more than 257 crimes since they arrived in 2013, according to Atlanta Police records. Three of those were homicides. In March, her youngest son found the most recent bullet-ridden body.
“I cannot leave them at night. They’re too young to be in the house by themselves,” she said.
It’s challenging to meet the state’s work or volunteering requirements, she said. Staying home to watch her own children is not a job as defined by the Pathways handbook, because she’s not making money. It’s not volunteering because it’s not done for a registered charity.
But she does want Medicaid. She needs those doctors appointments for her chronic conditions. Her kids are developing some too, she adds. She and her children all have asthma, she says. She thinks they got it from their moldy apartment complex.
She wishes she knew what Medicaid wants her to do.
“Stuff like this makes you want to go into a panic,” she said. “Because you’re trying to survive and you can’t.”
To the state, she says, “You’re not telling me what I need to do to go further. You’re not telling me any information.
“So how can I tell you something that I don’t know that you need? I cannot supply you with what you don’t tell me that I need.”
BY THE NUMBERS
Over the course of a year, the state of Georgia will review all 2.8 million Georgians – one-quarter of the state – who receive Medicaid, to see who still qualifies. All states must do this following the end of pandemic amnesty. From May 31, 2023 to September 30, 2023, the state had made decisions on 584,626. Here are the results so far.
278,162: The state says it received no paperwork from the person or not enough, and terminated Medicaid.
196,106: Automatically renewed using income and other data that the state found in different databases.
64,089: The person sent in forms and was renewed.
46,269: Found ineligible after caseworkers reviewed file.
Source: Georgia Department of Community Health
EDITOR’S NOTE: This story has been corrected to say that the church parking lot where Tanya Davenport manages Intown Cares’ community resources table is located near the DeKalb County line, not in DeKalb County.