A call by more than two dozen governors, including Georgia Gov. Nathan Deal, for more flexibility in deciding who qualifies for Medicaid has advocates concerned the state could cut services to some of its neediest residents.
Governors have asked the Obama administration to eliminate a rule created by the federal health care overhaul that requires states to maintain current Medicaid eligibility standards. They argue that more leeway is needed to make tough budget decisions and better manage Medicaid based on states’ unique needs.
States are facing estimated budget gaps of at least $145 billion in 2012 and 2013, according to the National Conference of State Legislatures. Georgia’s budget shortfall is estimated at up to $2 billion for fiscal 2012, which begins in July.
“The Obama administration has states locked in,” said Stephanie Mayfield, Deal’s press secretary. “In order to find the best avenue to ensure that Medicaid is efficient, accountable and sustainable for Georgians and their families, the states need flexible adjustments to plan accordingly.”
No specific changes to eligibility currently are being considered, though the state would explore options if the requirement was lifted, Mayfield said.
Right now, states are required under the Affordable Care Act to keep coverage stable for adults in Medicaid until Jan. 1, 2014, when the insurance exchanges will kick in, and for children in Medicaid and the Children’s Health Insurance Program until Sept. 30, 2019.
Advocates worry that ending the mandate could mean some needy children, pregnant women and others might no longer qualify for coverage. Medicaid and PeachCare for Kids, Georgia’s CHIP program, cover about 1.6 million poor and low-income residents.
New eligibility limits would add to the ranks of Georgia’s uninsured residents, putting greater strains on emergency rooms and local health departments, said Tim Sweeney, a health care analyst for the Georgia Budget and Policy Institute.
In 2009, Georgia had the fifth-highest rate of adults under the age of 65 who lacked insurance at 22.5 percent, or 1.9 million people, according to Georgia State University. Nationally, 18.9 percent were uninsured.
Cutting eligibility would mean losing out on hundreds of millions of dollars in federal funding, as well as increased costs in uncompensated care in emergency rooms, said Linda Smith Lowe, a consumer health advocate.
Starting in 2014, the Medicaid expansion will add an estimated 650,000 people to the state’s Medicaid rolls, according to a study by the Kaiser Family Foundation. The report estimates the added cost to the state at $714 million between 2014 and 2019, while the federal government would contribute $14.5 billion. The governor’s office has projected that expansion will cost the state $2.5 billion during the next decade.
Georgia already has stricter eligibility standards for Medicaid than some states, said Cindy Zeldin, executive director of Georgians for a Healthy Future. “The last thing we want to do right now is cut back when we have to go the other direction.”
For children ages 6 to 19, Georgia’s Medicaid program covers up to 100 percent of the federal poverty level, compared with states such as South Carolina that cover 150 percent of the federal poverty level or more, according to Kaiser data. Georgia also covers low-income parents up to 50 percent of the federal poverty level, compared with states such as Arizona that cover 100 percent of the federal poverty level or more, Kaiser statistics show.
PeachCare could be vulnerable to eligibility changes, Sweeney said. The program covers roughly 200,000 children whose parents earn too much to qualify for Medicaid but not enough to afford private insurance.
The governor already has proposed Medicaid changes in fiscal 2012, including increasing co-pays ranging from 50 cents to $3 depending on the service to 60 cents to $3.40. Co-pays for inpatient treatment would jump from $12.50 per admission to $55.45. Co-pays also would be expanded to include PeachCare children ages 6 or older.
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