Georgia’s Medicaid, PeachCare ranks still on the rise

Georgia is among the states that chose not to expand Medicaid eligibility standards as the health care law — officially the Affordable Care Act — envisioned. But state officials believe that when uninsured Georgians begin seeking health insurance as the law requires, many will discover that they qualify for Medicaid or PeachCare for Kids under the criteria already in place.

That alone could cost the state an additional $55 million over the two years, according to projections by the state Department of Community Health.

Although Georgia’s economy is on the rebound, experts say the growing reliance on government-funded health care reflects the state’s persistently high rates of unemployment and people who are uninsured.

“Georgia has seen a less-than-stellar recovery,” said Pat Willis, executive director of the Voices for Georgia’s Children. “We continue to see a rise in poverty.”

For Cheryl Plowden and her family, the recession never ended.

In 2011, her husband, who had been self-employed for 17 years, died of cancer. Plowden’s children qualified for PeachCare, for which she pays $52 a month.

“We are not middle class anymore,” said Plowden, 49, of Fayetteville. She stays home to care for a daughter who was recently diagnosed with Lupus and kidney disease.

Since June 2009, when the nation’s economy began to grow again, Georgia’s Medicaid and PeachCare rolls have seen a bump of 15 percent, or about 240,000 additional people, according to DCH figures. The vast majority receive Medicaid. (The state calculates the annual numbers based on the average enrollment for each month. Figures for fiscal 2013, which ended June 30, are still being finalized.)

The programs are expected to gain another 80,000 people next year.

The bulk of Medicaid spending, 58 percent, goes to provide care for people who are blind, disabled or who require nursing home care and have exhausted their own resources. Adult Georgians who are poor but able-bodied do not qualify for Medicaid.

Medicaid also serves pregnant women and children whose families are poor. PeachCare provides health insurance for children of the working poor, who have somewhat higher incomes.

The federal government pays about 66 percent of the Medicaid bill and 76 percent of PeachCare. Georgia spends less on its average recipient than any state but California, according to research by the Kaiser Family Foundation. Nevertheless, the two programs represent nearly 16 percent of state revenues, according to DCH. That share has increased markedly since 2000, when it was just over 10 percent.

The future of Medicaid is a sore subject between Georgia and the Obama administration. The expansion of Medicaid was a key element in the health care act’s effort to extend coverage to all Americans. But the Supreme Court found that the federal government could not force states to make Medicaid available to more residents.

In Georgia, opening the program to people with somewhat higher incomes would have brought an estimated 650,000 more people into the Medicaid ranks by 2019. Gov. Nathan Deal refused to expand the program, saying it would cost the state an estimated $4 billion over 10 years — a price Georgia taxpayers can’t afford.

A joint committee of members of the state House and Senate recently began analyzing how the state can best meet the health needs of those who lack private insurance without overburdening taxpayers.

Deciphering enrollment trends in Medicaid and PeachCare can be complicated. For instance, although the recession began in December, 2007, both programs saw decreases in enrollment during 2008. Some advocates attribute that to DCH implementing stricter requirements on proof of identity, income and citizenship.

As for why the rolls continue to grow even as the economy improves, state officials and experts point to several factors. The most obvious is that the state’s population is growing — although not nearly as fast as the number of people enrolled in the two programs.

Beyond that, DCH spokeswoman Pamela Keene cited the lingering effects of the recession, the aging of the population, an increasing awareness of the programs, and a policy change that allowed thousands of children of state workers to shift from the state health insurance plan to PeachCare.

Timothy Sweeney, director of health policy for the Georgia Budget and Policy Institute, pointed to a decade-long national trend of fewer employers offering health insurance. DCH’s growing caseload “indicates private health insurance is not available to a lot of people in this state.”

Tricia Brooks, a senior fellow with the Georgetown University Center for Children and Families, said that in the past Georgia also had a lot of people who qualified for the programs but didn’t enroll. That gave the programs lots of room to grow, she said.

“The high growth has occurred in those states that traditionally have not done as good a job in enrolling people,” Brooks said, citing Florida and Texas.

Whatever the reason, studies have found lower rates of enrollment in Georgia than most states. Only 13 states have a lower percentage of their non-elderly population enrolled in Medicaid, Kaiser found.

Only three states have more children who qualify for government-paid health care but who remain uninsured, according to the Urban Institute. But, post-recession, Georgia did see a dramatic increase in child enrollment, the Georgetown center found.

It wasn’t just that more families sought help because the recession threw them into crisis, Brooks suggested. It’s that they passed the word.

“More and more people are finding out about programs they qualify for,” she said.

For Plowden, PeachCare makes the difference between scraping by and insurmountable debt.

With it, she pays $20 a month – instead of more than $1,000 — for the eight medicines that her 11-year-old daughter, Jasmine, takes daily. Visits every two weeks to two doctors cost $6 instead of hundreds.

“Without it, I wouldn’t be able to buy her medications,” she says. “We would probably be homeless.”