EXCLUSIVE: Georgia is cutting off Medicaid for 17,000 patients

Georgia cutting off Medicaid for 17,000 patients

The state is terminating Medicaid assistance for about 17,000 poor elderly or disabled Georgians, it says, as lawyers for some of them call the move a giant mistake.

The state Department of Community Health said the 17,000 had simply not responded to renewal notices informing them how to continue their coverage. Patients interviewed by The Atlanta Journal-Constitution say they never received renewal notices, and their lawyers say their clients’ Georgia Gateway computer accounts show that no such notices were ever sent.

Instead, they say, if they received any notice at all it was a cancellation notice.

Louis Askew, a 70-year-old Army veteran who depends on Social Security, received a cancellation notice from the state last month. Like the others, he is on Medicare, but he has so little money that Medicaid steps in to fill Medicare’s gaps. Medicaid pays his Medicare premium of more than $100 per month, as well as prescriptions and co-pays.

Or it used to. Out of the blue, he says, he received a notice saying his benefits were already denied. He called the lawyers listed on the notice and they took his case.

> RELATED: What to do, how to appeal if your Georgia Medicaid benefits were cut

Lawyers from Georgia Legal Services, a nonprofit organization that is working for some of the affected patients, have written to the state Department of Community Health to get the move reversed and ask for concrete information about how and why the notices were sent and how many people are affected.

“We represent some of the most vulnerable people in Georgia, seniors and disabled Georgians who will not have access to health care if these programs are ended” for them, said Vicky Kimbrell, a Georgia Legal Services attorney. “The computer and administrative errors that cause these terminations should not be allowed to happen and cause this harm to people.”

Terminating people’s Medicaid without first sending a renewal notice if they’re eligible is a violation of the law, Kimbrell said. Trying to figure out what happened, she speculated that maybe the annual cost-of-living increase for some Social Security recipients lagged behind the DCH’s corresponding increase to Medicaid thresholds. But even if so, she said, the DCH is prohibited from terminating assistance because of such lags. In any case, she said she still didn’t know because the DCH had not responded to the organization’s request for clarification as of Thursday afternoon.

Georgia Legal Services declined to comment further on how it learned about the mass disenrollment.

DCH officials told The Atlanta Journal-Constitution that the 17,000 people losing their benefits had failed to respond to renewal notices.

“It is important to note that the number represents individuals with overdue renewals who had been nonresponsive to the notices they received at the time they were up for renewal,” a DCH spokeswoman, Fiona Roberts, said in an email. “When their eligibility was up, they had not responded to their notices, therefore, their cases were closed because they did not complete the renewal process.”

Roberts added that “these individuals may submit either a renewal or application form to (the Division of Family and Children Services) in the three months after their closure (i.e. June through the end of August), and if they still qualify based on their current circumstances, their coverage will be reinstated back to the first of June.”

The notice received by Georgia Legal Services clients does not say that. In one place, it says they have 30 days to ask for a hearing to appeal. In another place, it says 10 days.

Either way, that’s days from the date on the notice; Askew says he got his notice two weeks after the date printed on it.

About 2 million Georgians receive care under Medicaid, a state-federal public health program for the poor, disabled and elderly living in nursing homes. The Georgians affected so far receive a scaled-down version of Medicaid that fills in gaps in Medicare benefits. Their Medicare enrollment did not appear to be affected.

The DCH contracts with DFCS to determine Medicaid eligibility, since that agency already measures eligibility for poor families seeking food stamps and other services. DFCS referred questions about the issue to the DCH.

The clients who called the nonprofit lawyers received a notice from the state titled “Change Results.” It said their Medicaid benefits were denied and payments would be stopped. It included a form at the end to ask for a hearing if the client disagreed with the decision.

What they should have received, and many did in the past, Kimbrell says, is a notice titled “Renewal.” A renewal tells them coverage will be terminated if they don’t renew, and it provides information about how to renew.

If their terminated clients go on the Georgia Gateway computer system that manages their accounts, there is no button for renewal, the lawyers say.

Askew said the state sent him the termination notice after the deadline to appeal had already passed. He said there’s no change in his income that would put him over the $1,041 monthly household income limit for receiving the Medicaid assistance.

Lily Foster, 77 and a stroke victim who lives near Vidalia, said nothing has changed in her financial circumstances or her need for the coverage. Her only income comes from Social Security, at less than $1,000 per month.

But suddenly her Georgia benefits dropped off. She didn’t even know it until a lawyer who was trying to figure out why she lost food stamps looked through her file and found the Medicaid notice.

Both Foster and Askew went to state offices themselves to try to figure out why their benefits were being cut off, they say, but they were unable to get answers.

Medicaid pays for Foster’s medications, more than 10 of them. Most important, she says, it also helps her with transportation for health care when it’s not an emergency. “I would have no way of getting anywhere, to doctors appointments or anywhere, without Medicaid services,” Foster said.

She’s had a recurring need for rehabilitation work following her stroke, and she recently spent six weeks at a physical therapy facility in Vidalia.

“If it weren’t for Medicaid, I wouldn’t even be able to talk to you,” Foster said.

She still believes the state didn’t mean what it said, and that her lawyers will get it fixed. If she is truly cut off from Medicaid, she said she’s not sure how to describe her reaction.

“You mean without a four-letter word?” she asked.