Sally became a mom and it nearly cost her her life.
In early 2020, a full 4 weeks prior to her due date, Sally was hospitalized with leg swelling and difficulty breathing, telltale signs that her heart -- her baby’s vital source of oxygen --was failing. With little time to spare, her obstetrician took her for an emergency C-section.
Miraculously, Sally and her baby survived, but both would spend several tumultuous nights in intensive care. Even after their first night home together, the next months and years were a blur of doctor’s visits, medication adjustments, and uncertainty for mother and child.
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Fortunately, Sally received Medicaid while pregnant, so she was able to afford her postpartum medical care. And with the passage of the Families First Coronavirus Response Act (FFCRA), she was guaranteed Medicaid for the duration of the pandemic. However, as provisions set up in FFCRA are set to expire April 1st, Sally is at risk of losing her health insurance and, conceivably, much more.
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Georgia currently ranks 3rd-to-last in the rate of uninsured individuals, outranking only Texas and Oklahoma. This gap in coverage is driven primarily by low rates of Medicaid enrollment that have lagged the rest of the country for years. And the gap has only widened in the last decade as Georgia remains one of 11 states that have not expanded Medicaid.
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Nearly 400,000 Georgians were added to Medicaid rolls since March of 2020, as federal provisions prohibited states from terminating Medicaid enrollment during the pandemic. However, these recent gains are soon to be reversed when the provisions set forth by the FFCRA expire March 31st. States will be required to re-determine eligibility for all Medicaid recipients over the course of the next 14 months, a process that is euphemistically called “Medicaid unwinding,” and Georgia is poised to be one of the states that is hit the hardest.
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The Georgia Budget and Policy Institute (GBPI) estimates that the process will result in 545,000 Georgians being purged from Medicaid rolls. Put another way, more than 20% of Georgians with Medicaid will lose their health insurance as compared to a projected 10-15% nationwide. This burden will fall heavily on families, particularly new mothers, who are at greatest risk for losing insurance, but also on hospitals, which will be forced to provide a greater proportion of uncompensated care and are already closing at alarming rates.
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While the federal government mandates “Medicaid unwinding,” Gov. Brian Kemp can take action to curtail its disruption to Georgian families. States can request waivers for continuous coverage, under which recipients can remain on Medicaid rolls despite a change in circumstance (i.e., a woman who is no longer pregnant). Oregon recently passed such a waiver based on the understanding that more frequent eligibility determination “results in poorer health outcomes and costs taxpayers [sic] money in administrative work.” Allowing Sally and other Medicaid enrollees who meet income eligibility to maintain continuous coverage will provide immediate relief to low-income families and stem the tide of the coming spike in uninsured Georgians.
Gov. Kemp can and should take this action a step further. Georgia currently has some of the most-restrictive Medicaid eligibility criteria in the nation. States that have expanded Medicaid guarantee coverage to all low-income residents. Georgia, on the other hand, has complex, restrictive eligibility requirements, which make the re-determination process complicated, time-consuming and expensive. Gov. Kemp asked for a budget of $11.5 million for Medicaid re-determination over 14 months. By eliminating non-income-based eligibility requirements, Gov. Kemp will make the determination process simpler, place less of a burden on taxpayers and help to close the coverage gap.
Time is running out for many Georgians like Sally. Hospitals are already closing at some of the highest rates in the country and hundreds of thousands of Georgians are about to be faced with the reality of losing their health insurance. Gov. Kemp must act now by extending continuous eligibility and eliminating non-income-based Medicaid eligibility for the health of this great state.
Toby Terwilliger, M.D., is an assistant professor in the division of hospital medicine at Emory University School of Medicine. Justin L. Williams, Ph.D., is a clinical psychologist and an assistant professor within pediatrics at Emory University. Jacquelyn O’Banion, M.D. is an associate professor of ophthalmology and the director of global ophthalmology at Emory School of Medicine. Tracey L. Henry, M.D., M.P.H., M.S. is an associate professor of medicine at Emory University School of Medicine. Veda Johnson, M.D., is a professor of pediatrics and Marcus Professor in general academics and pediatrics at Emory University School of Medicine. The authors’ views expressed here are their own.
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