Georgia dropped more than 300,000 children from the Medicaid and PeachCare for Kids health insurance program, with one of the worst child disenrollment rates in the nation, according to a new study from Georgetown University. The study authors fear the majority of them are now uninsured and might decide they cannot afford health care as a result.
Georgia and all states are re-evaluating all Medicaid case files in a year-long national culling process, after case rolls swelled during the pandemic. The process is scheduled to finish soon.
Georgia’s number of children kicked off Medicaid was bigger by December than the entire population of Augusta or Columbus. Georgia disenrolled far more children than California, a state that started with more than double the child Medicaid enrollment of Georgia, the report found.
Pediatricians in Georgia have seen the experience in person as families show up to find out they’re not covered, and turn around and leave without care. “It’s so hard,” said Dr. Anu Sheth, a Lawrenceville pediatrician and board member of the Georgia Chapter of the American Academy of Pediatrics. “It’s heartbreaking for the kids.”
There is no way to track exactly where those children wound up. Despite Georgia officials’ suggestion that many might have gone on to better insurance, the researchers say disheartening signs indicate that the vast majority may have simply lost insurance and perhaps gone without care, the study’s authors said.
“It’s very likely that a substantial share of children losing Medicaid, especially those disenrolled for (missing paperwork) reasons, likely ended up uninsured,” said Edwin Park, one of the study’s authors, addressing the Georgia data. Missing paperwork is the most common reason behind Georgia’s disenrollments.
Medicaid is the government health insurance program for poor children and some poor adults, such as some who are elderly, disabled. Some may meet eligibility requirements by working at least 80 hours a month.
During the pandemic, everybody who got on Medicaid stayed on, and didn’t have to do the annual paperwork to show they still qualified. In Georgia the rolls swelled to one-quarter of the state’s population, 2.8 million people. But now that federal pandemic emergencies have ended, the federal government is requiring every state to go back through all their case files over the course of a year to evaluate each one and make sure they still qualify. The process is called redetermination, or undwinding.
Georgia has made “concerted efforts … to ensure that children retain health care coverage,” a spokeswoman for the state Department of Community Health said in a written statement. And those have increased as the process went on, which may mean that the numbers improved after the study’s data gathering stopped.
In the period of the study, up to December, the research showed some states were doing better than others. Georgia was among the worst, what study author Joan Alker called “the big three.”
The top three states for disenrolling children — Texas, Florida and Georgia — when taken together are responsible for 45% of the nation’s disenrolled children as of December.
Georgia officials responsible for Medicaid — the state Department of Community Health and the state Department of Human Services ers — point to huge numbers of signups for private plans on the Affordable Care Act marketplace. That could mean, they suggest, that those kids’ families’ incomes rose and the kids moved and got better insurance.
However, the Georgetown researchers said, very few of those new signups were children, a small fraction of the number disenrolled by Georgia. Dependents are expensive on ACA and other private plans, they said.
When it comes to keeping children who should qualify for Medicaid covered by Medicaid, the Georgia DCH and DHS officials say they’ve gone to extra lengths for the unprecedented task. They’ve more than doubled their expected hiring of caseworkers to more than 1,000.
Indeed, Sheth, the doctor, said she’s worked with state officials on the issue, and was impress by their desire to try to make it work. She sees they have implemented heavy advertising to alert patients they need to check in with the Medicaid office. She’s seen them change some policies to make continued enrollment easier.
One thing that remains a problem, she said: the state’s Gateway computer system for Medicaid.
The Atlanta-Journal-Constitution’s reporting has also found Gateway to be an obstacle for some individual patients, especially those with only cell phones for a computer. Glitches in the Gateway mobile computer interface gave misleading information on patients’ accounts, for example.
AJC reporting also found that enrollees were told to seek help at the Medicaid office, only to find it closed, or that caseworks work remotely. Enrollees have recounted rarely being able to get through to caseworkers by phone.
The study authors say there are measures that states still can take. But Texas, Georgia and Florida, the report said, are among states that “have prioritized the hasty disenrollment of adults and children, despite projections that many still remain eligible.”
Some examples: Ohio has applied for official federal permission, called a Medicaid waiver, to allow children from babies to six years old to stay on without going through the annual application.
In addition, other states’ computer systems, on average, are finding much more enrollment qualification information automatically in accessible databases than Georgia is.
So far Arizona has been able to re-enroll 75% of its Medicaid beneficiaries with automated database searches, for example, said Joan Alker, executive director of Georgetown’s Center for Children and Families, which released the study. In contrast, Georgia has re-enrolled 35% of its enrollees with automated searches.
“Many of them should be covered by Medicaid and that’s their affordable choice for coverage,” said Alker. “So they’re likely facing a gap in coverage. Which is not good news.”
Georgia officials told the AJC they have expanded the ways that computer systems can make a Georgia enrollee automatically re-qualified for Medicaid. And Georgia patients will see that, they said.
“The state continues using implemented improvements to minimize the number of procedural terminations and maximize the number of ex parte renewals,” DCH reported.
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