This article first appeared in Political Peach News

Medicaid, the federal health insurance program for low-income adults and children, is designed to keep citizens healthy and provide necessary medical care. It also provides critical funding for hospitals and other health providers serving the poor. Since the start of COVID, due to a federal continuous coverage mandate, Medicaid enrollment in Georgia has grown by about 40% to around 2.7 million Georgians. These citizens constitute more than a quarter of our population and primarily include children of low-income parents, the elderly, and the disabled.

In fact, Medicaid and PeachCare (Georgia’s Medicaid program for children) are critical to so many Georgians. 69% of these 2.7 million are children whose parents earn less than $7,060 annually for a family of three. According to the advocacy group Georgians for a Healthy Future, 50% of all Georgia births are covered by Medicaid. It is also the primary payer in 75% of nursing home stays and pays the costs of Medicare for 168,000 seniors. But very few adults without dependent children are eligible for Medicaid in our state, regardless of income.

All 2.7 million Georgia Medicaid recipients will need to undergo a reevaluation process that begins on the first of April, and the entire process must be finished in 14 months. The Georgia Budget and Policy Institute (GPBI) estimates that over half a million Georgians will lose coverage during this “unwinding” process. Some will lose coverage because they are no longer eligible, for example a child may have aged out, or a parent’s income could have increased. But around 250,000 people will lose coverage when, in fact, they are actually eligible. This could happen for a number of reasons, including administrative error or the beneficiary either not getting mailings about the need to re-enroll, not filling out required paperwork correctly, or being unable to use the online re-enrollment website.  For whatever reason, many Georgians with continuous healthcare coverage during the pandemic will likely become uninsured and lack access to medical care. Virtually all of these are our most vulnerable citizens.

Across the country, his unwinding will be much harder in the few states (including Georgia) that have not expanded Medicaid under Obama’s Affordable Care Act. “In states that have expanded [Medicaid], the potential harm will not be as great as what we could see in Georgia. And that’s because we have a coverage gap. So, people who aren’t eligible for Medicaid yet unable to get the tax subsidies in the ACA marketplace will fall into the coverage gap and will likely go without insurance coverage,” says Ife Finch Floyd of GPBI. Floyd says another reason the unwinding process will be more difficult in Georgia is that we are a high-poverty state. “In the expansion states, they just have lower child poverty rates, so there just may be fewer people to recertify in the first place.”

This massive recertification is being handled by the Georgia Division of Family and Children Services (DFCS). If past performance of this division is any indication, it might not go smoothly. DFCS has had a recent history of deficiencies. An article in the AJC at the end of 2022 discussed a scathing report by the Office of Child Advocacy investigating DFCS’s handling of child abuse cases. It noted that “caseworkers at DFCS are leaving their jobs in droves, fueled by low pay, frustration with leadership, and exhaustion from increased workloads.” This agency is now charged with new responsibilities for unwinding and re-certifying Georgians for Medicaid.

During the pandemic, DFCS case workers were given a $480 per month bonus, which expired at the end of 2022 and has not been renewed. In addition, DFCS has had significant staff turnover and vacancies. Base salaries for beginning case workers are $32,000, and a maximum of $41,000 for supervisors.  The state’s budget for Fiscal Year 2024, which has to be passed by the legislature by Wednesday, currently includes a $2,000 pay increase for all state workers, which may help slightly.  But no additional funds or salary increases were included in the recently passed FY23 amended budget, and apparently, none will be in the FY24 budget either.

A number of advocacy organizations that work with low-income populations are increasingly worried about how this unwinding is going to get done and the risks to vulnerable citizens who will lose access to healthcare. “I’m very much concerned that DFCS is not resource ready, not staff ready, not trained. And I do have grave concerns that they may not have the capacity, at this point, to get this work done within the next 12 to 14 months,” says Yolanda Pickstock, Legislative Director for Georgia Stand-Up, an organization that advocates for Medicaid recipients.

Governor Kemp seems to be slowly moving ahead with his idea of Medicaid lite. Dubbed the “Pathways to Coverage” Medicaid waiver, this is a plan to expand Medicaid to a limited number of Georgians who both have incomes below the poverty line of $13,590 and can work at least 80 hours per month.  A good summary of Gov. Kemp’s plan from GBPI estimates that it might insure around 31,000 at a cost per enrollee of $2,420. But full Medicaid Expansion would enroll almost 500,000 for a cost per enrollee of $496.

One legislator has said that not fully expanding Medicaid amounts to legislative malpractice. In addition, if we were to expand Medicaid, far fewer people would lose coverage during the recertification process. While the expansion will not affect the unwinding, it would certainly help struggling Georgians, and it would provide more income for financially strapped hospitals for services performed.

The press and healthcare activists got excited a few weeks ago when newly elected Speaker of the House Jon Burns made a statement at the Atlanta Press Club that sounded like he might possibly be interested in at least some expansion of the Medicaid rolls. “We have some ideas. I won’t share it with you now, but we have some ideas in this space. And we’re going to work on them. We want to be new. We want to be innovative….” He added that he wants it to be “cutting edge.” He doesn’t mention Kemp’s waiver plan, so it’s not clear what he might be referencing. But the ground might be shifting.

The ground is certainly shifting in other states. Recently the North Carolina legislature voted with Republican support to expand Medicaid, leaving only ten states without full Medicaid. And voters in South Dakota voted in November for expansion. But in Georgia, we have only Kemp’s weak waiver plan. The negative effect on children, the elderly, and low-income Georgians cannot be understated. Governor Kemp and the Republican legislators have their heads in the sand about not only the massive task of unwinding on state workers but also the consequences of administrative problems. Additionally, the potential loss of access to health care for our most vulnerable citizens, the loss of financial resources for struggling hospitals, and the consequential need for providing more uncompensated hospital treatment are all matters of concern that our elected officials should address.

Krista Brewer

Krista Brewer is a native Atlantan who has a professional background in writing, reporting and editing. For several decades she has closely followed Georgia politics, focusing on topics such as healthcare, voting and immigrant rights, and budget and environmental issues. She is active on Twitter and invites readers to follow her @KristaRBrewer.