May 31, 2024 - Business

Experts urge Georgia to reform health insurance system

a stethoscope with a glowing lightbulb at the end of it

Illustration: Tiffany Herring/Axios

Health care researchers and advocates want Georgia to implement new policies across its health insurance system as the state concludes its yearlong process of redetermining eligibility for Medicaid and the Children's Health Insurance Program.

Why it matters: Georgia has dropped over 600,000 residents, including more than 300,000 children, from Medicaid and PeachCare for Kids (Georgia's CHIP) since the expiration of pandemic-era coverage protections in April 2023.

  • More than 80% of the overall disenrollment was due to missing documents or "procedural" paperwork issues, according to the Kaiser Family Foundation, which publishes health care research and journalism.

The big picture: States have been grappling with the federally mandated "unwinding" of Medicaid for 14 months, in a process that's put additional stress on the nation's most vulnerable citizens.

  • When the unwinding ends, experts say the next multi-year challenge will be finding and re-enrolling thousands of eligible, uninsured children in the states hit hardest.

Threat level: Urban Institute senior fellow Matthew Buettgens told Axios "the consequences of children unnecessarily losing coverage can last throughout their adult lives."

What they're saying: Leah Chan, the Georgia Budget and Policy Institute's health justice director, told Axios that Georgia should implement automatic renewals instead of putting families and state employees through an "onerous paperwork process."

  • She also said Georgia could get the federal government's permission to offer continuous coverage to children from birth to kindergarten.

The other side: A spokesperson for Georgia's Department of Community Health told Axios that Georgia is performing auto-renewals, and is relieving the paperwork burden by verifying Medicaid eligibility based on data from public benefit programs — including SNAP, CAPS, TANF and WIC — for children, pregnant women, low-income families, people with disabilities, and older Georgians.

  • The spokesperson said residents will maintain continuous coverage while the state processes their renewals, and Georgia has implemented 12 months of continuous eligibility and enrollment for children on Medicaid and PeachCare to help reduce coverage disruptions.
  • The spokesperson also said anyone late returning their paperwork has 90 days to restart the process and potentially retain their coverage.

What we're hearing: Laura Colbert, executive director of nonprofit Georgians for a Healthy Future, said in a statement that Georgia could enable Medicaid insurers to help members and likely eligible Georgians complete and submit their renewal and application paperwork.

  • Colbert also wants Georgia to allow health care providers, pharmacists, and some community-based organizations to conduct initial Medicaid eligibility screenings to help eligible kids get enrolled in Medicaid more easily.

Yes, but: A DCH spokesperson said Georgia Pathways, which offers Medicaid with a work requirement, is a valuable option among the coverage programs, along with traditional Medicaid, Medicare, employer-sponsored insurance, and individual marketplace insurance.

  • The spokesperson said more than 1.3 million residents selected private health insurance plans for this year through Georgia Access, a state-based health insurance marketplace that includes Affordable Care Act plans. The spokesperson said more than 54% of the residents earn up to $22,590 annually.

Friction point: Nearly 300,000 more residents would receive health insurance if Georgia fully expanded Medicaid under the ACA, according to an Urban Institute report. However, state lawmakers killed Medicaid expansion efforts during the 2024 legislative session.

The intrigue: KFF reported on May 16 that Georgia saw the third-highest increase in ACA marketplace enrollment nationwide over the past four years.

Caveat: However, research published in Health Affairs found that Georgia's reinsurance program inadvertently increased the cost of subsidized ACA coverage and decreased enrollment.

  • A Kemp spokesman told the AJC that Georgia has slashed premiums statewide by 11%.

What's next: KFF reports Georgia could see more disenrollment if Congress fails to renew ACA subsidies.

Editor's note: This article has been updated to add comments from Georgia's Department of Community Health.

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