Missing paperwork costs 500,000 their Medicaid in Georgia

Throughout three years of the pandemic public health emergency, no one on Medicaid was required to update their paperwork to show they still qualified. As a result, the rolls grew so that Medicaid covered 2.8 million Georgians, or one-quarter of the state’s population.

Last year, all states were asked by the federal government to recertify every Medicaid recipient and drop those who no longer qualify or who don’t complete the required paperwork.

States were given over a year to do the work, and that deadline is looming.

Starting Jan. 1, Washington ordered states to stop disenrollments of most children who have been on Medicaid for less than a year. As of 2019, 56% of Georgia Medicaid enrollees were children up to and including 18 year olds, according to KFF, a nonprofit health research organization.

State officials acknowledge the numbers but say that some of those people have obtained other insurance and ghosted the Medicaid office. The Department of Human Services, whose Division of Family Children Services caseworkers do the evaluations, say they have also recognized the overwhelming burden of the re-evaluation process, and more than doubled their hiring goals for caseworkers to process the applications. They add that they have done what they can to contact every Medicaid enrollee, but many have changed addresses and phone numbers, and only alert their doctors, not the Medicaid office.

In Georgia, basic Medicaid coverage for poor children and some poor adults has existed for years. Last year, the state opened a new limited Medicaid expansion program known as “Pathways to Coverage.” Pathways was intended to expand Medicaid coverage to poor adults who are able to work or perform other approved activities for 80 hours per month, but enrollment has been far lower than state officials hoped for. An effort in the Legislature to approve a greater expansion of Medicaid to more residents failed in March.

Advocates for patients say the system is complicated and glitchy. Attorneys say they have seen the state lose paperwork they know was sent. Doctors say that for those who want to prove their eligibility for Medicaid, the bureaucracy overseen by the Georgia Department of Human Services and the Department of Community Health is a bog.

“I see it in my office every day,” said Dr. Hugo Scornik, a Conyers-based pediatrician and past president of the Georgia Chapter of the American Academy of Pediatrics. Families are coming in to his office with no insurance for their children, and then are faced with deciding whether to pay for medications, vaccines, and necessary care like asthma inhalers.

“It just kind of changes the equation for these families,” Scornik said. “Can they afford this medication your child needs? It’s just really, really tough,” he said.

“So it just it’s it’s really heartbreaking for me to see all this happening for technical red tape reasons.”

Scornik was not surprised to hear the numbers. Families who come to him say that after they learn they’ve been disenrolled they can’t get through to caseworkers to solve the issue.

When they do get through to someone at the state, they’re told there’s a long backlog and it will take time. His patients who know they’ve been disenrolled and are trying to get re-evaluated, can go uninsured for months, he said.

State Department of Community Health spokeswoman Fiona Roberts pointed out that some of those people will have moved on to other coverage and simply never re-applied for Medicaid, but exact numbers were not available. Federal data shows that an estimated 196,000 Georgians who were probably on Medicaid have now enrolled in Affordable Care Act private health insurance.

Some people who get kicked off will eventually get back on Medicaid. But in the end, said Matthew Buettgens, a senior policy fellow at the liberal-leaning Urban Institute, the numbers on Medicaid will be lower. Buettgens produced a forecast at the beginning of redetermination that is tracking fairly close to the actual Georgia numbers so far. He predicted that after all is said and done, Medicaid will insure 564,000 fewer Georgians.

The research has shown him how volatile income is in the population that swings between eligibility for Medicaid, the ACA marketplace, and nothing at all, he said. “There’s a constant churning of people whose family’s income is falling below the eligibility threshold, and likewise going in the other direction as well,” he said.

Medicaid Renewal Tips

All Medicaid recipients must renew their eligibility status every year in Georgia.

Medicaid enrollees should log into their online Gateway account to be certain their contact information is current for their mailing address, email address and/or phone number. Enrollees choose the way the state notifies them about any changes in their coverage: mail, email or phone.

Make sure to check your mail and messages, and keep an eye out for any letters from the state.

The state has established a website with tips for enrollees in many languages: staycovered.ga.gov.

The main phone number is 1-877-GA-DHS-GO (1-877-423-4746).

Those who are denied can request an appeal called a “fair hearing” if they do so in time.

For those who believe they have been denied although they are still eligible, attorneys at Georgia Legal Aid, and in the Atlanta area Atlanta Legal Services, may help.

For more information, click here to see this explainer in the AJC.

EDITOR’S NOTE: This story has been corrected to note that Washington allows children on Medicaid to go through re-determination in 2024 if they have been enrolled for at least a year. It has also removed an incorrect number provided by the state Department of Community Health for Medicaid enrollees who have switched to private health insurance, and provided additional data.