Nearly 100,000 Georgians lost their Medicaid coverage last month, most of them for procedural reasons.

More Georgians who went through the Medicaid unwinding process last month lost their coverage than kept it, with nearly 100,000 people dropped from the public health insurance program in just one month, according to new state data released Wednesday. 

The people who went through Medicaid redetermination last month represent the largest group yet to go through the process in Georgia. The state started renewals for nearly 217,000 people last month, a big jump from the 12,500 Georgians in the initial round.

All 2.7 million adults and children covered by Medicaid in Georgia must go through the renewal process, which is a massive undertaking that states have until next May to complete. A federal rule had barred states from kicking people off Medicaid during the pandemic.

As many as 545,000 people in Georgia could lose their coverage, according to a state estimate. 

Of the 216,991 Georgians who went through the process last month, about 96,000 people have lost their coverage. 

Most of them — about 89,000 — had their coverage terminated “due to lack of information received by the state to make an eligibility determination,” according to a press release from the state Department of Community Health, which administers the Medicaid program.

About 20,000 of them would have been no longer eligible because they make too much money, are now an adult and too old for the program, moved out of state or otherwise no longer meet the state’s strict coverage rules, according to information from the health department.

There are another 57,000 people in last month’s group who are still going through the redetermination process. 

More than 64,000 people kept their coverage last month — and many of them were re-enrolled automatically with data already on file. All told, 71,000 Georgians have successfully renewed their Medicaid coverage since the unwinding kicked off this spring.

The state agency summarized last month’s data in a press release issued Wednesday, but the report was not made available the same day.

Health care advocates responded with concern to the high number of procedural denials but said a drop-off in automatic renewals and the large pool of people with still-pending statuses were also troubling. 

“Most of those who are losing coverage are losing it for a procedural reason, which means that likely many of those folks are still eligible but there’s been some sort of human or technological error in the process of being renewed — and that includes kids as well,” said Leah Chan, director of health justice with the Georgia Budget and Policy Institute.

The state’s publicly released information for the unwinding has not included a breakdown for how many enrollees going through the process each month are children. 

“These disenrolled individuals are likely children and parents in very low-income households, those living in unstable housing, and children who move between parents, grandparents, and other family members for care,” said Laura Colbert, executive director of Georgians for a Healthy Future, which is a nonprofit patient advocacy group.

“It is very likely that the majority of these kids are still eligible for Medicaid coverage but may not find out until they visit the doctor, try to fill a prescription, or have an emergency,” Colbert said.

There was also a notable decline last month in the rate of automatic renewals, which are done with data the state already has access to — like payroll or unemployment data — and does not require the Medicaid enrollee to do anything. The rate went from nearly 49% in May to about 23% last month.

“This data includes some very troubling signs for Georgia families,” Colbert said of the monthly data released Wednesday. “The combination of low automatic renewals and very high disenrollments means that eligible kids and families are losing their Medicaid coverage unnecessarily.”

Chan with GBPI said the number of pending cases this early in the process is also concerning and raises questions about the state’s capacity to handle the workload.

All told, the status of 63,000 people who are part of these first two groups to go through redetermination is still marked as pending. They will keep Medicaid coverage until their eligibility is determined.

Chan said the high rate of procedural denials and the number of pending cases is an indicator of the “enormous pressure” on what she described as an under-resourced frontline staff at the state Department of Human Resources, which is handling the day-to-day work of the unwinding.

The unwinding is also happening as the state rolls out a new program that slightly expands Medicaid eligibility for low-income Georgians who satisfy work and activity requirements. That program launched early this month.

Colbert and Chan both urged the state to take advantage of new federal options meant to give states more flexibility and help ease the workload. For example, states can lean more on managed care plans to help enrollees complete and submit renewal forms, such as completing certain fields for them.

If someone thinks their coverage was cut off in error, they have 30 days to appeal the decision. And if someone loses Medicaid coverage because they did not react in time to requests for information, they have 90 days to submit updated proof of eligibility to have their coverage retroactively restored. 

For more information, visit staycovered.ga.gov.

This story comes to GPB through a reporting partnership with Georgia Recorder. 

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