Snared in red tape, more than 63,000 Georgia kids lost Medicaid access to doctor last month

Caption

Most of the children who lost Medicaid coverage last month had their health insurance terminated for procedural reasons and not because they were no longer eligible.

Children accounted for about two-thirds of the nearly 96,000 Georgians who lost their Medicaid coverage last month as part of the nationwide unwinding of a pandemic-era federal policy.

And most of the children — 63,481 of them — had their health insurance terminated for procedural reasons, according to information provided by the state Department of Community Health in response to a request from the Georgia Recorder.

“To see that 63,000 children lost Medicaid because of just something that went wrong in the process tells me that this is not a process that is sustainable,” said Callan Wells, senior health policy manager with GEEARS: Georgia Early Education Alliance for Ready Students.

“We really need to make major systemic changes so that we’re not seeing 63,000 children losing Medicaid, losing health care coverage, losing the ability to go to the doctor to be treated for their ongoing chronic conditions, missing opportunities for early intervention. We can’t keep doing this,” she said.

Of the 67,454 total children whose Medicaid coverage was terminated last month, about 4,000 were ruled no longer eligible, according to the department’s data. 

But the state agencies responsible for the unwinding say some of the enrollees whose coverage was marked as being ensnared in a bureaucratic process were likely also no longer eligible. 

Information on file with the state suggested that about 20,000 of the 89,000 total adults and children who were disenrolled last month after not completing the renewal process in time would be ineligible for Medicaid today, according to DCH. For example, they may now earn too much money, live in another state or be too old for the state’s program for children. 

“We are anticipating that many of the people who are no longer eligible have aged out of PeachCare for Kids, but we are actively focused on reaching as many Medicaid members as possible, especially children, to ensure they are prepared to go through the redetermination process,” said Kylie Winton, communications director for the Department of Human Services, which is handling the day-to-day work of the unwinding.

These renewals usually happen every year, but states were barred from kicking people off the public health insurance program during the pandemic, which caused Georgia’s Medicaid rolls to swell to 2.7 million people. Now, all states must complete the massive undertaking of reviewing each person’s eligibility by next summer.

Nationally, at least 3.8 million people have been disenrolled across 39 states and the District of Columbia, according to KFF Health News.

In Georgia, which has one of the highest uninsured rates in the country, as many as 545,000 people could lose their coverage, according to an estimate from last year. A significant number of Georgia children — 40% — are covered by Medicaid, according to Georgetown’s Center for Children and Families.

Last month’s unwinding data represents the first large group of people to go through the process in Georgia, and it showed that more people lost coverage than kept it. When the state reported that monthly data earlier this month, the status of about 60,000 people was still pending — more than half of them children.

Winton said the state continues its efforts to reach families that may be at risk of losing their health insurance, including multiple attempts to contact them by mail, email and text as well as a broad public information campaign. She said there is also a push to inform Medicaid enrollees that they have 90 days from their redetermination date to submit their paperwork and potentially regain coverage and, for those who are no longer eligible, highlight other coverage options. 

“All Georgians who are eligible for Medicaid should have the opportunity to retain their coverage, and that’s why the state has leveraged multiple waivers from the federal government to improve our processes, hired hundreds of new staff, and worked to increase our phone system capacity,” Winton said Friday. “We are listening to the community and working through the challenges that members are encountering.” 

The state has applied for seven waivers designed to cut down the number of procedural denials, allowing the state to do things like accept updated contact information from managed care plans, according to Winton. 

Caylee Noggle, the outgoing commissioner of the Department of Community Health, which administers the Medicaid program in Georgia, told members of the Board of Community Health earlier this month that her agency also planned to target back-to-school registration as an outreach opportunity.

“We are committed to continuing to do all that we can to make sure that no one loses coverage who should have either the ability to remain on Medicaid or to get connected either to Pathways or to the marketplace or some other coverage option,” Noggle said.

Pathways is Gov. Brian Kemp’s plan to slightly expand Medicaid for low-income Georgians who complete 80 hours of work or qualifying activity each month to gain and keep coverage. That program, which launched this month, could enroll as many as 100,000 people, according to a state estimate.  

But health policy experts say the unwinding of the pandemic-era rule is also bringing new attention to an arduous process that has long left Georgia’s youngest residents vulnerable to potentially inconsistent Medicaid coverage. 

In the long term, Wells advocates for ending the renewal requirement for children up to the age of 6. 

Wells and others are also urging the state to lean more on local organizations that can act as trusted messengers in their communities to raise awareness of the redetermination process and help those who are eligible keep their coverage.

And they are pushing back on the perception some have that a procedural denial must be the fault of the individual.

“This is a very onerous process littered with landmines and there’s so many barriers along the way to completing the process. It’s not all on the family. It’s a process that’s just not a very person-centered process in the first place,” said Leah Chan, director of health justice with the Georgia Budget and Policy Institute, adding that low public awareness of the unwinding also remains a concern. 

Chan said she hopes state agencies will adjust when troubling trend lines appear in the monthly data, such as the early numbers showing a disproportionate number of children losing coverage.

“This is not an immovable situation. We have the tools to see this data and make sure this is not what the data looks like in the months to come,” Chan said.

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 complete the renewal process in time, they have 90 days to submit updated proof of eligibility to have their coverage retroactively restored. 

For more information about the unwinding, visit staycovered.ga.gov. More information about Georgia Pathways can be found here. 

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