Millions of adults and children will likely be re-evaluated for Medicaid eligibility in 2023

For just over two years, enrollees in Medicaid and PeachCare for Kids have had continuous coverage, meaning access to affordable health care without interruptions, regardless of changes in eligibility. 

That’s because the ongoing federal COVID-19 Public Health Emergency, set in March 2020, increased federal funding for Medicaid subject to states’ implementation of continuous enrollment. Typically, states re-evaluate the eligibility of Medicaid recipients annually.

Medicaid makes health care affordable for low-income families. Since February 2020, enrollment in Medicaid and the Children’s Health Insurance Program has gone up almost 30% nationally. 

Meanwhile, the number of uninsured kids in Georgia has gone down significantly since the pandemic, largely due continuous coverage under PeachCare for Kids, Georgia’s state CHIP program. 

But public health agencies are expecting an end to the emergency designation in 2023, likely in the spring, and 2.6 millions adults and children in Georgia will have their eligibility re-evaluated for the first time since the pandemic. States will have up to one year for redeterminations. 

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Even people who maintain eligibility next year could temporarily lose coverage during redeterminations, said Laura Colbert, director of Georgians for a Healthy Future. 

“Often Medicaid members, because they are in low income families, they tend to be harder to reach,” Colbert said. “Because they're busy, because they live in rural areas, because they move more often.”

Colbert says low-income adults will likely see the largest coverage losses, because they don’t often qualify for Medicaid unless they are pregnant, disabled or have certain cancers. 

“Unless our state leaders choose to expand Medicaid,” Colbert said. 

Under full Medicaid expansion, adults with incomes up to 138% of the federal poverty level — about $18,700 a year for a single-person household — would be eligible for coverage. 

Instead, Georgia’s Medicaid waiver, Georgia Pathways, will cover people up to 100% of the FPL with work requirements. That plan is scheduled to be implemented July 2023, according to Fiona Roberts, spokesperson for the Georgia Department of Community Health. 

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States will receive a 60-day notice from the federal government before the end of the PHE. Georgia released its unwinding plan in October, emphasizing the need for more staff and improved communications. 

States are required to develop unwinding plans that lay out how public health entities will conduct Medicaid redeterminations, “to prevent improper terminations, mitigate churn, and provide smooth transitions.” 

To help fulfill those goals, Georgia will implement seven strategies under authoritative power from the Centers for Medicare and Medicaid Services that allow the state to: renew Medicaid for SNAP recipients, partner with the postal service to update contact information and automatically re-enroll recipients that don’t have changes in eligibility, among others.

Georgians can find more information on rederminations at staycovered.ga.gov.