Medicaid enrollment in Georgia has hiked up during the COVID-19 pandemic, prompting some analysts to call for fully expanding coverage for the program that helps low-income families.
Others, however, back the partial Medicaid expansion Gov. Brian Kemp steered through the General Assembly two years ago that won federal approval last year.
The number of Medicaid beneficiaries in Georgia jumped by about 338,000 between March 2020 when the pandemic broke out and December, boosting the total number of children, adult and family recipients to roughly 2,104,000, according to state Department of Community Health (DCH) data.
Climbing Medicaid enrollment underscores how the pandemic is spurring economic uncertainty for poor children in Georgia, who make up roughly two-thirds of the program’s beneficiaries, said Laura Harker, a senior policy analyst at the nonprofit Georgia Budget and Policy Institute (GBPI).
“It reflects some of the challenges to the whole household when a family member loses income or loses their job that could result in them qualifying or their children qualifying in Medicaid,” Harker said.
Currently, Medicaid coverage is available for Georgia adults with incomes about 35% below the federal poverty line, as well as children in households making up to 138% above the poverty line and low-income senior, blind and disabled adults.
Eligibility is set to change under Kemp’s plan for partial Medicaid expansion, which would cover adults earning up to 100% of the poverty line or possibly 50,000 more beneficiaries, according to state estimates. It also requires recipients to work, attend school or volunteer at least 80 hours each month.
The plan won federal approval last October and is set to roll out in phases starting in July.
Its backers view the plan as a timely tool to help prop up Georgia’s lowest-earning residents as they struggle through the pandemic, particularly if certain jobs never return or are changed drastically in the rebounding economy.
“[The plan] tried to address those jobs right around the eligibility level and create a pathway off Medicaid,” said Chris Denson, the policy and research director for the nonprofit Georgia Public Policy Foundation (GPPF). “There are going to be a lot of long-term ramifications out of this pandemic as far as the economy.”
Kemp’s partial-expansion plan has many detractors who want Georgia to join other states in fully expanding Medicaid under the Affordable Care Act, which would cover adults up to 138% of the poverty line and could add 500,000 more recipients to the program, according to GBPI’s estimates.
Full expansion would also boost the federal government’s share of costs for administering Medicaid in Georgia from about 60% currently to 90%, greatly reducing the state’s required contributions, supporters say.
Democratic state lawmakers citing the spike in enrollment have renewed longstanding calls for full Medicaid expansion, a step Georgia’s Republican-led legislature has avoided in favor of Kemp’s plan for partial expansion.
“It is a fiscally responsible option [and] it is a morally responsible option,” said state Rep. Teri Anulewicz, D-Smyrna. “We are turning down federal funds due to political partisanship and that is thwarting Georgians.”
Cost savings from the federal government under full expansion could help the state plug holes in its $26-billion budget for areas like public schools and health care that faced spending cuts last year due to the pandemic, said Harker of the GBPI.
“We’re missing out on the enhanced federal match,” Harker said. “Other states are able to use that money to support their budgets as they face the downturn.”
Critics of that approach argue Georgia’s costs to run Medicaid would still be too high to manage hundreds of thousands more beneficiaries, even if the federal government ups its end of the cost-sharing arrangement. They prefer striking a balance between helping struggling Georgians and weaning them off government assistance.
“As Medicaid enrollment continues to grow, then it crowds out other state priorities,” said Denson of the GPPF. “And there’s always a chance that the feds will drop that matching rate.”
Republican state lawmakers, who hold majorities in both General Assembly chambers, look unlikely to tackle the issue this year after passing a bill in June aimed at expanding Medicaid coverage for new mothers to six months after birth instead of the current two months.
House Appropriations Committee Chairman Terry England, R-Auburn, argued Georgia’s spending might increase by hundreds of millions of dollars with full expansion, calling it a “policy decision” instead of a “budget decision” that would need legislation to pass.
“I think we’ve had numerous discussions over that over the years,” England said. “Remember that with expansion of Medicaid, there is also an increased liability from the state’s portion.”
Still, Medicaid costs are set to increase in the coming months once the federal government nixes a temporary larger share it has been paying amid the pandemic. Georgia Department of Community Health officials project needing an additional $201 million to cover rising Medicaid costs in fiscal 2022.
Kemp’s office pointed to the governor’s budget proposal that includes an additional $329 million for Medicaid through June 2022, plus another $76 million for agencies to implement the partial-expansion plan and other changes to boost insurance coverage and private-sector insurance competition.
“It is crucial that we provide life-saving healthcare to our most vulnerable Georgians, especially during a pandemic,” said Mallory Blount, Kemp’s press secretary.
“Doing so will reduce Georgians’ dependence on the failed promises of the Affordable Care Act, giving low-income Georgians access to affordable care, and increasing competition in the private sector to make more options available throughout the state.”