Who is eligible
Children up to age 1 with family income up to 205% of FPL; children 1-5 with family income up to 149% of FPL; children 6-18 with family income up to 133% of FPL; pregnant women with family income up to 220% of FPL; parents with family income up to 35% of FPL; individuals who are elderly, blind and disabled (See income and resource limits.)
- healthinsurance.org contributor
- September 29, 2016
The benefits of Medicaid remain out of reach for many Georgians. Georgia’s Medicaid program is more restrictive than average, with income limits lower than national averages. The state’s uninsured rate hovers at about 20 percent. Georgia is leaving billions of dollars on the table and 600,000 people without Medicaid coverage by passing up federal funding to expand Medicaid.
Two laws designed to make expansion difficult were enacted during the 2014 legislative session. HB 990 prohibits Medicaid expansion without legislative approval, while HB 943 prohibits state and local employees from advocating for Medicaid expansion.
But by the spring of 2016, Medicaid expansion began to appear more likely in Georgia, fuled in part by support from hospitals facing severe financial challenges. The state has raised Medicaid reimbursement rates for providers, including OB-GYNs in the state, in an effort to keep providers solvent and able to accept Medicaid patients. And Republican lawmakers began indicating that they might be open to a privatized version of Medicaid expansion, like the model used in Arkansas.
Although Governor Nathan Deal has long been opposed to Medicaid expansion, he has started to express a willingness to consider a modified version of expansion, as have more GOP lawmakers in Georgia. In June 2016, talking about the possibility of Medicaid expansion during the 2017 legislative session, Deal said “I still have the same concerns. And you won’t see anyone advocating a wholesale Medicaid expansion. But I do think there will be variations that will be discussed, and I look forward to talking to members of the General Assembly.”
If lawmakers do pass a Medicaid expansion bill in 2017, it would require approval from CMS before it could be implemented, since the state’s leaders do not appear interested in straight expansion as called for in the ACA (all modified expansion proposals have to be approved by CMS, since the federal government provides the funding for Medicaid expansion).
In August 2016, the Georgia Chamber of Commerce outlined a proposal for a conservative approach to Medicaid expansion dubbed the “Georgia Way,” but without providing specifics in terms of funding or how many people would be covered (for perspective, Families USA estimates that under straight expansion as called for in the ACA, 682,000 people would become newly eligible for Medicaid in Georgia).
Who qualifies for Medicaid in Georgia?
As of July 1, 2014, Georgia’s Medicaid eligibility standards are set at the following levels:
- Children up to age 1 with family income up to 205 percent of FPL
- Children ages 1-5 with family income up to 149 percent of FPL
- Children ages 618 with family income up to 133 percent of FPL
- Pregnant women with family income up to 220 percent of FPL
- Parents with family income up to 35 percent of FPL
- Individuals who are elderly, blind and disabled: see income and resource limits
How to apply for Medicaid if you live in Georgia
If you need health insurance and think you may qualify for Medicaid, there are several way you can apply.
Call the Division of Family and Children Services (DFCS) information line at 1-877-423-4746. You will be directed to a local office that can help you.
Complete a paper application. Contact your DFCS county office and ask them to mail you an application. You can return it by mail, fax, or in person.
Georgia has not yet expanded Medicaid through the ACA
Some states have taken advantage of a part of the Affordable Care Act to expand Medicaid to adults under 65 who don’t have dependent children. The federal government is funding 100 percent of the expansion through 2016, but Georgia did not expand Medicaid during the first three years of implementation, so they missed out on the years of full federal funding. Starting in 2017, states will pay 5 percent of the cost of Medicaid expansion, and will pay 10 percent by 2020. After that, the 90/10 split between the federal and state governments will remain permanently in place.
By September 2016, 31 states and DC had expanded Medicaid, but Georgia was among the 19 states that had not yet accepted federal funding for Medicaid expansion. Gov. Deal says expanding Medicaid would cost the state $2.5 billion over 10 years. While agreeing with Deal’s estimate, the Urban Institute says the state is missing out on $33.7 billion in federal Medicaid funding and $12.8 billion in lost hospital reimbursements over the same time by not expanding Medicaid.
Georgia’s decision on Medicaid impacts many people. The Kaiser Family Foundation estimates that 305,000 people are caught in the coverage gap, meaning they earn too much to qualify for Georgia’s Medicaid program, but too little to qualify for subsidies that would help them purchase private insurance through the health insurance marketplace.
History of Medicaid in Georgia
The federal legislation authorizing Medicaid was enacted in 1965, and Georgia implemented its program in October of 1967. The Georgia Medicaid program is managed by the Georgia Department of Community Health (DCH).
A major trend in state Medicaid programs has been the move from fee-for-service to managed care arrangements. In fee-for-service, the doctor, hospital or clinic is reimbursed for each visit, test or procedure performed. In managed care, the health care provider gets a set fee each month for each person covered, regardless of the actual services provided.
Georgia Medicaid first adopted managed care in 1993 and transitioned to a state-wide Medicaid managed care system called Georgia Families in 2006. Nearly all Medicaid beneficiaries — including low-income adults and children, foster care children, and pregnant women —must enroll in Georgia Families. However, individuals with disabilities or long term care needs do not receive services through Georgia Families.
Georgia Medicaid enrollment has grown by about 209,000 people over the past three years. Enrollment was 1,535,090 as of September 2013. As of July 2016, enrollment had grown to 1,744,095. The new enrollees are all eligible based on Georgia’s existing eligibility guidelines, but enrollment has still increased by 14 percent, due in large part to the outreach and enrollment efforts conducted as part of the ACA.