Georgia and the ACA’s Medicaid expansion

Nearly half a million would gain coverage if the state were to accept federal Medicaid expansion funding

georgia Medicaid guide

The benefits of Medicaid remain out of reach for many Georgians. Georgia has not accepted federal funding to expand Medicaid under the ACA, and the state’s Medicaid program is more restrictive than average, with only six states having lower income limits for Medicaid eligibility for low-income parents. Non-disabled adults without dependent children are ineligible for Medicaid in Georgia regardless of how low their income is.

According to US Census data, 12.9 percent of Georgia residents were uninsured in 2016 — only three states had higher uninsured rates at that point. Georgia is leaving billions of dollars on the table and nearly half a million 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.

By the spring of 2016, Medicaid expansion began to seem within reach 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 began to express a willingness to consider a modified version of expansion, as did 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.”

Ultimately, however, there has been no progress on Medicaid expansion in Georgia as of mid-2018. Deal is term-limited, so Georgians will elect a new governor in the 2018 election. A governor who supports Medicaid expansion could help to shepherd legislation, but lawmakers will have to get behind the idea of Medicaid expansion, since state law prohibits expansion unless it’s passed by the state legislature.

There are still 19 states where Medicaid has not been expanded as of mid-2018. Voters in Maine approved expansion in the 2017 election, but Maine’s governor has been blocking implementation and the issue is tied up in the court system. Virginia enacted legislation to expand Medicaid as of 2019. And voters in Utah, Idaho, and Nebraska will get to vote on Medicaid expansion in the 2018 election. But Georgia is still firmly among the hold-out states that continue to reject funding for Medicaid expansion.

Deal and Republican lawmakers claim that expanding Medicaid will be too costly for the state (states will eventually pay 10 percent of the cost; the federal government will pay the other 90 percent), but an Urban Institute analysis found that while providing Medicaid coverage to nearly half a million low-income Georgia residents would only increase state spending by 6.3 percent, that expense “would be offset largely by savings in other areas, including uncompensated medical care for people who are currently uninsured.”

Who qualifies for Medicaid in Georgia?

As of 2018, 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 of minor children 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.

Complete an online application at either Georgia Gateway or www.healthcare.gov.

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

The majority of the states have taken advantage of a provision in the Affordable Care Act (ACA) to expand Medicaid to adults under 65 whose income doesn’t exceed 138 percent of the poverty level. The federal government funded 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 began to 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.

Georgia’s decision on Medicaid impacts hundreds of thousands of people, increases the uncompensated care burden for hospitals in the state, and results in a less healthy risk pool for the state’s private market (people with income between 100 percent and 138 percent of the poverty level qualify for premium subsidies to buy plans in the exchange, but if the state were to expand Medicaid, they’d qualify for Medicaid instead; lower income is correlated with poorer health).

The Kaiser Family Foundation estimates that 240,000 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. This is about half of the population that would become eligible for Medicaid if the state were to expand coverage (the rest earn a little above the poverty level, and are thus eligible for premium subsidies in the exchange until if and when the state expands Medicaid).

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 statewide 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.

Despite the fact that Georgia has not expanded Medicaid, enrollment in Medicaid/CHIP in Georgia has grown by about 18 percent (more than 277,000 people) since late 2013. Enrollment was 1,535,090 as of September 2013. As of March 2018, enrollment had grown to 1,812,195. The new enrollees are all eligible based on Georgia’s existing eligibility guidelines, but enrollment has still increased fairly significantly, due in large part to the outreach and enrollment efforts of Navigators and enrollment assisters, and marketing associated with the ACA’s exchanges.


Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.

Georgia Medicaid

How to apply

Online at either Georgia Gateway or healthcare.gov; in person (Call 1-877-423-4746 for directions to a local office.) Submit a paper application by mail, fax or in person. (Contact your DFCS county office for an application.)

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.)

More Georgia coverage

Insurance Guide

A guide to health insurance in your state.

Exchange

News, history, and enrollment info for your state marketplace

Medicare

Insurance for those over 64 (off-site)