understanding medicaid in georgia and the opportunity to improve it

A CHART BOOK FOR

Understanding Medicaid in Georgiaand the Opportunity to Improve It

v1 / September 2015

2 Understanding Medicaid in Georgia and the Opportunity to Improve Itv1 / September 2015

UNDERSTANDING GEORGIA’S MEDICAID PROGRAM TODAY

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Medicaid Plays an Important Role in Covering GeorgiansWho Gets Medicaid in GeorgiaHow Restrictive is Georgia’s Program Today?Medicaid Protects Georgians During Economic DownturnsMedicaid Controls Costs

TABLE OF CONTENTSGEORGIA’S OPPORTUNITY TO CLOSE THE COVERAGE GAP

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10111213141516

Georgia’s Health Insurance Coverage GapUsing Medicaid to Close the Coverage GapCommunities Across Georgia Stand to BenefitWorkers in Key Sectors Could be CoveredDemographics of Adults in the Coverage GapGeorgia’s Veterans are in the Coverage GapState Coverage Gains Show Promise

THE ECONOMIC & SOCIAL BENEFITS OF CLOSING THE COVERAGE GAP

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18 Closing the Coverage Gap is a Good Deal for Georgia19 Closing the Gap is Good for Georgia’s Economy20 States are Saving Money by Closing the Gap21 Medicaid Brings Trustworthy Funding22 Health Insurance Matters23 Medicaid is Access24 Georgia Can’t Afford to Wait25 Georgia is in the Driver’s Seat

CONTACT INFORMATION

APPENDIX

SECTION

1

SECTION

2

SECTION

3


SECTION

1 Understanding Georgia’sMedicaid Program Today• Medicaid Plays an Important Role in Covering Georgians• Who Gets Medicaid in Georgia• How Restrictive is Georgia’s Program Today?• Medicaid Protects Georgians During Economic Downturns• Medicaid Controls Costs


Medicaid is a public health insuranceprogram for low-income people. It wascreated in 1965.

Medicaid covers mostly children, pregnantwomen, parents, seniors over age 65, andpeople with disabilities.

In Georgia, more than 1.9 million peoplehave health coverage through Medicaid.Sixty-four percent of beneficiaries arechildren.

Medicaid is a partnership between thestates and federal government. Each stateenjoys flexibility managing its programin accordance with national guidelines.In exchange, the federal governmentprovides the bulk of funding.

In FY 2015 and 2016 every dollar Georgiaspends on Medicaid benefits is matchedby more than two dollars in federal funds.

Medicaid and PeachCare for Kids Play anImportant Role in Health Coverage in Georgia

1 in 5 of all Georgians

1 in 5 of all poor adults in Georgia*

1 in 2 of all children in Georgia

*Poor is defined as ≤100% Federal Poverty LevelSource: GBPI calculations based on data from U.S. Census Bureau and Georgia Department of Community Health


Who Gets Medicaid in Georgia?Several populations are covered and each group has its ownincome eligibility guidelines.

Eligibility levels determine who can receive Medicaidcoverage. States set eligibility levels based onpersonal income and assets. Eligibility levels forchildren, parents, and pregnant women include a5% income disregard.

Georgia has set very restrictive Medicaid eligibility.

Elderly, blind, and disabled people cannot have incomehigher than 75 percent federal poverty level (FPL) or$13,200 for an elderly couple. Income limits are higherfor those needing long-term care.

Parents with minor children must earn an annualincome below 38 percent FPL or $7,600 for a familyof three in order to qualify for Medicaid.

Pregnant women cannot have income higher than225 percent FPL which is $26,500 for an individual or$45,200 for a family of three.

Children are eligible for Medicaid at varying rates as they age, starting at 210 percent FPL for an infant up to age 1, decreasing to 138 percent FPL for children ages 6-19. Children in families beyond these income limits can get coverage through PeachCare for Kids, which covers children up to 252 percent FPL or $50,600 for a family of three.

Adults without dependent children are not eligible for Medicaid in Georgia.

Source: Georgia Department of Community Health, thresholds rounded

Noteligible

50%0% 100% 150% 200% 250% 300%

ADULT WITHOUTDEPENDENT CHILDREN

PARENT

AGED, BLIND, DISABLED

BREAST & CERVICALCANCER

NURSING HOME &COMMUNITY CARE

PREGNANT WOMEN

RIGHT FROM THE STARTMEDICAID FOR CHILDREN

% FEDERAL POVERTY LEVEL

Children Elgibility Levels are Cumulative

Children Ages 6-19Children Ages 1-5Children Ages 0-1PeachCare

For more information on poverty level by family size, see Appendix.

The Federal Poverty Line is$11,770 for an individual and$15,930 for a couple.

50

44

in spendingper Medicaid enrollee,about 30 percent belowthe national average

in EligibilityOnly seven states make it harderfor parents to get Medicaid

Georgia’s Medicaid program hasvery limited eligibility criteria,making it difficult for people toqualify for coverage.

Only seven states offer stricterstandards for parents of minorchildren. For working parents,maintaining eligibility is verydifficult. Because the maximumallowable income is so low ($7,600annually for a family of three),working parents can end up losingtheir eligibility with just a littleovertime or even a promotion thatcomes with slightly higher wages.

How Restrictive is Georgia’s Program Today?

th

th

Sources: Kaiser Family Foundation State Health Facts

6

Understanding Medicaid in Georgia and the Opportunity to Improve It

v1 / September 2015


Medicaid is a countercyclicalprogram, meaning it grows to meetthe need when the economy isbad and residents face job loss oreconomic hardship.

On several occasions, leaders at thefederal level increased federalMedicaid contributions to help statesmanage enrollment growth whenstates experience declining revenues.

This countercyclical aspect provedcritical for many Georgia families atthe height of the Great Recessionwhen the state’s unemployment rateremained over 10 percent for morethan two years and unemploymentpeaked at more than 500,000 people.

Between the start of the recessionin 2007 and the depth of its impactin 2010, 150,000 more low-incomeGeorgians gained coverage throughMedicaid. The majority of thoseenrollees were children.

DEC2002

-5%

-10%

-15%DEC

2006DEC

2004DEC

2008DEC2010

DEC2003

DEC2007

DEC2005

DEC2009

DEC2011

Impact of 2001Recession

Impact of GreatRecession

Medicaid Protects Georgians DuringEconomic Downturns

Percent Change in Medicaid Enrollment

When economic cycle is down, Medicaidenrollment increases.

15%

10%

5%

0%

Source: GA Department of Community Health and U.S. Bureau of Labor Statistics


Not only does Medicaid provide accessto critical health care services, it alsodoes it less expensively than privateinsurers do.

Ninety-four cents of every dollar spenton Medicaid goes directly to healthservices. Medicaid also spends less perenrollee than private insurers for bothchildren and adults.

Medicaid’s costs increased atabout one-fourth the rate of privateinsurance since 2007.

Medicaid Controls Costs

For every dollar spent on Medicaid:

$$0.94

is spent directly onhealth services

$0.06is spent onadministrative costs

MEDICAID

1.1%

PRIVATEINSURANCE

Medicaid’s modest growth in per enrollee spending since 2007

4.4%

Since 2007, Medicaidspending has grownmore slowly than privateinsurance. .

Source: Center on Budget and Policy Priorities


SECTION

2 Georgia’s Opportunity toClose the Coverage Gap• Georgia’s Health Insurance Coverage Gap• Using Medicaid to Close the Coverage Gap• Communities Across Georgia Stand to Benefit• Workers in Key Sectors Could be Covered• Demographics of Adults in the Coverage Gap• Georgia’s Veterans are in the Coverage Gap• State Coverage Gains Show Promise


Georgia’s Health Insurance Coverage GapParents are only eligible for Medicaidif they earn less than 38 percent ofFederal Poverty Level. For a singleparent with one child, this means theparent loses eligibility if they make morethan about $6,000 annually. They donot become eligible for subsidies topurchase private insurance until theymake above $15,930. This leaves alarge insurance coverage gap forlow-income adults trying to accessaffordable health insurance.

A single adult or couple withoutdependent children are not eligible forMedicaid at all. They remain in thecoverage gap unless they make morethan $11,770 or $15,930 respectively.

Many people in the coverage gapwork low-wage jobs where they arenot offered health benefits. A personmaking minimum wage would haveto work more than 30 hours perweek all year to earn enough incometo qualify for subsidies through thefederal health insurance marketplace.

INSURANCEMARKETPLACE

COVERAGE

CURRENTMEDICAIDCOVERAGE

VETERANS

WORKINGPARENTS

LOW-WAGEWORKERS

COVERAGE GAP

300,000uninsured Georgians

are now in the coverage gap, where they are ineligible to enroll inMedicaid and do not earn enough to get tax credits on healthcare.gov.


The Affordable Care Act (ACA) offersstates an option to increase Medicaideligibility for adults up to 138% FPL.This is equal to an annual income of$16,200 for an individual and $ 27,700for a family of three in 2015.

This expanded eligibility would primarily help parents and other working adults who are not offered coveragethrough their jobs and cannot affordother coverage.

75 138

38 138

138

% FPL

20%0% 40% 60% 80% 100% 120% 140% 160%

CHILDLESSADULT

PARENT

AGED, BLIND, &DISABLED

Using Medicaid to Close the Coverage Gap

Current & Expanded Eligibility

ACA offers states an optionto increase Medicaid eligibility(for adults) up to 138% FPL

= $16,243Annual IncomeIndividual

= $27,724Annual IncomeParent, family of 3

= $16,243Annual IncomeIndividual

138%

Current eligibility

Expanded eligibility

Source: Georgia Department of Community Health, 2015 Financial Limits

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Approximately 500,000 Georgianscould enroll in quality, affordablehealth insurance if Georgia closesits coverage gap.

This would drastically reducethe number of uninsured amongstlow-income individuals in the state.

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under 45%

55% and above

50 to 54%

45 to 49%

Communities Across Georgia Stand to Benefit

Percent of uninsured adults who could get Medicaid

ECHOLS

Source: GBPI analysis of U.S Census Bureau data. Specific county-by-county figures available upon request


The majority of people who couldbe newly covered are working.Many of these workers are insome of Georgia’s most importanteconomic sectors, such asconstruction, transportation,education, and retail.

Lower-wage workers are lesslikely to have access to affordablehealth coverage through their jobsthan workers at higher wage jobs.Closing the coverage gap willincrease health coverage forhundreds of thousands of workerswithout job-based coverageand is a smart investment in thehard-working people who enableGeorgia to prosper.

MORE THAN 300,000 LOW-WAGEWORKERS KEEP GEORGIA THRIVING

BUT ARE UNINSURED.

CLOSING THE COVERAGE GAPCOULD KEEP THEM & GEORGIA

WORKING HEALTHY!

THAT’S GOOD FOR ALL GEORGIANS!

Sources: U.S. Census data compiled by Center on Budget & Policy Priorities

Trucking5,650

Construction30,860

Workers in Key Sectors Could be Covered

Adult Citizens in Georgia with Family Income at or Below 138% of Poverty

Grocery Stores12,320

Department andDiscount Stores9,250

Child Day Care7,930

Employment Services(temp agencies)7,190

Advanced Education7,000

Building Services (janitor,extermination, cleaning)6,340

Across the state, 23 percent of alladults ages 18-64 went withouthealth insurance in 2013. For adultsin families earning less than 138percent of the poverty level(about $27,700 for a family ofthree), the uninsured rate wasnearly twice the statewide average(45 percent), while adults withincome greater than four-timesthe poverty level went withouthealth insurance less than ninepercent of the time.

Georgians of all racial and ethnicbackgrounds would benefit from theenhanced coverage opportunitiesthat would come if Georgia closesits coverage gap. However, racialand ethnic minorities in Georgiacurrently face higher poverty ratesthan their white counterparts, andas a result, face disproportionatelyhigh uninsured rates.

Younger Georgians make up themajority of uninsured adults. Theytend to have lower incomes thanolder Georgians, making it lesslikely that they will be eligible forhealth insurance subsidies.

Source: Center on Budget and Policy Priorities analysis of U.S.Census Bureau Data

Ages 18-3960%

White37%

Black36%

Demographics of Adults in the Coverage Gap

Uninsured Georgia Adults below 138% FPL

Other5%

Hispanic22%

Ages 50-6420%

Ages 40-4920%

Source: GBPI analysis of U.S Census Bureau data. (pie chart)

14

Understanding Medicaid in Georgia and the Opportunity to Improve It

v1 / September 2015


Many veterans without job-based healthcoverage face some of the same barriersto health care as other uninsuredAmericans. Not all veterans are eligiblefor health benefits through theDepartment of Veteran Affairs (VA).

Geographic and other barriers may alsoprevent some people with VA healthbenefits from accessing needed medicalservices if they don’t have additionalinsurance.

Younger veterans are more likely to beuninsured than their older counterpartsand are more likely to only have VAhealth benefits, leaving them partiallyuncovered.

Veterans without insurance aremore likely than insured veterans todelay care due to cost. They are alsomore likely to report unmet health ordental needs.

Georgia’s Veterans are in the Coverage Gap

Increasing Medicaid coverage could extend health insurance tonearly half of Georgia’s uninsured veterans

Source: Uninsured Veterans and Family Members: State and National Estimates of Expanded Medicaid Eligibility Under the ACA. The Urban Institute,March 2013.

25,000 UNINSURED VETERANS

+ 7,000 = UNINSURED SPOUSES32,000

NEWLY INSURED GEORGIANS


States that have closed their coveragegaps have seen greater gains in the thenumber of adults with health insurancecoverage than states that did not closetheir coverage gaps.

Nine of the 10 states with the highestuninsured rates in 2014, includingGeorgia, were states that had not yetclosed their coverage gaps.

2009 20112010 2012 2013 2014

86%

84%

82%

80%

78%

76%

74%

72%

70%

Source: National Health Interview Survey, 2009-2014 data. National Center for Health Statistics, U.S. Centers for Disease Control and Prevention

State Coverage Gains Show PromiseStates that have closed their coverage gaps are leading national coverage gains.

Percent Insured, 2009 to 2014

88%

Expansion States

Non-Expansion States

Georgia72.8

80.4

79.8

81

76.4

74.8

81.6

77.3

86.7


SECTION

3 The Economic & Social Benefitsof Closing the Coverage Gap• Closing the Coverage Gap is a Good Deal for Georgia• Closing the Gap is Good for Georgia’s Economy• States are Saving Money by Closing the Gap• Georgia Can’t Afford to Wait• Medicaid Brings Trustworthy Funding• Health Insurance Matters• Medicaid is Access• Georgia’s in the Driver’s Seat


New State InsurancePremium Tax Revenue

Expansion SpecificState Spending

Four-Year Net StateSavings(After New Revenue)

State Income andSales Tax Revenue

Total New Revenue

$306 $575million

$148million

$417

$723million

Source: GBPI calculations based on state expenditure estimates released in 2012 and “The Economic Impact of Medicaid Expansion in Georgia,” William S. Custer, Feb. 2013

- =

New revenues exceedstate costs to close thecoverage gap by $148million.

Closing the Coverage Gap is a Good Deal for GeorgiaNew revenues collected from existing funding sources would exceed the costs to close Georgia’s coverage gap.

Georgia’s Medicaid Expansion Ledger (2016-2019 Total)


Despite giving up two-years worth offull federal funding — likely about$6 billion that could have bolsteredGeorgia’s health care system —substantial economic benefits will accrueif Georgia closes its coverage gap.

Over the next eight years, each $1invested by the state would generatemore than $12 in new federal fundingto the state’s health care system andwould generate a $24 return forGeorgia’s economy as a whole.

This new economic activity would beprojected to create more than 56,000jobs statewide.

Georgia invests$1 for MedicaidExpansion

Georgia’s $1 Medicaidinvestment leverages$12.43 in federal money

Georgia’s economy gets$24.42 return for each $1Georgia invests over 10 years

Closing the Gap is Good for Georgia’s Economy

The federal government will cover the vast majorityof the costs of closing the coverage gap

Source: GBPI calculations based on state expenditure estimates released in 2012 and “The Economic Impact of Medicaid Expansion in Georgia,”William S. Custer, Feb. 2013.


KENTUCKY

59.7 percent decrease inuncompensated care chargesin 2014, a decrease from $1.9billion to $766 million.

$16.4 million in savings inthe first year and half bytransitioning “spend down”Medicaid enrollees to the newadult group.

$108.9 million projected in totalsavings and revenue increasesin the first year and a half.

ARKANSAS

56.4 percent reduction inuncompensated care in thefirst six months.

$17.2 million in state general fundsavings in 2015 from decreaseduncompensated care.

$6.4 million in reducedspending on community healthcenters without reducedservices due to previouslyuninsured patients now utilizingMedicaid insurance.

MICHIGAN

85 percent decrease inuncompensated care costs in agroup of Detroit-area hospitals.

$190 million in projected savingsfor state fiscal year 2015 byusing federal funds to cover apreviously state funded programfor mental/behavioral health.

$203.7 million in savings andnew revenue in the firstsix months.

• See savings related topreviously eligible Medicaidbeneficiaries now eligible forthe new adult group underexpansion

• See revenue gains related toexisting insurer or providertaxes

Source: Robert Wood Johnson Foundation – StateHealth Reform Assistance Network

States are Saving Money by Closing the Gap

According to a Robert WoodJohnson Foundation report,every expansion state shouldexpect to:

• Reduce state spending onprograms for the uninsured


Federal Medicaid funding has long beena stable revenue source for Georgia’shealth care system. Federal funds currentlyprovide for more than two-thirds ofthe costs to cover more than 1.9 millionchildren, persons with disabilities,pregnant women, and others.

During times of severe economicdownturn, such as during the GreatRecession and in the aftermath of 9/11,additional federal help has come tostates to enable them to managegreater Medicaid enrollment even whilestate revenues decline.

’99 ’07’03 ’11’00 ’08’04 ’12’01 ’09’05 ’13’02 ’10’06 ’14 ’15

80%

75%

70%

65%

60%

55%

50%

Enhanced FMAP (CHIP)

Federal MedicalAssistance Percentages

Medicaid Brings Trustworthy FundingThe federal match rate for Georgia has remained consistent since theprogram began in the 1960s.

Federal Medical Assistance Percentage — Medicaid and Children’sHealth Insurance Program

Source: U.S. Department of Health and Human Services


HEALTH INSURANCE IMPROVESFINANCIAL HEALTH

Sources: New England Journal of Medicine,Commonwealth Fund, National Bureau of EconomicResearch, Association of County Commissionersof Georgia

Health Insurance Matters

The debate over closingGeorgia’s coveragegap often focuses onthe impact on the stateBudget.

This ignores an equallyimportant consideration:the value of healthinsurance.

Several recent studiesdemonstrate the valueof health insurance toindividuals and thehealth system.

1People with health insuranceare 80 percent less likely to

have catastrophic medical bills.

2People who have health

insurance are 50 percent lesslikely to borrow money or failto pay other bills because of

medical debt.

351 percent of people withouthealth insurance have medicalbill problems or medical debtas compared to 29 percent ofpeople with health insurance.

1, 2. Results compare people who gained coverage inOregon versus those who are eligible but uninsured3. Results from Commonwealth Fund Biennial HealthInsurance Survey

HEALTH INSURANCE IMPROVESPHYSICAL HEALTH

1People received more

preventive care, like cholesterolscreenings, pap smears, andmammograms when insured.

2People reported higherrates of “excellent” or “very good” health

3Expansion of Medicaid reduced

mortality by six percent

1. Results compare people who gained coverage inOregon versus those who are eligible but uninsured2, 3. Study compared mortality and health outcomesin 3 states that expanded adult Medicaid eligibilitywith neighboring states without expansions

$COMMUNITIES AND THE HEALTH

SYSTEM SAVE MONEY WITHHEALTH INSURANCE

1Each additional uninsured

person costs their local hospital$900 per year in

uncompensated care costs.

2Local taxes often go to supporthospital uncompensated carecosts. In 2012, 43 of the 109

Georgia counties with a hospitalprovided funding to their

local hospital.


Uninsured

Medicaid

Employer-sponsored insurance

39.8%

88.1%

89.8%

Multiple studies have demonstratedthat those insured by Medicaid havecomparable access to care as those withemployer-sponsored insurance.

About 72 percent of Georgia’s doctorsare accepting new Medicaid patients.That is higher than the national averageof 68.9 percent.

Comparatively, about 81.7 percentof physicians are taking newprivately insured patients and80 percent are taking newMedicare patients.

Physicians acceptingnew Medicaid patientsin Georgia(higher than the national average)

Medicaid is Access

71.9%

PERCENT OF PEOPLE WITH USUAL SOURCE OF CAREa place they can go when they get sick or

need advice about their health

Source: National Electronic Health Records Survey, 2013 data. National Center for Health Statistics, U.S. Centers for Disease Control and Prevention.


Four of Georgia’s rural hospitals have closed in the last several years.Fifteen more are financially fragile according to the 2015 final reportfrom Georgia’s own Rural Hospital Stabilization Committee. Increasinghealth coverage would provide Georgia’s hospitals with an increasesource of revenue and a lower burden of uncompensated care.Closing Georgia’s coverage gap could keep hospital doors open inrural communities.

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Expandedcoveragecan helpsave thesehospitals.

15 HOSPITALSFINANCIALLYFRAGILE

Georgia Can’t Afford to Wait

PEOPLE & COMMUNITIES

Stacy Soulimiotis had a successful career, butseveral years ago she decided she wantedto go back to school to get her mastersdegree. While she was in school, Stacy’smother fell ill and needed Stacy to care forher. Stacy is stuck in the coverage gap.

“I am grateful and honored to have been afull-time caregiver for my mother, but I hadto put my life on hold to do so. Workingwas out of the question, and finishing my

master’s degree was not possible. I also did not expect to be stricken with so much grief after her passing. I am trying to get back on my feet, but I feel as though I was being punished for deciding to dedicatemyself to caring for someone else insteadof myself.”

— Stacy Soulimiotis

HOSPITALS & COMMUNITIES

4 HOSPITALSCLOSED

25

Georgia can map a route to close the coveragegap in a way that works best for our state.Medicaid provides significant flexibility to statesin the design of each state’s program. Georgiacan create a program that works best for itsbudget, its health care system, and Georgians.

Georgia can hit the brakes at any time.If the federal government ever fails to pay itsshare of the costs, Georgia can discontinue theexpansion at no cost.

Understanding Medicaid in Georgia and the Opportunity to Improve Itv1 / September 2015

Georgia is in the Driver’s Seat!

GEORGIA’S PATHTO COVERAGE


For more information, contact:

Cindy ZeldinExecutive [email protected] ext. 1

Georgians for a Healthy Future provides a strong voice for Georgiaconsumers and communities on the health care issues and decisionsthat impact their lives. Our vision is of a day in which all Georgianshave access to the quality, affordable health care they need to livehealthy lives and contribute to the health of their communities.Georgians for a Healthy Future has a history of providing substantivehealth policy information to legislators, community leaders, andadvocates throughout the state, equipping consumers with the toolsthey need to be informed consumers and advocates, and engagingwith policymakers to spark policy change for a healthier Georgia.

Tim SweeneyDeputy Director—[email protected] ext. 103

The Georgia Budget & Policy Institute (GBPI) conducts research,data and fiscal analysis and offers a host of policy solutionsto show Georgia ways to improve education, health care andeconomic opportunity for all. We couple our research with robustcommunications and outreach strategies to educate lawmakers,the media and advocacy partners around the state to inform andinfluence the public debate and responsible decision-making. GBPIis committed to building an economy that works for all Georgians.GBPI is an independent, nonpartisan nonprofit source for policyanalysis to elected and appointed officials throughout the state.

Laura ColbertCommunity Outreach [email protected] ext. 2


Family Size 100%Federal Poverty Line

Annual Income

138%Federal Poverty Line

Annual Income

1

2

3

4

5

6

$11,770

$15,930

$20,090

$24,250

$28,410

$32,570

$16,242

$21,983

$27,724

$33,465

$39,205

$44,946

Appendix

References for all slides and data available online

Annual Incomes of Peoplein the Coverage Gap

Family size

Adults without dependent children

1 person $0 to $11,770

2 people (married couple)

Parents of dependent children2 people (parent & child)

3 people

4 people

5 people

$0 to $15,930

$5484 to $15,930

$6612 to $20,090

$7836 to $24,250

$8956 to $28,410

FEDERAL POVERTY LINE BY FAMILY SIZE ANNUAL INCOMES OF PEOPLE IN THE COVERAGE GAP

understanding medicaid in georgia and the opportunity to improve it

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