Georgians—Particularly Children and Families of Color—At Risk of Losing Coverage During Medicaid Unwinding

Thanks to a pandemic-era policy, millions of Georgians have had uninterrupted access to affordable health care over the past three years— allowing them to see a doctor, refill prescriptions and get vaccines during a time of health and economic uncertainty. Starting in April 2023, that continuous Medicaid and PeachCare coverage began to unwind, and every child and adult enrolled in Georgia’s health care safety net will have their eligibility re-determined prior to the end of May 2024. This unprecedented health care event will put pressure on state agencies and jeopardize the health and financial security of Georgians with lower incomes. Hundreds of thousands of Georgians will lose coverage. An estimated 45 percent of those losing coverage will be impacted by procedural denials, which means they are still eligible but are denied coverage due to a human or technological error in the process—like the form being sent to the wrong address. The burden of this health care coverage loss will likely fall heaviest on children, young adults and postpartum people from communities of color.

Georgia will Continue to Receive Additional Federal Funding to Cover Medicaid Enrollees Through End of 2023

In exchange for keeping Georgians continuously enrolled in Medicaid since the pandemic started, Georgia has received an enhanced Federal Medical Assistance Percentage (FMAP). Medicaid is a partnership between the state and federal government, and the FMAP determines the amount the federal government pays to the state for providing Medicaid services. The federal government gradually began decreasing the pandemic-related enhanced FMAP in April. Although the Medicaid unwinding period extends through May 2024, Georgia will go back to its standard FMAP of about 66% in January 2024. Medicaid unwinding is likely to result in significant declines in enrollment and, in turn, decreased total Medicaid spending. As the process unfolds, further adjustments to the budget will likely be needed to balance enrollment reductions and FMAP cuts.

*Assumes adjusted base Medicaid FMAP of 65.89 percent and PeachCare FMAP of 76.12 percent starting October 2023.

Source: Federal Consolidated Appropriations Act, 2023.

Investments in the Governor’s Health Care Expansion Plan for Low-Income Georgians

In 2019, the passage of the Governor’s signature health care legislation, the Patients First Act or SB 106, paved the way for Georgia to seek federal approval for three new programs:

• The Georgia Pathways to Coverage program, which proposes to partially expand Medicaid eligibility to low-income adults who meet work or other monthly reporting requirements;

• The Georgia Reinsurance Program, which establishes a claims-based reinsurance program to help offset costs of enrollees in the individual health insurance market who have large medical claims; and

• The Georgia Access Model, which would remove the state from the federal marketplace (often referred to as HealthCare.gov) without a statebased alternative. With the passage of SB 65 during the 2023 Legislative Session, the state has pivoted away from the original Georgia Access Model plan and moved toward a state-based health insurance exchange. Going forward, the program will be funded by user fees rather than state General Funds.

Overall, the state has made a significant investment in all three programs. The Pathways to Coverage Program and Georgia Access Model’s statebased exchange are set to launch in 2023, and the Reinsurance Program launched in 2022. It will be important to track the impact of these investments on increasing access to affordable, high-quality health care.

About $424 Million Invested Since 2021 to Launch Health Care Programs Established by the Patients First Act of 2019

Source: GBPI analysis of Georgia’s 2021 Amended Fiscal Year Budget