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A CHART BOOK FOR
Understanding Medicaid in Georgia
and the Opportunity to Improve It
v1 / September 2015
2 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
UNDERSTANDING GEORGIA’S MEDICAID PROGRAM TODAY
PAGE
PAGE
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4
5
6
7
8
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
TABLE OF CONTENTS
GEORGIA’S OPPORTUNITY TO CLOSE THE COVERAGE GAP
PAGE
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10
11
12
13
14
15
16
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
THE ECONOMIC & SOCIAL BENEFITS OF CLOSING THE COVERAGE GAP
PAGE
PAGE
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18 Closing the Coverage Gap is a Good Deal for Georgia
19 Closing the Gap is Good for Georgia’s Economy
20 States are Saving Money by Closing the Gap
21 Medicaid Brings Trustworthy Funding
22 Health Insurance Matters
23 Medicaid is Access
24 Georgia Can’t Afford to Wait
25 Georgia is in the Driver’s Seat
CONTACT INFORMATION
APPENDIX
SECTION
1
SECTION
2
SECTION
3
3 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
SECTION
1
Understanding Georgia’s
Medicaid 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
4 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
Medicaid is a public health insurance
program for low-income people. It was
created in 1965.
Medicaid covers mostly children, pregnant
women, parents, seniors over age 65, and
people with disabilities.
In Georgia, more than 1.9 million people
have health coverage through Medicaid.
Sixty-four percent of beneficiaries are
children.
Medicaid is a partnership between the
states and federal government. Each state
enjoys flexibility managing its program
in accordance with national guidelines.
In exchange, the federal government
provides the bulk of funding.
In FY 2015 and 2016 every dollar Georgia
spends on Medicaid benefits is matched
by more than two dollars in federal funds.
Medicaid and PeachCare for Kids Play an
Important 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 Level
Source: GBPI calculations based on data from U.S. Census Bureau and Georgia Department of Community Health
5 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
Who Gets Medicaid in Georgia?
Several populations are covered and each group has its own
income eligibility guidelines.
Eligibility levels determine who can receive Medicaid
coverage. States set eligibility levels based on
personal income and assets. Eligibility levels for
children, parents, and pregnant women include a
5% income disregard.
Georgia has set very restrictive Medicaid eligibility.
Elderly, blind, and disabled people cannot have income
higher than 75 percent federal poverty level (FPL) or
$13,200 for an elderly couple. Income limits are higher
for those needing long-term care.
Parents with minor children must earn an annual
income below 38 percent FPL or $7,600 for a family
of three in order to qualify for Medicaid.
Pregnant women cannot have income higher than
225 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
Not
eligible
50%0% 100% 150% 200% 250% 300%
ADULT WITHOUT
DEPENDENT CHILDREN
PARENT
AGED, BLIND, DISABLED
BREAST & CERVICAL
CANCER
NURSING HOME &
COMMUNITY CARE
PREGNANT WOMEN
RIGHT FROM THE START
MEDICAID FOR CHILDREN
% FEDERAL POVERTY LEVEL
Children Elgibility Levels are Cumulative
Children Ages 6-19
Children Ages 1-5
Children Ages 0-1
PeachCare
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 spending
per Medicaid enrollee,
about 30 percent below
the national average
in Eligibility
Only seven states make it harder
for parents to get Medicaid
Georgia’s Medicaid program has
very limited eligibility criteria,
making it difficult for people to
qualify for coverage.
Only seven states offer stricter
standards for parents of minor
children. For working parents,
maintaining eligibility is very
difficult. Because the maximum
allowable income is so low ($7,600
annually for a family of three),
working parents can end up losing
their eligibility with just a little
overtime or even a promotion that
comes 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
7 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
Medicaid is a countercyclical
program, meaning it grows to meet
the need when the economy is
bad and residents face job loss or
economic hardship.
On several occasions, leaders at the
federal level increased federal
Medicaid contributions to help states
manage enrollment growth when
states experience declining revenues.
This countercyclical aspect proved
critical for many Georgia families at
the height of the Great Recession
when the state’s unemployment rate
remained over 10 percent for more
than two years and unemployment
peaked at more than 500,000 people.
Between the start of the recession
in 2007 and the depth of its impact
in 2010, 150,000 more low-income
Georgians gained coverage through
Medicaid. The majority of those
enrollees were children.
DEC
2002
-5%
-10%
-15%
DEC
2006
DEC
2004
DEC
2008
DEC
2010
DEC
2003
DEC
2007
DEC
2005
DEC
2009
DEC
2011
Impact of 2001
Recession
Impact of Great
Recession
Medicaid Protects Georgians During
Economic Downturns
Percent Change in Medicaid Enrollment
When economic cycle is down, Medicaid
enrollment increases.
15%
10%
5%
0%
Source: GA Department of Community Health and U.S. Bureau of Labor Statistics
8 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
Not only does Medicaid provide access
to critical health care services, it also
does it less expensively than private
insurers do.
Ninety-four cents of every dollar spent
on Medicaid goes directly to health
services. Medicaid also spends less per
enrollee than private insurers for both
children and adults.
Medicaid’s costs increased at
about one-fourth the rate of private
insurance since 2007.
Medicaid Controls Costs
For every dollar spent on Medicaid:
$
$0.94
is spent directly on
health services
$0.06
is spent on
administrative costs
MEDICAID
1.1%
PRIVATE
INSURANCE
Medicaid’s modest growth in per enrollee spending since 2007
4.4%
Since 2007, Medicaid
spending has grown
more slowly than private
insurance..
Source: Center on Budget and Policy Priorities
9 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
SECTION
2
Georgia’s Opportunity to
Close 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
10 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
Georgia’s Health Insurance Coverage Gap
Parents are only eligible for Medicaid
if they earn less than 38 percent of
Federal Poverty Level. For a single
parent with one child, this means the
parent loses eligibility if they make more
than about $6,000 annually. They do
not become eligible for subsidies to
purchase private insurance until they
make above $15,930. This leaves a
large insurance coverage gap for
low-income adults trying to access
affordable health insurance.
A single adult or couple without
dependent children are not eligible for
Medicaid at all. They remain in the
coverage gap unless they make more
than $11,770 or $15,930 respectively.
Many people in the coverage gap
work low-wage jobs where they are
not offered health benefits. A person
making minimum wage would have
to work more than 30 hours per
week all year to earn enough income
to qualify for subsidies through the
federal health insurance marketplace.
INSURANCE
MARKETPLACE
COVERAGE
CURRENT
MEDICAID
COVERAGE
VETERANS
WORKING
PARENTS
LOW-WAGE
WORKERS
COVERAGE GAP
300,000
uninsured Georgians
are now in the coverage gap, where they are ineligible to enroll in
Medicaid and do not earn enough to get tax credits on healthcare.gov.
11 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
The Affordable Care Act (ACA) offers
states an option to increase Medicaid
eligibility for adults up to 138% FPL.
This is equal to an annual income of
$16,200 for an individual and $ 27,700
for a family of three in 2015.
This expanded eligibility would primarily
help parents and other working adults
who are not offered coverage
through their jobs and cannot afford
other coverage.
75 138
38 138
138
% FPL
20%0% 40% 60% 80% 100% 120% 140% 160%
CHILDLESS
ADULT
PARENT
AGED, BLIND, &
DISABLED
Using Medicaid to Close the Coverage Gap
Current & Expanded Eligibility
ACA offers states an option
to increase Medicaid eligibility
(for adults) up to 138% FPL
= $16,243
Annual Income
Individual
= $27,724
Annual Income
Parent, family of 3
= $16,243
Annual Income
Individual
138%
Current eligibility
Expanded eligibility
Source: Georgia Department of Community Health, 2015 Financial Limits
TF
IELD
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MERLER Y
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HOUSTON CKL
12 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
Approximately 500,000 Georgians
could enroll in quality, affordable
health insurance if Georgia closes
its coverage gap.
This would drastically reduce
the number of uninsured amongst
low-income individuals in the state.
BIBB
TIFT
TELFAIR
EARLY
BURKE
GLASCOCK
CHATHAM
BRANTLEY
WARE
LEE
DOOLY
CRISP
TAYLOR
MACON
HARRIS
TROUP
HENRY
JONES
LONG
PIKE
TATTNALL
CLAY
ELBERT
O
C
JOHNSON
MONROE
CRAWFORD
TERRELL
BAKER
WORTH
IRWIN
COFFEE
APPLING
LOWNDES CHARLTON
WAYNE
PIERCE
BUTTS
BULLOCH
MILLER
D
A
JACKSON
PUTNAM
LAURENS
E CATOO-
SA
WALKER
CHAT-
TOOGA
FLOYD
FANNIN
GILMER
PICKENS
CHEROKEE
GORDON
BARTOW
RABUN
STE-
PHENS
BANKS N
FR
KL
IN
HART
MADISON
TOWNS
UNION
WHITE
LUMPKIN
D
W
N
HALL
FORSYTH
CL
O
EE
KE OGLE-
THORPE
GWINNETT
DeKALB
ROCK-
DALE
MORGAN
TALIA-
FERRO
WILKES
NEWTON
GREENE
COBB
PAULDING
DOUGLAS
FULTON
CLAY-
TON
POLK
HARALSON
CARROLL
HEARD
COWETA
SPALDING
JASPER
BA
OW
WALTON
BALDWIN
HANCOCK
WASHINGTON
WILKINSON
JEFFERSON
JENKINS
SCREVEN
EFFING-
HAM
EVANS
TOOMBS
EMANUEL
TREUTLEN CANDLER
DODGE
EY
WILCOX
PULASKI
TWIGGS
BLE
SUMTER
TALBOT
MUSCO-
GEE
CHATTA- MARION
HOOCHEE
STEWART
QUIT-
MAN
CALHOUN
MITCHELL
DOUGHERTY
COLQUITT
DECATUR GRADY THOMAS BROOKS
BERRIEN
COOK
BEN HILL
JEFF
DAVIS
ATKINSON
BACON
CLINCH CAMDEN
GLYNN
McINTOSH
BRYAN
LIBERTY
WARREN
COLUMBIA
LINCOLN
RICHMOND
UPSON
LA
M
A
R
PE
ACH
RANDOLPH TURNER
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
Restaurants and
Other Food Service
56,390
13 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
The majority of people who could
be newly covered are working.
Many of these workers are in
some of Georgia’s most important
economic sectors, such as
construction, transportation,
education, and retail.
Lower-wage workers are less
likely to have access to affordable
health coverage through their jobs
than workers at higher wage jobs.
Closing the coverage gap will
increase health coverage for
hundreds of thousands of workers
without job-based coverage
and is a smart investment in the
hard-working people who enable
Georgia to prosper.
MORE THAN 300,000 LOW-WAGE
WORKERS KEEP GEORGIA THRIVING
BUT ARE UNINSURED.
CLOSING THE COVERAGE GAP
COULD KEEP THEM & GEORGIA
WORKING HEALTHY!
THAT’S GOOD FOR ALL GEORGIANS!
Sources: U.S. Census data compiled by Center on Budget & Policy Priorities
Trucking
5,650
Construction
30,860
Workers in Key Sectors Could be Covered
Adult Citizens in Georgia with Family Income at or Below 138% of Poverty
Grocery Stores
12,320
Department and
Discount Stores
9,250
Child Day Care
7,930
Employment Services
(temp agencies)
7,190
Advanced Education
7,000
Building Services (janitor,
extermination, cleaning)
6,340
Across the state, 23 percent of all
adults ages 18-64 went without
health insurance in 2013. For adults
in families earning less than 138
percent of the poverty level
(about $27,700 for a family of
three), the uninsured rate was
nearly twice the statewide average
(45 percent), while adults with
income greater than four-times
the poverty level went without
health insurance less than nine
percent of the time.
Georgians of all racial and ethnic
backgrounds would benefit from the
enhanced coverage opportunities
that would come if Georgia closes
its coverage gap. However, racial
and ethnic minorities in Georgia
currently face higher poverty rates
than their white counterparts, and
as a result, face disproportionately
high uninsured rates.
Younger Georgians make up the
majority of uninsured adults. They
tend to have lower incomes than
older Georgians, making it less
likely that they will be eligible for
health insurance subsidies.
Source: Center on Budget and Policy Priorities analysis of U.S.
Census Bureau Data
Ages 18-39
60%
White
37%
Black
36%
Demographics of Adults in the Coverage Gap
Uninsured Georgia Adults below 138% FPL
Other
5%
Hispanic
22%
Ages 50-64
20%
Ages 40-49
20%
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
15 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
Many veterans without job-based health
coverage face some of the same barriers
to health care as other uninsured
Americans. Not all veterans are eligible
for health benefits through the
Department of Veteran Affairs (VA).
Geographic and other barriers may also
prevent some people with VA health
benefits from accessing needed medical
services if they don’t have additional
insurance.
Younger veterans are more likely to be
uninsured than their older counterparts
and are more likely to only have VA
health benefits, leaving them partially
uncovered.
Veterans without insurance are
more likely than insured veterans to
delay care due to cost. They are also
more likely to report unmet health or
dental needs.
Georgia’s Veterans are in the Coverage Gap
Increasing Medicaid coverage could extend health insurance to
nearly 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 SPOUSES
32,000
NEWLY INSURED GEORGIANS
16 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
States that have closed their coverage
gaps have seen greater gains in the the
number of adults with health insurance
coverage than states that did not close
their coverage gaps.
Nine of the 10 states with the highest
uninsured rates in 2014, including
Georgia, were states that had not yet
closed 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 Promise
States that have closed their coverage gaps are leading national coverage gains.
Percent Insured, 2009 to 2014
88%
Expansion States
Non-Expansion States
Georgia
72.8
80.4
79.8
81
76.4
74.8
81.6
77.3
86.7
17 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
SECTION
3
The Economic & Social Benefits
of 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
18 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
New State Insurance
Premium Tax Revenue
Expansion Specific
State Spending
Four-Year Net State
Savings
(After New Revenue)
State Income and
Sales Tax Revenue
Total New Revenue
$306
$575
million
$148
million
$417
$723
million
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 exceed
state costs to close the
coverage gap by $148
million.
Closing the Coverage Gap is a Good Deal for Georgia
New revenues collected from existing funding sources would exceed the costs to close Georgia’s coverage gap.
Georgia’s Medicaid Expansion Ledger (2016-2019 Total)
19 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
Despite giving up two-years worth of
full federal funding — likely about
$6 billion that could have bolstered
Georgia’s health care system —
substantial economic benefits will accrue
if Georgia closes its coverage gap.
Over the next eight years, each $1
invested by the state would generate
more than $12 in new federal funding
to the state’s health care system and
would generate a $24 return for
Georgia’s economy as a whole.
This new economic activity would be
projected to create more than 56,000
jobs statewide.
Georgia invests
$1 for Medicaid
Expansion
Georgia’s $1 Medicaid
investment leverages
$12.43 in federal money
Georgia’s economy gets
$24.42 return for each $1
Georgia invests over 10 years
Closing the Gap is Good for Georgia’s Economy
The federal government will cover the vast majority
of 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.
20 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
KENTUCKY
59.7 percent decrease in
uncompensated care charges
in 2014, a decrease from $1.9
billion to $766 million.
$16.4 million in savings in
the first year and half by
transitioning “spend down”
Medicaid enrollees to the new
adult group.
$108.9 million projected in total
savings and revenue increases
in the first year and a half.
ARKANSAS
56.4 percent reduction in
uncompensated care in the
first six months.
$17.2 million in state general fund
savings in 2015 from decreased
uncompensated care.
$6.4 million in reduced
spending on community health
centers without reduced
services due to previously
uninsured patients now utilizing
Medicaid insurance.
MICHIGAN
85 percent decrease in
uncompensated care costs in a
group of Detroit-area hospitals.
$190 million in projected savings
for state fiscal year 2015 by
using federal funds to cover a
previously state funded program
for mental/behavioral health.
$203.7 million in savings and
new revenue in the first
six months.
• See savings related to
previously eligible Medicaid
beneficiaries now eligible for
the new adult group under
expansion
• See revenue gains related to
existing insurer or provider
taxes
Source: Robert Wood Johnson Foundation – State
Health Reform Assistance Network
States are Saving Money by Closing the Gap
According to a Robert Wood
Johnson Foundation report,
every expansion state should
expect to:
• Reduce state spending on
programs for the uninsured
21 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
Federal Medicaid funding has long been
a stable revenue source for Georgia’s
health care system. Federal funds currently
provide for more than two-thirds of
the costs to cover more than 1.9 million
children, persons with disabilities,
pregnant women, and others.
During times of severe economic
downturn, such as during the Great
Recession and in the aftermath of 9/11,
additional federal help has come to
states to enable them to manage
greater Medicaid enrollment even while
state 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 Medical
Assistance Percentages
Medicaid Brings Trustworthy Funding
The federal match rate for Georgia has remained consistent since the
program began in the 1960s.
Federal Medical Assistance Percentage — Medicaid and Children’s
Health Insurance Program
Source: U.S. Department of Health and Human Services
22 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
HEALTH INSURANCE IMPROVES
FINANCIAL HEALTH
Sources: New England Journal of Medicine,
Commonwealth Fund, National Bureau of Economic
Research, Association of County Commissioners
of Georgia
Health Insurance Matters
The debate over closing
Georgia’s coverage
gap often focuses on
the impact on the state
Budget.
This ignores an equally
important consideration:
the value of health
insurance.
Several recent studies
demonstrate the value
of health insurance to
individuals and the
health system.
1
People with health insurance
are 80 percent less likely to
have catastrophic medical bills.
2
People who have health
insurance are 50 percent less
likely to borrow money or fail
to pay other bills because of
medical debt.
3
51 percent of people without
health insurance have medical
bill problems or medical debt
as compared to 29 percent of
people with health insurance.
1, 2. Results compare people who gained coverage in
Oregon versus those who are eligible but uninsured
3. Results from Commonwealth Fund Biennial Health
Insurance Survey
HEALTH INSURANCE IMPROVES
PHYSICAL HEALTH
1
People received more
preventive care, like cholesterol
screenings, pap smears, and
mammograms when insured.
2
People reported higher
rates of “excellent” or
“very good” health
3
Expansion of Medicaid reduced
mortality by six percent
1. Results compare people who gained coverage in
Oregon versus those who are eligible but uninsured
2, 3. Study compared mortality and health outcomes
in 3 states that expanded adult Medicaid eligibility
with neighboring states without expansions
$
COMMUNITIES AND THE HEALTH
SYSTEM SAVE MONEY WITH
HEALTH INSURANCE
1
Each additional uninsured
person costs their local hospital
$900 per year in
uncompensated care costs.
2
Local taxes often go to support
hospital uncompensated care
costs. In 2012, 43 of the 109
Georgia counties with a hospital
provided funding to their
local hospital.
23 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
Uninsured
Medicaid
Employer-sponsored insurance
39.8%
88.1%
89.8%
Multiple studies have demonstrated
that those insured by Medicaid have
comparable access to care as those with
employer-sponsored insurance.
About 72 percent of Georgia’s doctors
are accepting new Medicaid patients.
That is higher than the national average
of 68.9 percent.
Comparatively, about 81.7 percent
of physicians are taking new
privately insured patients and
80 percent are taking new
Medicare patients.
Physicians accepting
new Medicaid patients
in Georgia
(higher than the national average)
Medicaid is Access
71.9%
PERCENT OF PEOPLE WITH USUAL SOURCE OF CARE
a 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.
24 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
Four of Georgia’s rural hospitals have closed in the last several years.
Fifteen more are financially fragile according to the 2015 final report
from Georgia’s own Rural Hospital Stabilization Committee. Increasing
health coverage would provide Georgia’s hospitals with an increase
source of revenue and a lower burden of uncompensated care.
Closing Georgia’s coverage gap could keep hospital doors open in
rural communities.
?
?
?
?
?
?
?
?
?
?
?
?
?
?
?
Expanded
coverage
can help
save these
hospitals.
15 HOSPITALS
FINANCIALLY
FRAGILE
Georgia Can’t Afford to Wait
PEOPLE & COMMUNITIES
Stacy Soulimiotis had a successful career, but
several years ago she decided she wanted
to go back to school to get her masters
degree. While she was in school, Stacy’s
mother fell ill and needed Stacy to care for
her. Stacy is stuck in the coverage gap.
“I am grateful and honored to have been a
full-time caregiver for my mother, but I had
to put my life on hold to do so. Working
was 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 dedicate
myself to caring for someone else instead
of myself.”
— Stacy Soulimiotis
HOSPITALS & COMMUNITIES
4 HOSPITALS
CLOSED
25
Georgia can map a route to close the coverage
gap in a way that works best for our state.
Medicaid provides significant flexibility to states
in the design of each state’s program. Georgia
can create a program that works best for its
budget, its health care system, and Georgians.
Georgia can hit the brakes at any time.
If the federal government ever fails to pay its
share of the costs, Georgia can discontinue the
expansion at no cost.
Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
Georgia is in the Driver’s Seat!
GEORGIA’S PATH
TO COVERAGE
26 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
For more information, contact:
Cindy Zeldin
Executive Director
czeldin@healthyfuturega.org
404-567-5016 ext. 1
Georgians for a Healthy Future provides a strong voice for Georgia
consumers and communities on the health care issues and decisions
that impact their lives. Our vision is of a day in which all Georgians
have access to the quality, affordable health care they need to live
healthy lives and contribute to the health of their communities.
Georgians for a Healthy Future has a history of providing substantive
health policy information to legislators, community leaders, and
advocates throughout the state, equipping consumers with the tools
they need to be informed consumers and advocates, and engaging
with policymakers to spark policy change for a healthier Georgia.
Tim Sweeney
Deputy Director—Policy
tsweeney@gbpi.org
404.420.1324 ext. 103
The Georgia Budget & Policy Institute (GBPI) conducts research,
data and fiscal analysis and offers a host of policy solutions
to show Georgia ways to improve education, health care and
economic opportunity for all. We couple our research with robust
communications and outreach strategies to educate lawmakers,
the media and advocacy partners around the state to inform and
influence the public debate and responsible decision-making. GBPI
is committed to building an economy that works for all Georgians.
GBPI is an independent, nonpartisan nonprofit source for policy
analysis to elected and appointed officials throughout the state.
Laura Colbert
Community Outreach Manager
lcolbert@healthyfuturega.org
404-567-5016 ext. 2
27 Understanding Medicaid in Georgia and the Opportunity to Improve It
v1 / September 2015
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 People
in the Coverage Gap
Family size
Adults without dependent children
1 person $0 to $11,770
2 people (married couple)
Parents of dependent children
2 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

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Understanding Medicaid in Georgia and the Opportunity to Improve it

  • 1. A CHART BOOK FOR Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015
  • 2. 2 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 UNDERSTANDING GEORGIA’S MEDICAID PROGRAM TODAY PAGE PAGE PAGE PAGE PAGE 4 5 6 7 8 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 TABLE OF CONTENTS GEORGIA’S OPPORTUNITY TO CLOSE THE COVERAGE GAP PAGE PAGE PAGE PAGE PAGE PAGE PAGE 10 11 12 13 14 15 16 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 THE ECONOMIC & SOCIAL BENEFITS OF CLOSING THE COVERAGE GAP PAGE PAGE PAGE PAGE PAGE PAGE PAGE PAGE 18 Closing the Coverage Gap is a Good Deal for Georgia 19 Closing the Gap is Good for Georgia’s Economy 20 States are Saving Money by Closing the Gap 21 Medicaid Brings Trustworthy Funding 22 Health Insurance Matters 23 Medicaid is Access 24 Georgia Can’t Afford to Wait 25 Georgia is in the Driver’s Seat CONTACT INFORMATION APPENDIX SECTION 1 SECTION 2 SECTION 3
  • 3. 3 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 SECTION 1 Understanding Georgia’s Medicaid 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
  • 4. 4 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 Medicaid is a public health insurance program for low-income people. It was created in 1965. Medicaid covers mostly children, pregnant women, parents, seniors over age 65, and people with disabilities. In Georgia, more than 1.9 million people have health coverage through Medicaid. Sixty-four percent of beneficiaries are children. Medicaid is a partnership between the states and federal government. Each state enjoys flexibility managing its program in accordance with national guidelines. In exchange, the federal government provides the bulk of funding. In FY 2015 and 2016 every dollar Georgia spends on Medicaid benefits is matched by more than two dollars in federal funds. Medicaid and PeachCare for Kids Play an Important 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 Level Source: GBPI calculations based on data from U.S. Census Bureau and Georgia Department of Community Health
  • 5. 5 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 Who Gets Medicaid in Georgia? Several populations are covered and each group has its own income eligibility guidelines. Eligibility levels determine who can receive Medicaid coverage. States set eligibility levels based on personal income and assets. Eligibility levels for children, parents, and pregnant women include a 5% income disregard. Georgia has set very restrictive Medicaid eligibility. Elderly, blind, and disabled people cannot have income higher than 75 percent federal poverty level (FPL) or $13,200 for an elderly couple. Income limits are higher for those needing long-term care. Parents with minor children must earn an annual income below 38 percent FPL or $7,600 for a family of three in order to qualify for Medicaid. Pregnant women cannot have income higher than 225 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 Not eligible 50%0% 100% 150% 200% 250% 300% ADULT WITHOUT DEPENDENT CHILDREN PARENT AGED, BLIND, DISABLED BREAST & CERVICAL CANCER NURSING HOME & COMMUNITY CARE PREGNANT WOMEN RIGHT FROM THE START MEDICAID FOR CHILDREN % FEDERAL POVERTY LEVEL Children Elgibility Levels are Cumulative Children Ages 6-19 Children Ages 1-5 Children Ages 0-1 PeachCare 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.
  • 6. 50 44 in spending per Medicaid enrollee, about 30 percent below the national average in Eligibility Only seven states make it harder for parents to get Medicaid Georgia’s Medicaid program has very limited eligibility criteria, making it difficult for people to qualify for coverage. Only seven states offer stricter standards for parents of minor children. For working parents, maintaining eligibility is very difficult. Because the maximum allowable income is so low ($7,600 annually for a family of three), working parents can end up losing their eligibility with just a little overtime or even a promotion that comes 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
  • 7. 7 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 Medicaid is a countercyclical program, meaning it grows to meet the need when the economy is bad and residents face job loss or economic hardship. On several occasions, leaders at the federal level increased federal Medicaid contributions to help states manage enrollment growth when states experience declining revenues. This countercyclical aspect proved critical for many Georgia families at the height of the Great Recession when the state’s unemployment rate remained over 10 percent for more than two years and unemployment peaked at more than 500,000 people. Between the start of the recession in 2007 and the depth of its impact in 2010, 150,000 more low-income Georgians gained coverage through Medicaid. The majority of those enrollees were children. DEC 2002 -5% -10% -15% DEC 2006 DEC 2004 DEC 2008 DEC 2010 DEC 2003 DEC 2007 DEC 2005 DEC 2009 DEC 2011 Impact of 2001 Recession Impact of Great Recession Medicaid Protects Georgians During Economic Downturns Percent Change in Medicaid Enrollment When economic cycle is down, Medicaid enrollment increases. 15% 10% 5% 0% Source: GA Department of Community Health and U.S. Bureau of Labor Statistics
  • 8. 8 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 Not only does Medicaid provide access to critical health care services, it also does it less expensively than private insurers do. Ninety-four cents of every dollar spent on Medicaid goes directly to health services. Medicaid also spends less per enrollee than private insurers for both children and adults. Medicaid’s costs increased at about one-fourth the rate of private insurance since 2007. Medicaid Controls Costs For every dollar spent on Medicaid: $ $0.94 is spent directly on health services $0.06 is spent on administrative costs MEDICAID 1.1% PRIVATE INSURANCE Medicaid’s modest growth in per enrollee spending since 2007 4.4% Since 2007, Medicaid spending has grown more slowly than private insurance.. Source: Center on Budget and Policy Priorities
  • 9. 9 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 SECTION 2 Georgia’s Opportunity to Close 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
  • 10. 10 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 Georgia’s Health Insurance Coverage Gap Parents are only eligible for Medicaid if they earn less than 38 percent of Federal Poverty Level. For a single parent with one child, this means the parent loses eligibility if they make more than about $6,000 annually. They do not become eligible for subsidies to purchase private insurance until they make above $15,930. This leaves a large insurance coverage gap for low-income adults trying to access affordable health insurance. A single adult or couple without dependent children are not eligible for Medicaid at all. They remain in the coverage gap unless they make more than $11,770 or $15,930 respectively. Many people in the coverage gap work low-wage jobs where they are not offered health benefits. A person making minimum wage would have to work more than 30 hours per week all year to earn enough income to qualify for subsidies through the federal health insurance marketplace. INSURANCE MARKETPLACE COVERAGE CURRENT MEDICAID COVERAGE VETERANS WORKING PARENTS LOW-WAGE WORKERS COVERAGE GAP 300,000 uninsured Georgians are now in the coverage gap, where they are ineligible to enroll in Medicaid and do not earn enough to get tax credits on healthcare.gov.
  • 11. 11 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 The Affordable Care Act (ACA) offers states an option to increase Medicaid eligibility for adults up to 138% FPL. This is equal to an annual income of $16,200 for an individual and $ 27,700 for a family of three in 2015. This expanded eligibility would primarily help parents and other working adults who are not offered coverage through their jobs and cannot afford other coverage. 75 138 38 138 138 % FPL 20%0% 40% 60% 80% 100% 120% 140% 160% CHILDLESS ADULT PARENT AGED, BLIND, & DISABLED Using Medicaid to Close the Coverage Gap Current & Expanded Eligibility ACA offers states an option to increase Medicaid eligibility (for adults) up to 138% FPL = $16,243 Annual Income Individual = $27,724 Annual Income Parent, family of 3 = $16,243 Annual Income Individual 138% Current eligibility Expanded eligibility Source: Georgia Department of Community Health, 2015 Financial Limits
  • 12. TF IELD HI W R RA Y RS HA HA BE M M U Mc DU FA YE TT FF IE E M ER IW ET H ER SC HL EY MON W TGOW EB ST ER H EE MERLER Y LA N IE R SE MI NO LE D A SO A RR AR N HOUSTON CKL 12 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 Approximately 500,000 Georgians could enroll in quality, affordable health insurance if Georgia closes its coverage gap. This would drastically reduce the number of uninsured amongst low-income individuals in the state. BIBB TIFT TELFAIR EARLY BURKE GLASCOCK CHATHAM BRANTLEY WARE LEE DOOLY CRISP TAYLOR MACON HARRIS TROUP HENRY JONES LONG PIKE TATTNALL CLAY ELBERT O C JOHNSON MONROE CRAWFORD TERRELL BAKER WORTH IRWIN COFFEE APPLING LOWNDES CHARLTON WAYNE PIERCE BUTTS BULLOCH MILLER D A JACKSON PUTNAM LAURENS E CATOO- SA WALKER CHAT- TOOGA FLOYD FANNIN GILMER PICKENS CHEROKEE GORDON BARTOW RABUN STE- PHENS BANKS N FR KL IN HART MADISON TOWNS UNION WHITE LUMPKIN D W N HALL FORSYTH CL O EE KE OGLE- THORPE GWINNETT DeKALB ROCK- DALE MORGAN TALIA- FERRO WILKES NEWTON GREENE COBB PAULDING DOUGLAS FULTON CLAY- TON POLK HARALSON CARROLL HEARD COWETA SPALDING JASPER BA OW WALTON BALDWIN HANCOCK WASHINGTON WILKINSON JEFFERSON JENKINS SCREVEN EFFING- HAM EVANS TOOMBS EMANUEL TREUTLEN CANDLER DODGE EY WILCOX PULASKI TWIGGS BLE SUMTER TALBOT MUSCO- GEE CHATTA- MARION HOOCHEE STEWART QUIT- MAN CALHOUN MITCHELL DOUGHERTY COLQUITT DECATUR GRADY THOMAS BROOKS BERRIEN COOK BEN HILL JEFF DAVIS ATKINSON BACON CLINCH CAMDEN GLYNN McINTOSH BRYAN LIBERTY WARREN COLUMBIA LINCOLN RICHMOND UPSON LA M A R PE ACH RANDOLPH TURNER 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
  • 13. Restaurants and Other Food Service 56,390 13 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 The majority of people who could be newly covered are working. Many of these workers are in some of Georgia’s most important economic sectors, such as construction, transportation, education, and retail. Lower-wage workers are less likely to have access to affordable health coverage through their jobs than workers at higher wage jobs. Closing the coverage gap will increase health coverage for hundreds of thousands of workers without job-based coverage and is a smart investment in the hard-working people who enable Georgia to prosper. MORE THAN 300,000 LOW-WAGE WORKERS KEEP GEORGIA THRIVING BUT ARE UNINSURED. CLOSING THE COVERAGE GAP COULD KEEP THEM & GEORGIA WORKING HEALTHY! THAT’S GOOD FOR ALL GEORGIANS! Sources: U.S. Census data compiled by Center on Budget & Policy Priorities Trucking 5,650 Construction 30,860 Workers in Key Sectors Could be Covered Adult Citizens in Georgia with Family Income at or Below 138% of Poverty Grocery Stores 12,320 Department and Discount Stores 9,250 Child Day Care 7,930 Employment Services (temp agencies) 7,190 Advanced Education 7,000 Building Services (janitor, extermination, cleaning) 6,340
  • 14. Across the state, 23 percent of all adults ages 18-64 went without health insurance in 2013. For adults in families earning less than 138 percent of the poverty level (about $27,700 for a family of three), the uninsured rate was nearly twice the statewide average (45 percent), while adults with income greater than four-times the poverty level went without health insurance less than nine percent of the time. Georgians of all racial and ethnic backgrounds would benefit from the enhanced coverage opportunities that would come if Georgia closes its coverage gap. However, racial and ethnic minorities in Georgia currently face higher poverty rates than their white counterparts, and as a result, face disproportionately high uninsured rates. Younger Georgians make up the majority of uninsured adults. They tend to have lower incomes than older Georgians, making it less likely that they will be eligible for health insurance subsidies. Source: Center on Budget and Policy Priorities analysis of U.S. Census Bureau Data Ages 18-39 60% White 37% Black 36% Demographics of Adults in the Coverage Gap Uninsured Georgia Adults below 138% FPL Other 5% Hispanic 22% Ages 50-64 20% Ages 40-49 20% 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
  • 15. 15 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 Many veterans without job-based health coverage face some of the same barriers to health care as other uninsured Americans. Not all veterans are eligible for health benefits through the Department of Veteran Affairs (VA). Geographic and other barriers may also prevent some people with VA health benefits from accessing needed medical services if they don’t have additional insurance. Younger veterans are more likely to be uninsured than their older counterparts and are more likely to only have VA health benefits, leaving them partially uncovered. Veterans without insurance are more likely than insured veterans to delay care due to cost. They are also more likely to report unmet health or dental needs. Georgia’s Veterans are in the Coverage Gap Increasing Medicaid coverage could extend health insurance to nearly 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 SPOUSES 32,000 NEWLY INSURED GEORGIANS
  • 16. 16 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 States that have closed their coverage gaps have seen greater gains in the the number of adults with health insurance coverage than states that did not close their coverage gaps. Nine of the 10 states with the highest uninsured rates in 2014, including Georgia, were states that had not yet closed 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 Promise States that have closed their coverage gaps are leading national coverage gains. Percent Insured, 2009 to 2014 88% Expansion States Non-Expansion States Georgia 72.8 80.4 79.8 81 76.4 74.8 81.6 77.3 86.7
  • 17. 17 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 SECTION 3 The Economic & Social Benefits of 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
  • 18. 18 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 New State Insurance Premium Tax Revenue Expansion Specific State Spending Four-Year Net State Savings (After New Revenue) State Income and Sales Tax Revenue Total New Revenue $306 $575 million $148 million $417 $723 million 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 exceed state costs to close the coverage gap by $148 million. Closing the Coverage Gap is a Good Deal for Georgia New revenues collected from existing funding sources would exceed the costs to close Georgia’s coverage gap. Georgia’s Medicaid Expansion Ledger (2016-2019 Total)
  • 19. 19 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 Despite giving up two-years worth of full federal funding — likely about $6 billion that could have bolstered Georgia’s health care system — substantial economic benefits will accrue if Georgia closes its coverage gap. Over the next eight years, each $1 invested by the state would generate more than $12 in new federal funding to the state’s health care system and would generate a $24 return for Georgia’s economy as a whole. This new economic activity would be projected to create more than 56,000 jobs statewide. Georgia invests $1 for Medicaid Expansion Georgia’s $1 Medicaid investment leverages $12.43 in federal money Georgia’s economy gets $24.42 return for each $1 Georgia invests over 10 years Closing the Gap is Good for Georgia’s Economy The federal government will cover the vast majority of 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.
  • 20. 20 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 KENTUCKY 59.7 percent decrease in uncompensated care charges in 2014, a decrease from $1.9 billion to $766 million. $16.4 million in savings in the first year and half by transitioning “spend down” Medicaid enrollees to the new adult group. $108.9 million projected in total savings and revenue increases in the first year and a half. ARKANSAS 56.4 percent reduction in uncompensated care in the first six months. $17.2 million in state general fund savings in 2015 from decreased uncompensated care. $6.4 million in reduced spending on community health centers without reduced services due to previously uninsured patients now utilizing Medicaid insurance. MICHIGAN 85 percent decrease in uncompensated care costs in a group of Detroit-area hospitals. $190 million in projected savings for state fiscal year 2015 by using federal funds to cover a previously state funded program for mental/behavioral health. $203.7 million in savings and new revenue in the first six months. • See savings related to previously eligible Medicaid beneficiaries now eligible for the new adult group under expansion • See revenue gains related to existing insurer or provider taxes Source: Robert Wood Johnson Foundation – State Health Reform Assistance Network States are Saving Money by Closing the Gap According to a Robert Wood Johnson Foundation report, every expansion state should expect to: • Reduce state spending on programs for the uninsured
  • 21. 21 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 Federal Medicaid funding has long been a stable revenue source for Georgia’s health care system. Federal funds currently provide for more than two-thirds of the costs to cover more than 1.9 million children, persons with disabilities, pregnant women, and others. During times of severe economic downturn, such as during the Great Recession and in the aftermath of 9/11, additional federal help has come to states to enable them to manage greater Medicaid enrollment even while state 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 Medical Assistance Percentages Medicaid Brings Trustworthy Funding The federal match rate for Georgia has remained consistent since the program began in the 1960s. Federal Medical Assistance Percentage — Medicaid and Children’s Health Insurance Program Source: U.S. Department of Health and Human Services
  • 22. 22 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 HEALTH INSURANCE IMPROVES FINANCIAL HEALTH Sources: New England Journal of Medicine, Commonwealth Fund, National Bureau of Economic Research, Association of County Commissioners of Georgia Health Insurance Matters The debate over closing Georgia’s coverage gap often focuses on the impact on the state Budget. This ignores an equally important consideration: the value of health insurance. Several recent studies demonstrate the value of health insurance to individuals and the health system. 1 People with health insurance are 80 percent less likely to have catastrophic medical bills. 2 People who have health insurance are 50 percent less likely to borrow money or fail to pay other bills because of medical debt. 3 51 percent of people without health insurance have medical bill problems or medical debt as compared to 29 percent of people with health insurance. 1, 2. Results compare people who gained coverage in Oregon versus those who are eligible but uninsured 3. Results from Commonwealth Fund Biennial Health Insurance Survey HEALTH INSURANCE IMPROVES PHYSICAL HEALTH 1 People received more preventive care, like cholesterol screenings, pap smears, and mammograms when insured. 2 People reported higher rates of “excellent” or “very good” health 3 Expansion of Medicaid reduced mortality by six percent 1. Results compare people who gained coverage in Oregon versus those who are eligible but uninsured 2, 3. Study compared mortality and health outcomes in 3 states that expanded adult Medicaid eligibility with neighboring states without expansions $ COMMUNITIES AND THE HEALTH SYSTEM SAVE MONEY WITH HEALTH INSURANCE 1 Each additional uninsured person costs their local hospital $900 per year in uncompensated care costs. 2 Local taxes often go to support hospital uncompensated care costs. In 2012, 43 of the 109 Georgia counties with a hospital provided funding to their local hospital.
  • 23. 23 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 Uninsured Medicaid Employer-sponsored insurance 39.8% 88.1% 89.8% Multiple studies have demonstrated that those insured by Medicaid have comparable access to care as those with employer-sponsored insurance. About 72 percent of Georgia’s doctors are accepting new Medicaid patients. That is higher than the national average of 68.9 percent. Comparatively, about 81.7 percent of physicians are taking new privately insured patients and 80 percent are taking new Medicare patients. Physicians accepting new Medicaid patients in Georgia (higher than the national average) Medicaid is Access 71.9% PERCENT OF PEOPLE WITH USUAL SOURCE OF CARE a 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.
  • 24. 24 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 Four of Georgia’s rural hospitals have closed in the last several years. Fifteen more are financially fragile according to the 2015 final report from Georgia’s own Rural Hospital Stabilization Committee. Increasing health coverage would provide Georgia’s hospitals with an increase source of revenue and a lower burden of uncompensated care. Closing Georgia’s coverage gap could keep hospital doors open in rural communities. ? ? ? ? ? ? ? ? ? ? ? ? ? ? ? Expanded coverage can help save these hospitals. 15 HOSPITALS FINANCIALLY FRAGILE Georgia Can’t Afford to Wait PEOPLE & COMMUNITIES Stacy Soulimiotis had a successful career, but several years ago she decided she wanted to go back to school to get her masters degree. While she was in school, Stacy’s mother fell ill and needed Stacy to care for her. Stacy is stuck in the coverage gap. “I am grateful and honored to have been a full-time caregiver for my mother, but I had to put my life on hold to do so. Working was 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 dedicate myself to caring for someone else instead of myself.” — Stacy Soulimiotis HOSPITALS & COMMUNITIES 4 HOSPITALS CLOSED
  • 25. 25 Georgia can map a route to close the coverage gap in a way that works best for our state. Medicaid provides significant flexibility to states in the design of each state’s program. Georgia can create a program that works best for its budget, its health care system, and Georgians. Georgia can hit the brakes at any time. If the federal government ever fails to pay its share of the costs, Georgia can discontinue the expansion at no cost. Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 Georgia is in the Driver’s Seat! GEORGIA’S PATH TO COVERAGE
  • 26. 26 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 For more information, contact: Cindy Zeldin Executive Director czeldin@healthyfuturega.org 404-567-5016 ext. 1 Georgians for a Healthy Future provides a strong voice for Georgia consumers and communities on the health care issues and decisions that impact their lives. Our vision is of a day in which all Georgians have access to the quality, affordable health care they need to live healthy lives and contribute to the health of their communities. Georgians for a Healthy Future has a history of providing substantive health policy information to legislators, community leaders, and advocates throughout the state, equipping consumers with the tools they need to be informed consumers and advocates, and engaging with policymakers to spark policy change for a healthier Georgia. Tim Sweeney Deputy Director—Policy tsweeney@gbpi.org 404.420.1324 ext. 103 The Georgia Budget & Policy Institute (GBPI) conducts research, data and fiscal analysis and offers a host of policy solutions to show Georgia ways to improve education, health care and economic opportunity for all. We couple our research with robust communications and outreach strategies to educate lawmakers, the media and advocacy partners around the state to inform and influence the public debate and responsible decision-making. GBPI is committed to building an economy that works for all Georgians. GBPI is an independent, nonpartisan nonprofit source for policy analysis to elected and appointed officials throughout the state. Laura Colbert Community Outreach Manager lcolbert@healthyfuturega.org 404-567-5016 ext. 2
  • 27. 27 Understanding Medicaid in Georgia and the Opportunity to Improve It v1 / September 2015 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 People in the Coverage Gap Family size Adults without dependent children 1 person $0 to $11,770 2 people (married couple) Parents of dependent children 2 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