Georgia removes 300,000 children from Medicaid, though most still qualify, report says
Georgia has one of the worst child healthcare disenrollment rates in the country, according to a new report from Georgetown University, falling third in the country after Texas and Florida.
Strikingly, researchers say that the overwhelming majority of children disenrolled from health insurance in Georgia are likely still eligible for Medicaid, but have had their coverage revoked due to procedural red tape.
These changes come amid the end of a pandemic-era provision that allowed those who were on Medicaid to remain covered without filing renewal paperwork between 2020 and 2023. The continuous enrollment provision ended in March 2023, and for the past year, all 50 states and the District of Columbia have been going through the process of “unwinding,” or determining who is still eligible for Medicaid and Children's Health Insurance Program (CHIP) coverage and removing those who no longer qualify.
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Georgia’s unwinding process began in May 2023, and by December, more than 300,000 children had been disenrolled from Medicaid and CHIP. According to the study, Georgia has the 10th highest disenrollment rate in the country, with a 17% decline in child Medicaid and CHIP enrollment overall between May and December of last year.
“Obviously, unwinding is continuing past December,” said Edwin Park, a research professor at Georgetown University and one of the co-authors of the report. Their data, he said, “provides a snapshot about the impact of unwinding and what it means for children's coverage.”
What is driving up disenrollment?
Across the U.S., nearly 3 out of 4 disenrollments during the unwinding process have been due to “procedural reasons — paperwork reasons, red tape, failure to return forms — rather than a determination of a person being no longer eligible for Medicaid,” Park said. “Some people may get coverage in the marketplace, employer-sponsored insurance, separate CHIP programs, but a large share of those are likely ending up uninsured, and that's particularly the case for kids who are disenrolled.”
According to Joan Alker, the executive director of Georgetown’s Center for Children and Families and the lead author of the report, Georgia was only 55% through its unwinding process in December 2023, falling behind many other states in the study. Texas and Florida, which had the two highest rates of disenrollment, were roughly 75% done. If Georgia continues to remove children from Medicaid at a similar rate, the total could near 600,000 by the end of the unwinding process.
A variety of factors can contribute to families being unable to re-enroll in their state’s Medicaid or CHIP program, researchers say, but disenrollment data indicates that the majority of children are losing coverage because of barriers to enrollment access, not lack of eligibility.
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“When states are doing renewals, they have to do a computerized check called an ‘ex parte’ check, using available data that they have to see if children and families are still eligible,” Alker said. “States that are doing well in this process are doing as much as possible using their IT systems so that families aren't having to provide paperwork time and time again, and call into jammed call centers and provide paperwork that sometimes doesn't get uploaded correctly.”
States like North Carolina, Rhode Island and Arizona use high rates of ex parte renewals (over 90%), resulting in a faster, more streamlined process for families seeking to renew their coverage. In contrast, data from KFF Health News indicates that only 64% of Georgia residents are able to renew their coverage ex parte.
The remaining families trying to renew their eligibility through a renewal form may face a wide variety of hurdles to re-enrolling.
“Think of all the things that can go wrong there,” Alker said. “The state is sending out a form and they may not have the right address. A lot of movement happened during the pandemic, so they may not have the right address. The family may not get the form in the mail. The family may get the form in the mail and have too short an amount of time to respond because the mail was slow. The family may not understand the notice.”
Could Medicaid expansion help?
In December, Health and Human Services Secretary Xavier Becerra sent letters to Georgia Gov. Brian Kemp, as well as governors in eight other states, expressing concern about the high rates of child disenrollment and urging states to expand Medicaid.
“Because all children deserve to have access to comprehensive health coverage, I urge you to ensure that no child in your state who still meets eligibility criteria for Medicaid or CHIP loses their health coverage due to 'red tape' or other avoidable reasons as all states 'unwind' from the Medicaid continuous enrollment provision,” Becerra wrote.
States that have refused to expand their Medicaid programs, including Georgia, Texas and Florida, have some of the highest child disenrollment rates in the country overall.
“If you haven't adopted the Medicaid expansion, that means, by definition, a larger share of your Medicaid program is coverage of kids,” Park said. “Unwinding, then, will have a significant impact on kids’ coverage in the state, but also, if their parents aren't covered, it's less likely that they're going to stay on the Medicaid programs.”
However, state leaders have shown little interest in expanding Medicaid programs, citing the higher costs they believe the program would bring.
“Expanding Medicaid will take people off of their private sector insurance and put them onto government run health care,” Kemp said when asked about expanding Medicaid at a bill signing ceremony for the 2025 budget. “That is going to cost more money in the short term, more money in the long term, so to me, that does not make good budgeting sense to do that.”
Georgia's Department of Community Health, which helps run the state's Medicaid program, did not respond to a request for comment.
Maya Homan is a 2024 election fellow at USA TODAY, focusing on Georgia politics. Follow her on X, formerly Twitter, as @MayaHoman.
This article originally appeared on Savannah Morning News: Georgia removes 300,000 children from Medicaid coverage
