Explaining Medicaid

What is Medicaid? What is the Medicaid Expansion? What does it mean for Georgia? You can find everything you need to know about this issue here.

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The Georgia Medicaid program covers 1.7 million people. Changes to eligibility may allow an additional 650,000 Georgians access to the program. Learn more about the consequences of expanding the program or choosing to forgo expansion.

1. What is Medicaid?

2. What is Medicaid expansion?

3. Who pays for Medicaid?

4. If we don't expand, where will these people get coverage?

5. How will the Medicaid expansion help small businesses?

6. What is the overall economic impact of expanding Medicaid in Georgia?

7. Who makes the decision to expand in Georgia?


1. What is Medicaid?

Medicaid is a health insurance program that provides care to seniors in nursing homes and in communities, people with disabilities, pregnant women, low-income parents, and children. It offers basic health coverage like pre-natal care, doctor's visits, prescriptions, and covers nursing home costs for the elderly. The Georgia Medicaid program covers 1.7 million people. In Georgia, Medicaid does not cover low-income childless adults, and only covers working parents who make less than 50% FPL (Federal Poverty Level) or approximately $9,765 a year for a family of three in 2013.

Georgia Medicaid Income Limits Today
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2. What is the Medicaid expansion?

Under the Affordable Care Act, states have the option of expanding their Medicaid program to all adults who make up to 138% FPL, approximately $15,856 a year in 2013. In Georgia, about 600,000 people would gain health coverage under this expansion. Of these 600,000 people, most are working adults who do not have coverage through their jobs.

This is an opportunity for Georgia not only to cover needy children, but to also invest in health care for entire families. Parents who have coverage are more likely to ensure that their children are seeing doctors regularly. According to an Oregon study, people with Medicaid were 35% more likely get all needed care and 25% more likely to get all needed medications. In a related study, access to Medicaid decreased overall mortality by 6%.

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3. Who pays for Medicaid?

The majority of Medicaid costs are paid for by the federal government. The federal government currently pays about 65% of Georgia's Medicaid program, and the state covers the remaining 35%. For the current fiscal year, this amounts to $2.5 billion from the state budget, while the federal government contributes over $5 billion.

Under the Medicaid expansion, the federal government will cover 100% of the costs of expansion for the first three years. In 2017, the federal government will cover 95% of the costs for this expanded population and will phase down to 90% in 2020. These percentages are written into the Affordable Care Act, and cannot be changed without an act of Congress.

This expansion will bring in $14 billion over the course of the first five years that would go to providers, nurses, and hospitals. The state would spend $714 million over the first six years, an increase of 2% over what it normally spends on Medicaid.

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4. If we don't expand, where will these people get coverage?

Georgia ranks among the bottom of all states when it comes to access to health coverage. Nearly 2 million Georgians lack health coverage, which is nearly 20 percent of the state's residents. More than one-quarter of Georgians between 18-64 lack health coverage and that figure is even higher for adults at or near poverty. If Georgia doesn't expand Medicaid, many of these Georgians will remain uncovered and will continue to receive sporadic care at free clinics or turn to emergency rooms when their health problems become more severe.

The Medicaid expansion targets low-income working adults who aren't offered insurance through their job. New tax credits created by the Affordable Care Act will help Georgians making between 100% FPL and 400% FPL (or approximately $11,490 and $45,960 per year) to better afford private coverage though the new insurance exchange, or marketplace. Those who make less than 100% FPL are not eligible for these tax credits and would be left without an affordable coverage option if Georgia declines the Medicaid expansion.

5. How will the Medicaid expansion help small businesses?

In addition to being a great deal for the state as a whole, expanding Medicaid eligibility will help small businesses in Georgia by increasing health coverage options for their employees. Small businesses generally have more difficulty affording coverage for their workers than do larger businesses. Expanding Medicaid eligibility will improve access to insurance among low-wage workers, which will take pressure off businesses who cannot afford to cover their workers. It is a win-win because it ensures that more workers get health coverage while easing the financial burden on the businesses themselves.

6. What is the overall economic impact of expanding Medicaid in Georgia?

Expanding Medicaid will bring billions in new federal funding to insure more than 600,000 Georgians. Newly insured patients will bring much-needed revenue to rural hospitals and community clinics who currently provide care to Georgia's uninsured. This will not only create jobs, it will ensure that billions of dollars are infused back into the state's economy.

In addition to the direct economic impact, expanding health coverage will benefit hospitals and other providers by dramatically reducing the amount of uncompensated care that is delivered throughout Georgia. In total, Georgia health care providers serve countless patients who don't have insurance, and often deliver health care services they are never paid for directly. The costs of these uncompensated services - which total $4 billion or more every year in Georgia - eventually get passed on to patients with insurance in the form of higher monthly premiums that affect consumers and their employers.

7. Who makes the decision to expand in Georgia?

Georgia can expand its Medicaid program by submitting a State Plan Amendment to the Centers for Medicaid and Medicare Services. This requires the support of the Governor and the Georgia Department of Community Health. Support of the Georgia General Assembly is also needed in order to appropriate any needed state funding for the expansion.