Fast Facts on Medicaid Expansion

Key Takeaways

• The COVID-19 pandemic is disproportionately affecting Black Georgians, who are more likely to contract and pass away from the virus and work in jobs facing layoffs and furloughs, and will likely push communities of color deeper into poverty, and is decimating the livelihoods of hundreds of thousands of Georgians.
• Immediate Medicaid expansion would save lives, provide desperately needed coverage to Georgia’s most vulnerable, accelerate economic recovery and stabilize rural health systems.

Medicaid is a health insurance program funded by both the state and federal government that covers about 1 in 5 Georgians—mostly children, people with disabilities and elderly people who have low to moderate incomes. In Georgia, many adults do not qualify for Medicaid. Starting in 2014, states had the option to increase the income threshold for Medicaid to include more adults who make below or near the poverty line. However, Georgia has not expanded Medicaid to these levels, so adults between ages 19 and 64 without dependent children cannot get Medicaid coverage, and adults with dependents need to make below about $7,000 a year for a family of three.

The federal government pays for 90 percent of the costs for the expansion group, a higher share than the 67 percent the federal government pays for Georgia’s traditional Medicaid program. Georgia is one of 14 states not to adopt the expansion of Medicaid eligibility. As the state continues its response to the COVID-19 pandemic and prepares for future public health events, immediate adoption of the Medicaid expansion would allow the state to bring in more federal money to spend on health care services and ensure more Georgians can afford to get care for COVID-19 and underlying health conditions that could put them at higher risk.

Many Georgians cannot afford health care

• About 255,000 Georgians make too little to get financial help to buy health insurance on the Healthcare.gov marketplace and do not currently qualify for Medicaid. These Georgians have incomes below the poverty line (less than $12,769 a year for an individual or $21,720 a year for a family of three) and fall into the coverage gap with no affordable health insurance options.
• Another 219,000 uninsured Georgians make slightly above the poverty line (between 100 and 138 percent of poverty). Most will qualify for premium subsidies on healthcare.gov, but they may not be able to use the coverage because of high deductibles or copayments. Medicaid does not have deductibles and has small copayments based on income. In total, over 470,000 Georgians would be able to see a health provider and not worry about facing medical debt if the state expanded Medicaid.
• 1.4 million Georgians do not have health insurance, and Georgia’s uninsured rate of 13.7 percent is third highest in the country. In rural Georgia, the uninsured rate could climb to more than 25 percent by 2026.
• Substance abuse, unmet mental health needs and chronic diseases are decimating communities statewide, exacerbated by high uninsured rates that prevent Georgians from getting care because they cannot afford it.

Georgians need health coverage to stay healthy

• Georgians who could gain coverage under Medicaid expansion earn below 138 percent of the federal poverty level, or about $17,600 for an individual, $23,790 for a family of two and $29,970 for a family of three.
• Sixty percent of people who would be covered by Medicaid expansion are working but often not offered health benefits through their job or do not get paid enough to afford their employer plan. Only 41 percent of Georgia employers offer employer-sponsored health insurance.
• Closing Georgia’s coverage gap would extend health insurance to over 155,000 uninsured women. Georgia ranks among the bottom five states for women’s health insurance coverage.
• Closing the coverage gap could extend health insurance to nearly half of Georgia’s uninsured veterans, expanding coverage to 32,000 uninsured veterans and military spouses in our state.
• Closing the coverage gap would help address racial disparities in health care access and outcomes. About 36 percent of Georgians in the coverage gap are Black, and 22 percent are Latinx.

Closing coverage gap yields economic benefits for state and helps accelerate economic recovery

• For every dollar the state spends on closing the coverage gap, Georgia receives up to $9 in federal funding.
• Closing the coverage gap could create 56,000 jobs in Georgia each year and boost the state’s economic output by $6.5 billion annually.
• Closing the coverage gap could create 12,000 jobs and $1.3 billion in new economic activity in Georgia’s rural communities each year.
• Georgians are already paying federal taxes toward closing our coverage gap, but state leaders have refused billions in federal health care dollars meant to pay for Georgians’ health coverage and stabilize struggling rural hospitals.

Stabilize struggling rural hospitals by closing the coverage gap

• Seven rural hospitals have shuttered since 2013 across the state, and more than half of Georgia’s remaining rural hospitals are financially vulnerable to closure. At least 118 counties in Georgia are considered rural because they have a population below 50,000.
• Many Georgia hospitals are struggling because they treat so many patients who lack health insurance and cannot afford high out-of-pocket costs. Closing the coverage gap opens up an important revenue stream to ensure rural communities have access to health care.
• Taxpayers end up paying a share of the cost for uninsured people who show up in emergency rooms. Closing the coverage gap would allow people to go to their doctor instead of the emergency room when they get sick.
• Other states see significant reductions in uncompensated care after closing their coverage gaps: Arkansas experienced a 56.4 percent decrease; Kentucky saw a 59.7 percent decrease.

Strengthen mental health, substance use treatment by expanding health coverage

• Closing the coverage gap can significantly strengthen behavioral health treatment and services in Georgia. About 25 percent of uninsured Georgians who would qualify for Medicaid expansion coverage suffer from mental illness or substance abuse.
• States that closed their coverage gap expanded treatment services to more people with mental illness or substance use disorders. Kentucky saw a 700 percent increase in Medicaid beneficiaries using substance use treatment services after the state expanded eligibility in 2014.

Georgia can afford to close the coverage gap

• Georgia can afford to close the coverage gap, but state leaders have so far chosen to spend tax dollars in other ways, like $309 million for insurance company tax breaks. State leaders could also increase Georgia’s extremely low tobacco tax to the national average to raise hundreds of millions of dollars a year. Three in four Georgians support raising the tobacco tax by $1, according to a recent poll.
• Closing the coverage gap would extend health coverage to almost half a million Georgians, support struggling hospitals, create 56,000 jobs and bring in $3 billion from the federal government. The annual net cost to Georgia would be $143 million in 2020.

Expand health coverage immediately

• The COVID-19 pandemic is expected to result in more Georgians losing insurance and significant shortfalls in the state’s budget. To best respond to the COVID-19 pandemic, Georgia needs stronger health care infrastructure and federal assistance to shore up the budget. Expanding Medicaid would bring in millions more dollars to health care providers to care for patients and billions more in federal money to offset state spending increases and lower tax revenues.
• As of April 16, 2020, 940,000 Georgians have filed for unemployment benefits this year, and some of them are losing health insurance they received through their job. Depending on what the state’s new rate of unemployment is between 10 percent and 25 percent, the number of uninsured Georgians could increase by 101,000 to 524,000.
• Uninsured adults may face higher risk of exposure to COVID-19 because of the types of jobs they are more likely to hold. The occupations with the highest number of uninsured workers include cashiers, restaurant servers and cooks and retail sales, which require more contact with the public and do not allow for working at home. Expanding coverage will ensure more of these workers can afford testing and any necessary treatments.
• State leaders have delayed offering serious solutions for Georgia’s worsening health care crisis for years, waiting on Congress to provide a solution that hasn’t come. Rural communities and communities of color were already the hardest hit by the state’s health crisis. Without new solutions, this holds true for the COVID-19 public health crisis. The areas with the highest rates of confirmed COVID-19 cases per 100,000 people are mostly rural Southwest Georgia counties with large Black populations.
• As Georgia leaders refuse to close the coverage gap, the federal government simply keeps our tax dollars. Each year we wait, our state misses out on $3 billion in federal dollars meant to pay for Georgians’ health coverage. That is more than $8 million each day. Georgia has already missed out on $21 billion in federal health care dollars. Georgia cannot afford to keep waiting.
• The Families First Coronavirus Response Act gives states the option to provide free COVID-19 testing for the uninsured through Medicaid but does not cover treatment for the virus. The CARES Act set aside a $100 billion fund that hospitals can apply for to be reimbursed for treating uninsured COVID-19 patients or for other needs like equipment and staffing capacity. Georgia can support its hospitals by expanding coverage so they have the assurance they will get paid for services and can use most of the money they receive from the federal fund towards critical personal protective equipment and ventilators.

Georgia can expand Medicaid in a few different ways

• The Georgia Department of Community Health, the state Medicaid agency, can submit a state plan amendment to the federal government. The federal government has 90 days to approve it. Most expansion states took this path, referred to as a “traditional” Medicaid expansion.
• The state Medicaid agency can submit a request to the federal government to waive certain parts of the Medicaid program. This plan, called an 1115 Medicaid waiver, can include increasing the Medicaid income eligibility to 138 percent of poverty. So far, seven states expanded Medicaid using waivers. For more about the differences between traditional Medicaid expansion and Medicaid 1115 waivers, see this fact sheet.
• In December of 2019, Georgia submitted an 1115 waiver that partially expanded Medicaid eligibility up to 100 percent of the poverty line. The plan has not yet been approved, but it includes work reporting requirements and is expected to only receive a 67 percent federal match instead of the full expansion’s 90 percent match. Senate Bill (SB) 106, signed in March of 2019, restricted the Department of Community Health from extending coverage past the poverty line. State leaders should consider the following options to remove this restriction and allow the state to receive higher federal funding to cover more people during the crisis and beyond:
  • When state lawmakers reconvene for legislative session, they can amend SB 106 to allow expansion up to 138 percent of poverty and/or add language to the budget allowing the department to pursue a full expansion.
  • The Governor should consider if his emergency powers would allow him to authorize a full Medicaid expansion by suspending the restrictions from SB 106 to prevent delay in pursuing expanded coverage. The governor’s public health emergency powers allow him to “suspend any regulatory statute prescribing the procedures for conduct of state business, or the orders, rules, or regulations of any state agency, if strict compliance with any statute, order, rule, or regulation would in any way prevent, hinder, or delay necessary action in coping with the emergency.”
  • The Department of Community Health should consider ways to expand coverage through emergency 1115(a) Medicaid waivers and resubmitting the state’s current waiver to remove work reporting requirements.