As Medicaid Unwinding Draws Near, Legislators Should Invest in DFCS Staff to Help Keep Eligible Georgians from Losing Health Coverage

The Division of Family and Children Services (DFCS) eligibility workers, some of whom process Medicaid cases and who continue to have high turnover, experienced a drop in their pay a few months before the unprecedented challenge of redetermining more than two million people’s Medicaid eligibility. Pay is a key factor in not just recruiting but also in retaining more staff, which would reduce workloads, strengthen morale and improve the accuracy of eligibility determinations made through DFCS. If the state does not boost pay to address the retention problem at the agency, the state will remain in a vicious cycle of hiring new employees while other staff quit. The instability at DFCS increases the likelihood that many Georgians may lose health coverage because of human error. When people unnecessarily lose Medicaid and then must re-apply for the program, it is detrimental to the state’s bottom line. This boom-and-bust cycle of enrollment increases state administrative costs and creates unpredictable Medicaid expenditures.[1] A failure by the state to invest in its workers also means lower quality customer service for families trying to access other economic supports. 

Since the start of the pandemic-era Medicaid continuous coverage requirement, enrollment in the program has grown substantially. More than two million Georgians have had uninterrupted access to affordable health care. Starting in April, the DFCS will have about a year to re-determine the eligibility of every adult and child covered by Medicaid and PeachCare. As a result, more than 500,000 Georgians, including many children, could lose access to life-saving health care. Some will lose access because they are no longer eligible. But almost half may lose access for an avoidable, procedural reason—like their renewal form is sent to the wrong address.[2]

The pay for DCFS case processors is low. Base salary for an entry-level eligibility worker, that is an Economic Support Specialist 1, is $32,000. That is among the lowest salaries of all DFCS staff. The base salary for more experienced eligibility workers is still relatively low and DFCS eligibility staff have noted that the pay is not adequate for their workload.[3] (See table.)

Table of DFCS eligibility caseworkers' base salaries

However, between December 2021 and December 2022, these and some other DFCS frontline workers were receiving bonuses of $480 a month. If an eligibility staff person worked that full year, that was an additional $5,760 in bonus pay. In a news report, the Department of Human Services (DHS) has stated federal pandemic relief funds, which funded the bonuses, “ran out.” But a caseworker who was also quoted in the report said they were told by management that DFCS was “working to make this permanent because we value you.”[4]

Among DFCS’s frontline workers, which includes those who process Medicaid applications, there were steady staffing declines throughout the latter half of 2022. Frontline staff as of December 2022 was just short of 1,400 workers.[5] DHS Commissioner Candice Broce acknowledged that she “worries the loss of $480 a month for workers could exacerbate turnover in the new year.”[6]

It is imperative that lawmakers do not make the pay cuts to DFCS eligibility workers permanent. Below are cost projections that provide low and high estimates, which would at minimum recover the lost pay or provide an even greater increase in earnings for frontline staff. Legislators can include an additional:

  1. $3,760 per DFCS frontline worker. If Kemp’s proposed $2,000 cost of living adjustment (COLA) is approved, this would total $5,760, equivalent to the additional pay staff received in 2022. GBPI estimates this would cost about $6.7 million assuming about 1,780 workers and not including the cost of the proposed $2,000 COLA;[7] or
  2. $5,760 per DFCS frontline worker. If the legislature also approves the proposed $2,000 COLA, that would be a $7,760 per worker pay bump and provide a greater incentive for staff to stay on the job. This would cost a little more than $10 million.

Table of cost projections that provide low and high estimates to recover lost pay or greater increase in earnings for frontline staff

Kemp’s proposed $2,000 COLA will be insufficient to recover these workers’ lost pay and incentivize them to stay in their jobs. The fiscal year 2024 budget must include additional pay increases for DFCS workers who process Medicaid and other public benefit cases. These efforts will provide the necessary supports to retain skilled workers and prevent people struggling with low income from losing benefits for which they qualify.

End Notes

[1] Office of the Assistant Secretary for Planning and Evaluation. (2021, April 11). Medicaid churning and continuity of care. U.S. Department of Health and Human Services.

[2] Chan, L. (2022, October 26). Keeping Georgians covered: Tools for minimizing the harm of the Medicaid unwinding. Georgia Budget and Policy Institute.

[3] Suro, P. (2022, December 7). DFCS worker speaks out citing employees are overworked and burned out. 11Alive WXIA Atlanta.

[4] Landergan, K. (2023, February 3). DFCS caseworkers in Georgia: “It’s like being in an emergency room.” The Atlanta Journal Constitution.

[5] Comments from Deputy Commissioner for Family Independence, Melody DeBussey, during the February 15, 2023 DHS board meeting. Meeting was not recorded.

[6] Landergan, K. (2023, February 3). DFCS caseworkers in Georgia: “It’s like being in an emergency room.” The Atlanta Journal Constitution.

[7] GBPI assumed a 1,400-worker baseline given DFCS’ reported 1,393 in total frontline staff for December 2022 in its February 15, 2023 board meeting. Then GBPI added the number of eligibility staff the governor is proposing to hire, which includes 80 new staff for AFY 2023 and 300 staff for FY 2024. See Office of Planning and Budget. January 2023. AFY 2023 and FY 2024 governor’s budget report.


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