Key Elements of an Effective Medicaid Expansion for Georgia Lawmakers to Consider

Georgia approaches a critical juncture for leaders to remedy its strained health care system and close the insurance coverage gap through Medicaid expansion. State lawmakers sound more open than ever to accepting billions of federal dollars that can provide access to a doctor for hundreds of thousands of Georgians. Today, a Georgia Chamber of Commerce task force released recommendations for ways to expand Medicaid income eligibility. The Georgia Budget and Policy Institute, Georgians for a Healthy Future and other members of the Cover Georgia Coalition issued a joint release today to provide a quick response to the chamber’s new proposal.

Closing the coverage gap is a proven strategy that can strengthen Georgia’s health care system and give many more residents access to health care. More than half the states expanded their Medicaid program through the Affordable Care Act and are benefiting from increases in health care coverage and reduced budget expenses. Georgia is projected to receive $8.68 to $9.42 from the federal government for each dollar the state spends to expand Medicaid eligibility. Increases in coverage also reduced costs in states that already expanded their Medicaid program. The savings are largely due to lower uncompensated care costs and increased revenue from existing taxes on health providers and insurance plans. More than 300,000 Georgians in the coverage gap without affordable insurance options can gain access to health care through Medicaid expansion.

The good news is key leaders in Georgia are talking more than ever about ways to expand Medicaid eligibility. Lawmakers and other state leaders can look to lessons from other states as they develop a Georgia version of Medicaid expansion.

Ease enrollment for the newly eligible

To achieve true gains in health coverage, eligible residents need an easy way to participate in an expanded Medicaid program. Roadblocks to coverage include lock-out periods, work requirements and high cost-sharing measures such as premiums, co-payments, or required health savings account contributions. High cost-sharing burdens in some states caused significant drops in health coverage. This is also not a cost-effective solution for state budgets. Arizona and Virginia versions of modified Medicaid expansion cost $1.39 to $2.77 more in administrative expenses for each $1 raised through Medicaid cost-sharing. Arkansas saved $6 million in administrative costs when it eliminated health savings accounts for people below poverty level, which is $11,880 annual income for an individual.

Cover all benefits of traditional Medicaid

The traditional Medicaid benefits are designed to improve health outcomes among vulnerable residents in low-income and rural areas. Medicaid expansion planners in some states considered eliminating or reducing a few of these benefits, including non-emergency medical transportation and dental and vision coverage. Such restrictions are short-sighted; they can worsen families’ well-being in the short run and cost the state more in the long run.

Non-emergency transportation helps Georgia Medicaid enrollees without a reliable car or public transit to get to their appointments. Cutting out transportation is not likely to significantly reduce state costs, but would deeply impact rural Georgians who may live farther away from health facilities. Non-emergency medical transportation is less than two percent of traditional Medicaid spending in Georgia. This investment in increasing access to preventative care could help avoid emergency room visits that are 15 times more costly than routine transportation.

Basic adult dental and vision coverage is now offered through traditional Medicaid in Georgia. Iowa, Michigan and Kentucky are among states that tried to replace this benefit with an incentive program. That resulted in many enrollees not receiving preventative dental and vision care. Patients without vision and dental coverage are more likely to develop costlier conditions later on. That problem could’ve been prevented with low-cost, targeted benefits. From a budget perspective, investing in an ounce of prevention is far better than putting things off, only to pay for a pound of cure.

State lawmakers can give the health care system a boost and close the coverage gap through a thoughtful Medicaid expansion plan that uses lessons from other states about what works and what doesn’t.

In the end, the point of expanded Medicaid eligibility is to give hundreds of thousands of Georgians access to a doctor, with a secondary benefit that the state’s financially ailing health care system gets a timely boost. Adding restrictions gets in the way of Georgia reaching that goal.

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