OPINION: How Georgia can better support children and families amid Medicaid unwinding

(Credit: Kabita Darlami)

By Laura Colbert, Callan Wells and Brittany Newton

Since last April, we have answered phone calls, emails, and texts from frustrated Georgia families struggling through their Medicaid renewals. In one such exchange, “Naomi” shared that her 4-year-old grandson’s Medicaid coverage was canceled without any notice. They found out hours before her grandson’s regular dentist visit and a doctor’s appointment for school-required vaccines. 

Naomi — a savvy woman with a professional degree and previous high-level executive positions — could not get in touch with a state employee about restarting her grandson’s coverage. After calling and being placed on hold for more than two hours over several calls, she tried to visit the local county Medicaid office only to find it closed. 

Naomi was never able to speak with one of Georgia’s customer service agents, who are supposed to be available to help with questions like these. Instead, she worked through professional connections (an asset that many families don’t have) to restore her grandson’s coverage after two months of delay. 

Georgia is 10 months into the year-long “Medicaid unwinding” in which the state is required to assess almost every Medicaid member to determine if they are eligible to keep their health coverage. Most of Georgia’s 2.8 million Medicaid members are children. The program also covers low-income people with disabilities, seniors, pregnant women, new mothers (until their child’s 1st birthday), and a few other very limited groups. 

So far, more than 500,000 Georgians have lost their Medicaid coverage. Only 73,300 (14%) have lost coverage because the state knows they are no longer eligible. The remainder were disenrolled simply because the state is missing information, can’t get in touch, or documents go missing. In June 2023, some 7 out of 10 Georgians who lost Medicaid were children. Because the state hasn’t released child-specific data for any month since, we can’t tell how many total kids have become uninsured. 

With only a few months left in Georgia’s Medicaid unwinding, we know that this process has been frustrating and consequential for families. At a recent event in DeKalb County, more than 400 families showed up so they could get help with their Medicaid eligibility determinations because they’ve struggled on their own. 

Many families across the state haven’t had the benefit of in-person assistance. Some are temporarily uninsured, and others will go without health coverage for years.

Georgia has struggled more than most states to carry out the unwinding process, but none of the pain points should be surprising. 

For years, it has been challenging for Georgians to enroll in, renew, and keep their public benefits (Medicaid, SNAP food assistance, etc.). The systems that families must navigate often seem purposefully difficult, and even hostile to the people they are meant to help.

As Naomi’s story illustrates, the Medicaid renewal process begins with a printed and emailed notice to let the member know that their coverage is due for renewal and what actions they need to take. These notices regularly fail to reach members, and when they do, the notices are hard to understand without a law degree, or they convey conflicting information.  

When Medicaid members look for help, they report being unable to reach anyone through the state’s call line. Their county public benefits office may only be open one to three days per week for a narrow part of the work day. Sometimes when families are able to find the help they need and submit required paperwork, there is no guarantee that they will get or keep Medicaid because of computer system errors.

Even systems meant to streamline renewals and applications haven’t yet helped many Georgians. Only 35% of Georgia’s Medicaid members whose renewals are complete have been renewed automatically by the state. All other renewals have taken some kind of manual work by the member or their family and state workers.

State lawmakers approved an “express lane” option in 2022, which allows children applying for food assistance to also be considered for Medicaid with just one application. During the unwinding, assistants helping Georgians with their Medicaid and food assistance renewals noticed that kids were not automatically being considered for these programs without the family’s active permission for each child. An “express lane” should be the default option for kids — especially when we remember that food and health care can be difference makers for families living paycheck-to-paycheck. To Georgia’s credit, the state is changing this feature to be automatic for children after hearing this feedback.   

If Georgia were to follow our leaders’ oft-repeated mantra to run our state more like a business, we would have overhauled our public systems and policies years ago to be convenient, easy to use and dignified. 

The state should prioritize paying knowledgeable state workers fairly for their expertise as they process benefits applications and help families with questions. Case workers currently make an average of $35,000 annually which has contributed to poor morale and high turnover rates. A pay raise would improve the retention of workers and help ensure families can reach someone when they call or try to find in-person help before or after their work shifts.

Georgia’s Technology Authority should do a full review of the Gateway public benefits system to identify opportunities to update and improve this technology. Built and managed by Deloitte, the system is expensive, clunky, and takes months to update when problems are identified. It can also be hard to use on mobile devices, which is many families’ only access point. 

Any updates and improvements should begin with leaders asking the families who use our state’s public systems for their feedback and input. They are the experts in what does and doesn’t work because they are navigating all of it. They will expertly describe outcomes that will work better for their family and which would likely include ideas like using easier language in printed and digital materials; re-locating public benefits workers to libraries or recreation centers where families are already spending time; or creating a user-friendly app that allows them to easily upload pictures of requested documents or check the status of their application. 

We could also reduce the opportunities that currently exist for kids (and their parents) to lose their health coverage. Georgia could follow in the footsteps of seven other states that guarantee that Medicaid-eligible babies leave the hospital with coverage and keep it through their sixth birthday, with no renewals or interruptions. Not only would this help kids and families, it would also relieve state workers so they can focus on applications and renewals for other Georgians. 

Insured parents are more likely to have healthy, insured children. So let’s make it easier for parents too by raising the Medicaid income limits for parents. Right now, parents have to either make less than $7,800 per year for a family of four or meet the most stringent work requirements in the country to qualify for coverage. Our state leaders have the power to change that so that $31,200 for the same family qualifies parents for coverage.

The Medicaid unwinding has been a challenge for all states, but it didn’t have to be this hard on Georgia families. Let’s avoid this kind of upheaval in the future by making changes now. Our state leaders are in the midst of decisions about how to spend our tax dollars this year and what changes state agencies will need to make as they serve Georgia families. These improvements should go to the top of their lists. 

Laura Colbert is executive director of Georgians for a Healthy Future, Callan Wells is senior health policy manager for Georgia Early Education Alliance for Ready Students, and Brittney Newton is senior policy analyst for Voices for Georgia’s Children.

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