Articles Posted in Medicaid/SSI

Published on:

Medicaid expansion.jpg

Now that the election is over, and we know that the Affordable Care Act is here to stay, Georgia must decide whether it intends to expand its Medicaid program. This summer, the United States Supreme Court upheld the Affordable Care Act as constitutional, but left open the possibility for states to opt out of expanding their Medicaid program.

Budget analysts predict that the cost of Medicaid expansion in Georgia will be $1.8 billion over the next ten years. That is a 4.1% increase in spending. Georgia currently has approximately $1.9 million uninsured citizens. Of those, about 700,000 would be eligible for Medicaid.

Georgia Governor Nathan Deal has opposed expansion, although he now seems to be weighing his options. Governor Deal has indicated that he would support a “block grant.” A block grant would allow the federal government to deposit a set amount of funds to Georgia for Medicaid coverage with no corresponding state contribution. Currently, there is no federal congressional authority for block grants. Governor Deal argues that the state cannot afford an expansion of the program and does not have the funds now or in the future. Currently, Georgia is running a deficit on Medicaid financing.

States in the Southeast with high numbers of uninsured citizens will likely face additional costs with the expansion of Medicaid. However, more insured citizens also alleviate the burden on hospital and emergency rooms. The cost burden to states for uncompensated care will fall.

States, such as New York, Arizona, and Maine, that have already expanded Medicaid coverage have seen an improvement in overall health, access to care, and coverage for the uninsured. However, these states do not have the high numbers of uninsured waiting to join the Medicaid rolls, and therefore, the cost of expansion is more easily spread across the state.

Proponents of expansion argue that an expansion of Medicaid would inject $40 billion of federal funds into Georgia’s health care economy over the next ten years. Proponents further argue that even if Georgia refuses to expand its program, it will likely see a rise in Medicaid costs as more people apply into the system.

Published on:

In previous posts, I reported how Georgia was considering an overhaul of Medicaid this summer to account for anticipated budget shortfalls. However, last week’s ruling on the Affordable Care Act (ACA) will likely cause the state to put off an overhaul while it contemplates the expansion of Medicaid eligibility in Georgia.

Under the ACA, Medicaid is expanded to cover those who earn within 133% of the poverty level. That comes to about $31,000 for a family of four; $24,000 for a family of three; and $13,000 for an individual.

Currently, Georgia’s Medicaid program only covers adults with dependent children who earn within 50% of the federal poverty level. Non-disabled adults with no dependent children are not eligible for Medicaid under any income level. Under the original ACA bill, states that refused to expand Medicaid eligibility would lose all the original Medicaid funding. The Supreme Court found this portion of the bill to be draconian and ruled it unconstitutional. This leaves open the opportunity for states to opt out of Medicaid expansion.

Georgia’ Governor, Nathan Deal, last week was non-committal on whether Georgia would opt into the Medicaid expansion. If Georgia does choose to expand Medicaid eligibility, the federal government will pay for the extra cost over a three year period. After that, the federal government will pay for 90% of the cost thereafter.


More than 600,000 uninsured Georgians are expected to gain coverage through the ACA Medicaid expansion. If the state approves the expansion it could receive $9 for every $1 of state expenditure. Without Medicaid expansion, Georgia will lose more than $35 billion in ten years. Those federal dollars would flow to hospitals, doctors, emergency rooms, and pharmacies. These additional funds would go to communities throughout the state – particularly those serving an undue percentage of the uninsured. If Georgia does not expand Medicaid, then those federal tax dollars will simply flow to other states. This would lead to vastly different outcomes from state to state.

Expansion of Medicaid would likely provide coverage to an estimated 400,000 to 600,000 Georgians who are currently uninsured. When the uninsured have serious medical problems, they have no choice but to show up at the doors of local emergency room. Hospitals, providers, and those with private insurance now subsidize the cost of providing emergency medical care to the uninsured. With federally financed expansion, Georgia will no longer be primarily responsible for providing coverage to the uninsured.

However, Georgia’s largely Republican elected officials have either indicated a desire to opt out of the federal Medicaid expansion or are refusing to decide until after the November election. Georgia has one of the highest rates of uninsured in the country. Yet, it appears that Georgia, like other Southern states, may opt out of Medicaid expansion. Thus, the state most in need of federal Medicaid expansion support seems the one most likely to refuse it. And that is bad news for the working, uninsured, poor in Georgia.

Published on:


I decided not to abandon yesterday’s topic on the budget shortfalls of Medicaid because so much remains to be said regarding this. In my practice, I frequently am asked about fraudulent claims. It seems everyone jumps to the handy conclusion that anyone applying for Social Security benefits must be gaming the system. This public perception has absolutely nothing to do with the genuine struggles of people with long-term disabilities whom I am privileged to work for every day.

When policymakers propose cutting services to the needy, it helps if average taxpayers can tell themselves that the neediest don’t deserve it. Then we can go on about the business of cutting government safety net programs without any underlying guilt. But a myopic view of the world condition serves no one, least of all ourselves.

When I left off yesterday, I complained that the cost-cutting reforms of Medicaid should not be borne on the backs of the poor and disabled – the very group that Medicaid was designed to help. Too often in policy discussions, the easy implementation is to cut services.

Certainly, where fraud exists in the system it should be stomped out as it ruins the program’s integrity. Last year, the Georgia Attorney General recovered almost $58 million dollars in Medicare/Medicaid fraud prosecutions. And Kudos to Georgia Attorney General Sam Olens whose office investigates and prosecutes Medicaid fraud. However, if you look at my blog from yesterday you will see the annual Georgia portion of the Medicaid budget is 2.3 billion dollars. Thus, the percentage of the Medicaid budget attributable to fraudulent claims paid is less than one percent. Even if you assume that undetected fraud in the system raises that percentage, fraud is still not the driving force of Medicaid costs.

First, the recession has added more families to Medicaid rolls and the sluggish economy has done little to improve this. However, the bulk of the costs (over thirty percent) is long-term institutional care. Medicaid is the single largest payer of nursing home bills in America. The second largest cost to Medicaid is home-based health care provided to the chronically ill, elderly or disabled.

What I did not address in yesterday’s post was how we best address rising costs in Medicaid without cutting vital services to those that need it most. I am opposed to heavy co-pays on SSI recipients. This will only be a barrier to necessary treatment, and that may, in fact, cause more expensive Emergency Room visits and possibly institutional care. Studies on for-profit managed care companies handling Medicaid indicate that there are quality of care concerns.

Still, rising costs in Medicaid can quickly lead to state tax increases and reductions in services such as public safety or education. In the face of staggering budget deficits and growing unemployment, state legislators, faced with Medicaid taking up 20% of state budgets, are eager to cut reimbursement rates for Medicaid providers and reduce Medicaid rolls. How to reduce spending while ensuring basic and humane benefits for the most vulnerable citizens is the question challenging policymakers today. And the fact is that there are real human consequences when numbers don’t add up.

The reform I’d like to see is one proposed by President Ronald Reagan in 1982: Eliminate the state/federal sharing of Medicaid and federalize the whole program, much like Medicare. Medicaid really does threaten to crush state budgets. Responsibility for Medicaid should be shifted to the federal government where it belongs. Encapsulating the program into a federal model would allow for competitive bargaining and reduced administrative costs through efficiencies of scale. Federalization could actually control costs in effective ways that states cannot do alone. Moreover, the federal tax policy could shift the costs of the program onto those who can better afford to bear them. More importantly, health care costs could be contained without shifting the cost-cutting onto the elderly, disabled and poor, who can least afford it.