Articles Posted in Medicaid/SSI

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The United States Census Bureau recently came out with a report on the uninsured rate in each state in America in 2017. Georgia’s uninsured rate ranked the 4th highest in America, with 13.4% of Georgians lacking insurance in 2017. This was a slight increase from 2016 when 12.9% of Georgians were uninsured. Georgia only trailed behind Texas, Oklahoma, and Alaska. Nationally, the uninsured rate was 8.8%, affecting 28.5 million Americans. The number of Americans uninsured grew slightly from 28.1 million in 2016 but remained steady at 8.8%.

In 2017, Georgia was one of 14 states to have a higher uninsured rate than that of 2016.  The rate fell in only 3 states, in California, New York, and Louisiana. However, one key southeastern state, Kentucky, gives important indications on the expansion of Medicaid’s impact on uninsured rates. Kentucky was one of the few southeastern states that opted to expand its Medicaid program under the Affordable Care Act (ACA). Kentucky’s uninsured rate sharply dropper from 14.3% in 2013—the year before the ACA expansion—to 5.4% in 2017. Georgia leaders decided not to expand its state’s Medicaid program like Kentucky did, claiming this would be too costly.

Those supporting the ACA have argued that this data clearly shows the effectiveness of the act, despite attacks on it by congressional Republicans. Judith Solomon, a senior fellow at the Center on Budget and Policy Priorities, asserted that the data show the “resilience” of the ACA and the lack of progress in insuring Americans. However, those opposed to the ACA argued that this data shows the inherent flaws in the act. Marie Fishpaw and Doug Bader, of the Heritage Foundation, argued that the ACA is impeding progress on increasing health care access, “despite a growing economy and very low unemployment rate.” These conflicting opinions emphasize the complexity of this issue and the importance of engaging in meaningful dialogue on their implications in our lives.

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For those who successfully apply and qualify for Social Security disability benefits, many people wonder how much they will receive each month in payments. There is not one simple answer to this question, as it depends on which disability benefits you are eligible for, Supplemental Security Income (SSI) or Social Security Disability Insurance (SSDI). Also, another factor is how much money you earned and paid into the Social Security system. If you do not have enough work credits to qualify for SSDI, you may be eligible for SSI disability benefits if you are low income.  SSI benefits are $750 per month at the maximum level.  In America, 12 million people with disabilities receive either SSI or SSDI. In 2014, the average annual benefit for a disabled worker in Georgia was $14,028 or $1,169 per month. This was only slightly higher than the federal poverty threshold for a working-age single person of $12,316.

While certainly beneficial, it is difficult in Georgia to live solely off a disability payment. For example, the average rent for a one-bedroom apartment in Georgia is $908, which would leave on average only $261 for other costs—making subsidized housing one of the only affordable options for most people.  For information on finding affordable subsidized apartments in Georgia, based on your desired zip code and number of rooms, click here. The average utility bill per month is $134.14 in Georgia.  Food costs in Georgia are higher than the national average. Disability recipients may also qualify for SNAP benefits (food stamps) which generally are about $187 a month for a single adult.  Also, public transportation is not nearly as extensive in Atlanta as in other cities, especially for those living in the suburbs or rural areas.  Many cannot afford transportation.

The Social Security Administration also has the ability to decide that you are unable to handle your benefit payments yourself. In this case, you will be assigned to an Social Security Representative Payee to handle your benefits for you, who are required to spend the money on basic living expenses before giving any money to you for other purposes. These payees are often family or friends, but when this is not available, the Social Security uses qualified organizations as payees. Any remaining funds from the payments are required to be put into a saving account for your future use.  It is your responsibility to talk with your payee about how your money is being spent.

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The United Nations (UN) completed a study of poverty in the United States in December 2017. This UN report included data from visits to Alabama, California, Georgia, West Virginia, Washington, D.C., and Puerto Rico.

More than 5 million Americans live in “absolute poverty,” a term which refers to Americans living in third world conditions. According to the U.S. census, more than 40 million Americans live in poverty. Safehouse Outreach, an organization that assists people facing homelessness, reports an increase in the number of people underemployed over the last few years despite decreasing unemployment rates.  At least 40% of Safehouse Outreach’s clients are holding 2-3 jobs and still struggle to pay their rent. The UN report also showed that America has the highest child mortality and child poverty rate in the developed world.  Forty-six million Americans depend on food banks, which is 30% above the levels in 2007, according to Feeding America.  Many of the people living in poverty were either born into poverty or had become disadvantaged due to circumstances beyond their control — such as disability, divorce, illness, or old age.

In Georgia, over 1.6 million individuals are living in poverty.  The Center for American Progress, defines poverty as a family of four who earn less than $24,340 annually. Overall, this means that 16% of Georgians in 2016 were living in poverty.  However, 22.6% of Georgia’s children live in poverty, making Georgia rank 41st in America for poverty. Income inequality is also very high.  Income inequality is measured by the ratio of income going to the top 20% of households against the bottom 20% of households.  Georgia ranks 39th of all states in higher percentages of  income inequality.   In addition to poverty, Georgians are the most uninsured residents of any state, other than Texas.  The most recent healthcare data shows that 26.5% of Georgians under age 65 and also low income do not have health insurance.

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Matt Bevin, Governor of Kentucky, announced his plans to require all Kentucky residents who receive Medicaid to meet work requirements.  Following that decision, the ACLU filed a constitutional law suit.  However, shortly after the Governor’s announcements, a federal judge struck the regulations down, stating that they were “arbitrary and capricious”.

This issue is very important to many Americans.  In April 2018, 67.3 million people  were covered by Medicaid—making it the single largest source of health coverage in the United States. Mandatory eligibility groups for Medicaid  include low-income families, qualified pregnant woman and children, and individuals receiving Supplemental Security Income (SSI).

In Georgia, the basic eligibility criteria for Medicaid requires you to be living in a low-income household. This varies based on the number of people in a household and whether the household includes medically needy parents and children under age 19. The 2018 chart breaking down the maximum income level to be eligible for Medicaid can be found here.     In addition to meeting the financial limits, applicants in Georgia must also meet one of the following descriptions in order to be eligible for Medicaid:

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The Congressional Budget Office projects that recent tax cut legislation and spending packages will increase the federal deficit by $139 billion, raising it to $804 billion in 2018.  In December Congress passed a 1.5 trillion tax-cut package and early in 2018 approved a $400 billion budget.   The CBO projects the US will return to a trillion dollar deficit by next year.  Last week Congress submitted a plan to make up the difference with cuts to Medicare, Medicaid and Social Security.  The above slides were obtained by the Congressional Budget Office.  You can find these slides and more on their website.

Last Tuesday, House Republicans released a budget plan that would make large cuts to Medicare.   The budget plan intends to privatize Medicare ; thereby hoping to eliminate $537 billion out of the program over the next decade.  Congress argues that privatization of Medicare will bring down costs.

Seniors eligible for Medicare would receive a voucher rather than a Medicare card.  The voucher would be used to purchase private health care plans.  Private plans could be more expensive – leaving seniors to either foot the extra bill or change to plans that provided less care or limited the available providers.  Either way, the cost-shifting is born by the seniors.

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Last Thursday, the Trump Administration invited states to add a work requirement to Medicaid eligibility.  States and the federal government jointly fund Medicaid, but states are responsible for running it. The federal government cannot impose work requirements without Congressional approval.  However, states can impose a work requirement by requesting a waiver from the regulations for new programs that carry out the underlying mission of Medicaid.  States do this by applying for a waiver and having it approved by the President.  Hence, it is news when the President of the United States invites states to do this.

Presumably, the work requirement will exempt children, pregnant women, the elderly, and people with disabilities.  There is hope that it will also exempt full-time students and family care-givers.  Assuming all of these groups that currently receive Medicaid would be exempt under the new work requirement proposal that only leaves a small group that would be affected by it.

According to research by the Kaiser Family Foundation, only 1 in 10 people who receive Medicaid would be subjected to the work requirement.  Kaiser research further shows that in the non-exempt populations, more than 50% of the adult Medicaid recipients who would not be covered by the exemption are already working. Thus, a relatively small portion of the individuals who receive Medicaid would be affected.

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Today, the United States Senate released its draft legislation designed to “repeal and replace” Obamacare (also known as The Affordable Care Act).  What is most evident in this legislation is the massive destruction of the Medicaid program.  Medicaid is the single largest healthcare program in the United States.  Medicaid serves one in five Americans.  Medicaid covers not only poor individuals, but two-thirds of all nursing home residents.  Many nursing home bills run between $5000 and $7000 a month for skilled nursing care.  The majority of our elderly community cannot self-pay for that level care should it be necessary.  Medicare does not cover long-term skilled nursing care.  So when we talk about cutting Medicaid, we are talking about the future care of ourselves and those we love.

The Senate bill will phase out the Medicaid expansion that is part of Obamacare.   Obamacare provides for 100% federal funding over a three year period and 90% funding after that for those states that expanded their Medicaid programs.  Medicaid is a federal program that is administered by states.  Georgia did not elect to expand Medicaid.   Those states that did expand Medicaid saw a significant decrease in their uninsured populations.  And importantly, sick and indigent individuals had access to medical care.

Today’s proposed legislation proposes “block grants” and per capita spending limits – a draconian solution that has never been part of the Medicaid program.  Currently, Medicaid provides healthcare coverage to individuals qualifying from an income and asset standpoint.  This current legislation caps the amount of money provided to states regardless of the number of eligible recipients.  Hence, coverage will be drastically reduced for those states with significant poor populations.  Georgia ranks 42nd in overall poverty.  https://talkpoverty.org/state-year-report/georgia-2016-report/ is third in the nation for medically uninsured individuals.  http://www.georgiahealthnews.com/2016/09/georgia-ranks-high-rate-uninsured/

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Medicaid expansion.jpgNow 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.

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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.

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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.