Articles Posted in Medicaid/SSI

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Medicaid is the federal government health insurance program for people in poverty.  Before the Affordable Care Act (ACA) individuals qualified for this program if they lived at about 64% of the federal poverty level.  In 2023 the federal poverty level is $13,590 for an individual.  The ACA allowed states to expand eligibility for Medicaid to 138% of the federal level (about $18,754 for a single individual in 2023).

To date, forty states have expanded Medicaid.  The states that did not adopt Medicaid are:  Alabama, Florida, Georgia, Kansas, Mississippi, North Carolina, South Carolina, Tennessee, Texas, Wisconsin, and Wyoming.  South Dakota has adopted but not implement Medicaid expansion.

The American Rescue Plan Act (ARPA) of 2021 provided financial incentives for expanding Medicaid. The coronavirus pandemic adversely affected health outcomes through lack of access to healthcare and increased mortality.  Coverage options for many low-income adults are limited in non-expansion states.

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The country is still under a Public Health Emergency (“PHE”) and will be through January 11, 2023.  This can be extended by the Biden Administration.  At the start of the pandemic Congress enacted the Families First Coronavirus Response Act (FFCRA) which included a requirement that Medicaid programs keep people continuously enrolled through the end of the month in which the COVID-19 public health emergency ends.  Congress provided federal funding for states to do this.  Due to the continuous enrollment requirement, Medicaid enrollment has grown substantially and the uninsured rate has dropped.  But when the PHE  ends, millions of people could lose coverage that could reverse recent gains in coverage.

Total Medicaid grew to 90.6million in August 2022, an increase of 19.3 million or more than 27.15 from Enrollment in Feb 2020.  Kaiser Family Foundation estimates that between 5 million and 14 million people will lose Medicaid coverage once the PHE ends.  States are required to develop operational plans for how they will approach unwinding the process.

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Pending before the Supreme Court this session are two important health care cases:  Health and Hospital Corp. v Talevski and Kerr v. Edwards.  At issue is whether the Court could strip Medicaid beneficiaries, the providers that serve them, and any other beneficiary of a state administered health and welfare program, of access to court redress should state officials deny, reduce or terminate benefits guaranteed under federal law.  Federal statutes guarantee that the poorest Americans have rights.  Yet without the right to seek help from the federal courts when rights to essential services, such as medical care and food, are threatened, then the right ceases to exist.  The essence of legal entitlement is the ability to protect one’s benefits against arbitrary, unlawful termination or denial.  When access to a court is denied, then benefits cease to be rights and rather simply become a charitiable gift – which can be removed at will.

These cases ask whether the Court should reexamine its holding that Spending Clause legislation gives rise to privately enforeceable rights under Section 1983.  Like the review of Roe vs. Wade, these cases invite a review of fifty-five years of judicial precedent.  Moreover, the court’s review suggests it may have a disregard of all judicial opinions that expanded the rigths of beneficiaries for programs such as Medicaid – the nation’s largest public health insurer.  The state of South Carolina in Kerr expressly asks whether private individuals can bring claims against state Medicaid officials for violations of federal Medicaid law.  They argue for the elimination of section 1983 actions for Spending Clauses benefits.

About 84 million Americans receive Medicaid, SNAP or TANF benefits, that is about 26 percent of the US population.  About 45 million children receive SNAP benefits.  Of the 84 million, 41 % are white non-Hispanic, 20 % were black, 27 percent Hispanic.  The majority of the beneficiaries are women, 37 percent are children.  The result is that state officials may simply suspend Medicaid enrollment or deny covered treatments without having to face the prospect of court injunction.

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Centuries old downtown Atlanta hospital, Wellstar Atlanta Medical Center (formerly Georgia Baptist Hospital) is scheduled to close in November of 2022.  Wellstar claims it could not continue to operate the hospital at a loss.  Wellstar AMC claimed more than $262 million in uncompensated indigent care in the most recent years reported.  The national labor shortage also affected the hospital.  AMC has 460 beds, but could only staff 200.  Wellstar contends that closing AMC will allow it to fully staff other Georgia Wellstar hospitals.

Georgia remains a state that has not expanded Medicaid under the Affordable Care Act.  Under full Medicaid expansion, an estimated 500,000 Georgians would gain coverage.  Axios Atlanta reported last month that some Georgia Republicans are quietly changing their minds about Medicaid expansion.  Expanding Medicaid would allow for 90% federal health insurance coverage for low income residents.  Georgia is one of 12 states that have not expanded Medicaid under the ACA.  If passed, an estimated 500,000 Georgians would gain coverage.  Poll show that a majority of Georgians support expansion.

Two factors have influenced the shift in political thought on Medicaid expansion:  hospital closures and COVID-19.  Eight rural hospitals have closed in addition to AMC downtown.  Medicaid coverage would have added revenue for those uninsured requiring care.  Second, COVID-19 federal funds for hospitalized patients will end soon, causing a loss of coverage for over 250,000 currently insured.

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In response to COVID-19, the U.S. Department of Health and Human Services (HHS) is allocating $15 billion to Medicaid and Children’s Health Insurance Program (CHIP) providers. Additionally, HHS will also be distributing $10 billion to US safety net hospitals providing medical care to vulnerable citizens regardless of insurance status. These funds come from the Provider Relief Fund of the CARES Act, a bipartisan fund created to help health care organizations during the pandemic.

HHS Secretary Alex Azar emphasized that health care providers treating the most vulnerable Americans are “absolutely essential to our fight against COVID-19.” Medicaid and CHIP are essential programs that provide coverage for more than 70 million Americans, including individuals with disabilities. This funding, thus, came at an essential time to ensure the viability of these care providers.

The Partnership for Medicaid Home-Based Care Chairman David Totaro thanked HHS for the support, stating “[i]f HCBS providers are unable to continue delivering these health-sustaining services, at-risk populations will experience exacerbated chronic conditions or disabilities.” HHS began disbursing the payments on June 10. During the COVID-19 pandemic, it is critical to continue maintaining care for pre-existing conditions. In an emergency, dial 911 immediately.

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On March 25, 2019, the Georgia State House passed a bill paving the way for a limited Medicaid expansion. The Senate Bill 106 passed the Georgia House by a 104-67 vote, sending the bill to Governor Brian Kemp for his signature. The support for this bill came mostly from Republicans, with only six Democrats voting for it. This legislation has two parts to it. First, one waiver involves adding individuals to the Medicaid rolls. The second part allows Georgia to reorganize the state’s health insurance exchange, created by the Affordable Care Act for those without coverage from their employers or government program.   

Many Democrats argued that a complete expansion of Medicaid is necessary to cover hundreds of thousands of Georgians and to help rural hospitals. Rep. David Dreyer (D-Atlanta) argued that this legislation, as opposed to full Medicaid expansion, would “cover 200,000 less people, and we would likely be paying more.” However, Rep. Butch Parrish (R-Swainsboro) argued that this bill is “a step in the right direction that will improve health care and access in this state.” This limited expansion of Medicaid will likely help some individuals in Georgia with disabilities. It will be important to watch in the coming weeks and months the impact of this legislation. 

If you have questions about filing a disability claim, contact this law firm.

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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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