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During the period of the public health emergency of COVID-19, states were required to keep individuals on Medicaid rolls without annual reviews.  In May of this year, the Biden administration removed the public health emergency.  Now states have from April 2023 to June 2024 to requalify for Medicaid. This period is referred to as Medicaid Unwinding.   Nationally, 93 million Americans were on Medicaid during the pandemic.   In Georgia 2.7 million adults and children receive Medicaid.

On August 30th, The Centers for Medicare and Medicaid alerted state that they may be incorrectly disenrolling participants – mostly children – from Medicaid and the Children’s Health Insurance Program (CHIP). Two programming errors occurred during this period of unwinding.  First, states evaluated Medicaid eligiblity per household as a whole rather than separately by children and adults.  Second, states that were awaiting replies to questions from one household member would disqualify the whole household.  These procedures violate Medicaid and CHIP regulations.

Georgia is one of ten states that have not fully expanded Medicaid. Georgia began a limited Medicaid expansion in July 2023.  Adults who earn less than $14,600 a year will now clear the income threshold to apply for a Medicaid insurance card.  However, applicants must complete 80 hours of work, job training or qualifying activity each month to keep their coverage.  For those awaiting a decision on Social Security disabilty, they will not be eligible because the work requirements would eliminate disability eligibility.  Georgia is the only state with a work requirement for Medicaid eligiblity.

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Reports of Long Covid diagnoses and symptoms in patients have dropped since the beginning of the pandemic.  The percentage of people who have had COVID and currently report long COVID symptoms declined from 19% in June 2022 to 11% in January 2023. That decrease reflects a reduction in the share of people who have COVID and later report long COVID, which declined from 35% to 28% during the same period.

With the roll-out of vaccines, a significant portion of the population has been vaccinated which has reduced the number of new COVID-19 cases and hospitalizations.  Currently, 81% of the U.S. population has received at least one vaccine for COVID-19.  Vaccines have been shown to reduce the severity of COVID-19 symptoms and the risk of Long Covid.  Also, increased population immunity through vaccines and prior infections may be reducing these numbers.   Some of the reasons for this involve improved treatment, changes in virus variants and more awareness.

Since the beginning of the pandemic, healthcare providers have gained a better understanding of COVID-19 and have developed new treatments that can reduce the severity of symptoms and the risk of Long COVID. For example, the use of steroids and antiviral medications has been shown to be effective in treating COVID-19.

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More and more Georgians are dying of drug overdoses.  Drug overdoses have become a growing epidemic both in Georgia and nationally, increasing to skyrocketing rates since the COVID-19 pandemic. The Georgia Department of Public Health reports from 2019-2021, the total number of opioid-related overdose deaths increased from 853 to 1,718, an increase of 101%. The Centers for Disease Control (CDC) report that nearly 100,000 people die in this country every year due to drug overdose.  Drug overdose deaths rose by 30% nationally during the pandemic.  Fentanyl, a powerful synthetic opioid often found in drugs such as cocaine, heroin, and counterfeit pills has driven most of the rise in deaths. From 2019 to 2021, fentanyl-related drug overdose deaths increased 124%, from 614 to 1,379. Non-fatal drug overdoses are also increasing in Georgia. From 2019 to 2021, emergency department visits and hospitalizations for drug overdoses increased 10%, from 24,886 to 27,388.

The opioid crisis is a complex issue that requires a multi-pronged approach to tackle.  Some new approaches  are being implemented to battle this epidemic.

  1. Medication-Assisted Treatment (MAT)
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In 2021, The American Rescue Plan (ARP) implemented a One Year Child Tax Credit Expansion.   The ARP increased the credit from $2000 per child and it raised the age limit from 16 to 17 years.  The plan provided a credit for all working families earning up to $150,000 per couple or a single parent family earning $112,500.

President Joe Biden’s proposed budget for fiscal 2024 includes a reinstatement of the expanded child tax credit.  The Republicans and Senator Joe Manchin blocked the expansion of the child tax credit at the end of 2021.  The current child tax credit provides for $2000 per child.

The Brookings Institute  reported that the 2021 expanded child tax credit cut poverty in half across southern states.  The report noted that states with low cost of living and a high poverty rate had the most significant reduction in child poverty.  The tax credit had the most impact in states with large shares of historically vulnerable demographics, such as single mothers, rural families and Black communities.  The U.S. had a record low child poverty rate in 2021 down to 5.2% of the population, down 46% from the prior year.

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Georgians receiving SNAP (Supplemental Nutrition Assistance Progam) benefits will see cost of living adjustments for 2023.  Many of these adjustments actually began in October 2022.  The inflation rated adjustment bumped benefits up 12.5%.  A single individual receives $281 in benefits; a two person household receives $516; a three person household receives $740; and a four person household receives  $939.  Each additional person in the household receives $211.

To qualify for SNAP benefits households must have no more than the following in before tax annual income.  For a household of 1:  $17,667; for a household of 2,:  $23,803; for a household of 3:  $29,939 and for a household of 4:  $36,075.  For every additional person in the household, add $6136 per person.

The percentage of households in Georgia receiving SNAP benefits is 16.85 percent.  The average monthly benefits is $261.

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Every September 21st each year is recognized as World Alzheimer’s Day.  Alzheimer’s is a form of dementia that affects memory and impairs daily functions.  Alzheimer’s is the 7th most prevalent cause of death in the United States.  There is no cure although medications do appear to slow the progression at the early stage.  While most sufferers are in the elderly population, there are individuals under the age of 65 who are diagnosed with Alzheimer’s Disease.

Early Onset Alzheimer’s is included under the Compassionate Allowances in Social Security Disability.  With this diagnosis and an application for benefits, an approval will be fast-tracked.  Early Onset Alzheimer’s is a diagnosis of Alzheimer’s in a person under age 65.  Alzheimer’s Disease also meets a Medical Listing under Neurocognitive Disorders 12.02.  However, once a person reaches his/her full retirement age, the individual is no longer eligible for disability.

Alzheimer’s Disease onset usually begins with memory impairment, followed by learning and language deficits.  A person with Alzheimer’s may also exhibit depression, agitation, changes in personality and behavior, restlessness and withdrawal.  A diagnosis is made by clinical and family history and neuropsychological testing.  A clinical diagnosis can only occur post-mortem with a brain biopsy.

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Recently one of my uninsured disability clients told me she was receiving healthcare at Wal-mart.  When I looked it up, incredulously, it turns out Wal-mart is in the healthcare business.  Wal-mart has 4000 stores located in medically underserved communities.  Recently, the retail giant sought to address the needs of those communities’ access to healthcare.

Wal-mart expanded into clinical care by opening centers in Georgia and Texas in 2019.  In September 2019, Wal-mart launched its first clinic, Wal-mart Health in Dallas, Georgia.  Customers who are uninsured pay a flat fee of around $50.  A variety of health care professionals allow patients to bundle services at one time.   Wal-mart Health provides primary care, dental exams, X-rays, hearing services, mental health counseling, pharmacies and optical centers.  Wal-mart Health now has locations in Newnan, Fayetteville, McDonough, Cartersville, Marietta and Woodstock.

In May Wal-mart acquired a telemedicine company MeMD.  Last year, it acquired digital medical management company CareZone.  Wal-mart contends it is focused on “value-based” care.   This week Wal-mart and United Health Group announced a joint program to provide preventative healthcare for millions over age 65.  Fifteen locations will open in Georgia and Florida next year.  The plan is to provide seniors with healthcare through Medicare Advantage plans.

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Despite earlier judicial arguments by Republicans that abortion is a “state’s rights” issue, Senate Republican Lindsey Graham just introduced a national abortion ban at fifteen weeks  The bill includes procedures that are medication only abortions.  Moreover, the national abortion ban does not prevent states from enacting more restrictive abortion legislation.

Conservatives and libertarians traditionally reject federal over-reach.  However, some make exceptions for heavy-handed federal legislation when it involves controlling women’s bodies.  The concept that men, and some women entrenched in the patriarchal traditions, have the right to control a woman’s body over her own consent is, in essence, rape culture.  Allowing that a pregnant woman does not have autonomy over her reproductive choices is analogous to a culture that violates, intimidates and fails to respect her right to consensual sex.   Thus, abortion bans are just codified American rape culture.

This bill, coming just months after the Supreme Court removed a fifty year precedent of a right to abortion in Dobbs v. Jackson, proves that far right activists never intended to stop at state autonomy.  Moreover, we should not expect that this bill will be the limit of further national restrictions on gestational time periods for abortions, consensual sexuality between adults, same sex marriage or right to use contraception by women.

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August is Back to School Month for families with school age children.  The National Retail Federation (NRF) notes that consumers were cutting back on non-essential items or shopping sales in order to afford back to school supplies with the current inflation rate.  For families with disabilities, subsisting on Social Security benefits, this can be especially daunting.  NRF calculates the average cost per family to be $864 this year, mostly owing to inflation.

The Social Security Administration provides income for children through two programs.  SSA pays benefits for minor children of disabled adults who paid into the Title II program through pay roll taxes.  Second, SSA provides direct benefits to disabled children of low income families through its Supplemental Security Income program.  These benefits provide for approximately 4 million children in this country.

For families with a disabled child, the family must be low income to be considered eligible.  Review this chart to see if your family meets the threshold requirements.  The SSI Program provides critical support for 1.2 million children in this country.  Fifteen percent of all SSI recipients are children.   Because eligibility for SSI depends on meeting both medical and financial criteria, the rate of SSI receipt varies geographically depending on local health, economic and demographic factors.  In 2020, Georgia had 42,750 children receiving SSI.

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The Social Security Administration operates a Compassionate Allowance Program that identifies certain medical conditions that it will consider disabling.  These conditions allow SSA to accelerate claims processing for disability.  These medical conditions usually include certain cancers, some being at a later stage, adult brain disorders, and a number of rare diseases that affect children.  Waiting times for approval are reduced by several months if your condition qualifies.

Recently SSA announced 12 new conditions to its list.  These are:   Angioimmunoblastic T-cell Lymphoma, Blastic Plasmacytoid Dendritic Cell Neoplasm, Gerstmann-Straussler-Scheinker Disease, Microvillus Inclusion Disease – Child, Mowat-Wilson Syndrome, Myelodysplastic Syndrome with Excess Blasts, NUT Carcinoma, Pfeiffer Syndrome – Types II and III, Pontocerebellar Hypoplasia, Posterior Cortical Atrophy, Renal Amyloidosis – AL Type, and Sarcomatoid Mesothelioma.

SSA receives information from the public, medical experts, the disability program administrators, research from the National Institute of Health and public hearings to determine if new conditions should to be added to the list.

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