Enrollee surge due soon for Medicaid, PeachCare

Georgia’s Medicaid and PeachCare rolls will soon increase by tens of thousands of people.

It’s not from expanding Medicaid. Though states have that option under the Affordable Care Act, Georgia’s Republican-led government has decided against it, citing costs.

Instead, the growth will come from people who were already eligible for this government coverage but had not been getting it. These people, many of whom are children, have surfaced through the enrollment process in the health insurance exchange.

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Clyde Reese, the commissioner of the Department of Community Health, said Thursday that Georgia is finally getting a seamless electronic transfer of data on applicants from the federally run health exchange.

As of Thursday, DCH has received more than 40,000 “account transfers” from the exchange, “with about 2,000 arriving every hour,’’ an agency spokeswoman, Kallarin Richards, told GHN.

These potential sign-ups in Georgia have been stalled for months due to technological snags.

Community Health said Friday that it’s waiting until all of the transfers have been received from the exchange before processing them. “This will ensure DCH is working from the most recent data and can identify any duplicative applications that may exist,” Richards said in an email.

Federal health officials recently reported that more than 91,000 Georgians were identified through the health insurance exchange as eligible for Medicaid or PeachCare.

This enrollment growth of already eligible people is known as the “woodwork” or “welcome mat” effect. Experts had forecast earlier that the Affordable Care Act would lead many people who were already eligible for Medicaid and CHIP (known as PeachCare in Georgia) but had never enrolled to “come out of the woodwork” and finally sign up.

Georgia has estimated the woodwork effect would lead to 120,000 people joining the two programs – more than 90,000 of them children.

Prior to the DCH announcement, proponents of the ACA had been critical of what they saw as Georgia’s inaction on this enrollment.

Thirty-six states, including Georgia, used the federal insurance exchange instead of operating their own. But unlike roughly half of those 36 states, Georgia was not able to process applicants into Medicaid and its children’s insurance program.

DCH Commissioner Clyde Reese
DCH Commissioner Clyde Reese

In addition, the Peach State did not pursue the option to process “flat file” applications of people deemed eligible, which five other states were doing. These flat files, similar to Excel spreadsheets, provide basic information on eligible individuals, but states often have to follow up to fill in missing or incomplete information.

“We weren’t comfortable with flat files,’’ Reese told GHN on Thursday. “We were waiting to get full account transfers.”

The state has the fourth-highest number of kids without coverage, according to a November report.

In raw numbers, Georgia has nearly 220,000 children who are uninsured, trailing only Texas, California and Florida, said the report from Georgetown University’s Center for Children and Families. And all three of those states have much higher overall populations than Georgia.

Most of these kids are eligible for Medicaid and PeachCare but are not enrolled, added Tim Sweeney, health policy director at the Georgia Budget and Policy Institute.

“We have lamented the high number of uninsured kids in the state for years,” Sweeney said. This pending surge in children’s enrollment, he said, “is a success that we hadn’t been able to accomplish before the launch of healthcare.gov,’’ the federal website for the health insurance exchange.

He said the cost to the state of the woodwork effect has been projected to be about $90 million in fiscal year 2015.