State disputes report of big jump in Medicaid

Earlier this month, a consulting firm reported that Georgia’s Medicaid and PeachCare programs saw a huge enrollment spike of 98,800 in the first three months of 2014.


Avalere Health said the rise in beneficiaries for Georgia and 16 other states that have not expanded their Medicaid programs was due largely to the “woodwork effect.’’

That’s when increased outreach sparked by the Affordable Care Act encourages individuals who were already eligible but not enrolled in Medicaid to “come out of the woodwork’’ and sign up for it.

Georgia recorded the biggest enrollment increase among the 17 states from January through March, Avalere reported.

But the Georgia Department of Community Health, responding to a GHN request, has released a much lower enrollment increase for the first three months this year: 37,047.

A department spokeswoman, Pam Keene, also told GHN that the increase could be attributed to several factors besides ACA awareness, including routine applications being processed and a change in eligibility rules this year.

During the 12 months beginning in March 2013, Community Health reported, Georgia’s Medicaid and PeachCare enrollment climbed by just 20,000 members.

Caroline Pearson, an Avalere Health vice president, told GHN on Tuesday, “We are basing our analysis [on] the enrollment reports the states give to the federal government.”

She said she did not know why there was a discrepancy between the firm’s number – derived from states’ reports – and Community Health’s. Pearson added, “I think the reporting is somewhat inconsistent, state to state.”

Community Health said Tuesday that it stood by its figures.

Georgia, like about half of the states, has decided not to expand its Medicaid program, citing the costs. Expansion is called for under the Affordable Care Act, but the U.S. Supreme Court has ruled that state participation is optional.

Nevertheless, Georgia is expecting a big surge in “woodwork’’ enrollees soon. The state this month finally received a seamless electronic transfer of data on applicants from the federally run health exchange.

These potential sign-ups in Georgia have been stalled for months due to technological snags. But the federal exchange said these people appear already eligible for coverage under Medicaid or the Children’s Health Insurance Program, known in Georgia as PeachCare.

Community Health told GHN on Tuesday that it has received more than 88,000 applications from the federal government’s insurance exchange. These people are now being evaluated for possible eligibility for Medicaid and PeachCare, Keene said.

This woodwork effect may have a big financial impact on states, such as Georgia, that have not expanded their Medicaid programs, Avalere’s Pearson said. “A lot of states didn’t budget for’’ the effect, she said.

In states that have expanded Medicaid, the federal government is paying for 100 percent of the costs for the first three years for enrollees who became eligible because of expansion.

But for any previously eligible beneficiaries (such as woodwork enrollees), states get only their standard federal matching rate. That means that while the feds pay for two-thirds of Medicaid spending for these people in Georgia, the state must pay for the remainder.