This presentation shares information on the Medicaid program, who it supports, why its important, changes due to the covid19 pandemic and how to become a health advocate!
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This presentation shares information about the Medicaid program: who it supports, what programs are offered and current changes brought on due to the Covid-19 pandemic.
This presentation explains what Medicaid program is, who it protects, the creation of the coverage gap and what Medicaid advocacy looks like in the state of Georgia.
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This presentation shares information about the Medicaid program: who it supports, what programs are offered and current changes brought on due to the Covid-19 pandemic.
This presentation explains what Medicaid program is, who it protects, the creation of the coverage gap and what Medicaid advocacy looks like in the state of Georgia.
This is a powerpoint presentation converted to PDF regarding a consumer perspective on our state health system. Just the basic facts and what we need to still address, even after health reform. Brought to you by Jodiesjourney.com
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This presentation explains what Medicaid program is, who it protects, the creation of the coverage gap and what Medicaid advocacy looks like in the state of Georgia.
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3. Agenda
• Pathways to healthcare coverage
• What is Medicaid?
• Medicaid supports….
• What’s next for Medicaid?
• Becoming a health advocate
4. Pathways to coverage under the
ACA
Job-based coverage
Individual/non-group
(healthcare.gov)
Public health
insurance coverage
Medicare
TriCare (Veterans)
Kids:
PeachCare/Medicaid
Medicaid
5. 1 in 5 of all Georgians
1 in 5 of all poor adults in Georgia*
1 in 2 of all children in Georgia
*Poor is defined as ≤100% Federal Poverty Level
Source: GBPI calculations based on data from U.S. Census
Bureau and Georgia Department of Community Health
Medicaid plays an important role in health
coverage in Georgia
6. 5
The Federal Poverty
Line is $12,140 for an
individual and 16,460
for a couple.Not eligible
Adult without
dependent children
Parent
Aged, Blind, Disabled
Breast, Cervical Cancer
Nursing home & community care
Pregnant women
Children (Medicaid &
PeachCare)
50%0% 100% 150% 200% 250%
Children Eligibility
Levels are cumulative
Children Ages 6-19
Children Ages 1-5
Children Ages 0-1
PeachCare
Source: Georgia Department of Community Health, thresholds rounded
Who gets Medicaid in Georgia?
7. In Fulton County:
• 124,964 people in Fulton
County are covered
by Medicaid
• 104,193 are children
• Over 111,000 people in
Fulton County are uninsured
• 59,000 of these people
are employed
• 14,453 are children
8. The creation of the coverage gap
Employer-based
coverage
Individual/non-
group
(healthcare.gov)
(Coverage Gap)
Public health
insurance coverage
Medicare
Medicaid
TriCare (Veterans)
Kids:
PeachCare/Medicai
d
9. Georgia’s health insurance coverage gap
• 430,000+
uninsured, low-
income Georgians
• Ineligible for
Medicaid and do not
earn enough for
financial help on
healthcare.gov
10. • 37% white, 36% Black, 22% Hispanic
• 60% ages 18 to 39
• Working in construction, food service, grocery stores,
retail, education & childcare, trucking
Hard-working Georgians live in the coverage
gap
13. Provide financial assistance to those who
chose to seek care at home or in the
community, instead of an institutional setting.
NOW/COMP: allows seniors or those with
disabilities to live independently in the
community
New Options Waiver (NOW): for those
who need less intensive care and urgent
needs
Comprehensive Supports
Program(COMP): for those who need out of
home residential support and supervision or
intensive in-home services
Medicaid by a Different Name:
Home and Community Based Services Waivers
14. Medicaid by a Different Name:
ICWP (Independent Care Waiver
Program): helps adult Medicaid
recipients with physical disabilities
live in the community
CCSP (Community Care Services
Program): for frail, older and disabled
adults
SOURCE (Service Options Using
Resources in a Community
Environment): provides non-medical
care services
Home and Community Based Services Waivers
15. GAPP (Georgia Pediatric
Program): serves eligible children
under 21 years of age who are
medically fragile and in need of
medically necessary skilled
nursing care and/or medically
necessary personal care support
Katie Beckett Waiver- allows
children with disabilities to receive
care regardless of parental income
Medicaid by a Different Name:
For Children
16. Medicaid Supports Children
• Covers 1.3 million
children in Georgia
• PeachCare builds on
Medicaid
• Covers 100% of current
and former foster
children in Georgia
(~28,000 children)
18. Medicaid Supports People with Disabilities
Medicaid is the primary payer
for essential long-term
services and supports:
• Nursing home care
• Home- and community-
based services
• Wheelchairs, lifts,
supportive housing
services
19. Medicaid Supports Seniors
• 185,404 seniors in
Georgia are covered by
Medicaid
• Nursing home and long-
term care is covered by
Medicaid
• Medicaid also provides
resources that allow
seniors to age in place
20. Medicaid supports pregnant women &
newborns
• Medicaid provides
comprehensive care for
women while pregnant,
and up to 60 days post-
partum
• Pre-natal care can help
detect serious health
complications that are
easier and cheaper to
fix early on
22. No one can be
willingly disenrolled
from Medicaid
during nat’l public
health emergency
What you need to know about Medicaid
during COVID-19
No co-pays or
premiums for
Medicaid or
PeachCare for Kids
members during nat’l
PH emergency
All COVID-19
testing and
related
services
covered by
Medicaid
Increased
access to tele-
health
services for
other health
needs
If diagnosed
with COVID-
19, Medicaid
will cover all
costs
23. Temporary changes to Medicaid waiver
services:NOW/COMP only
• OT/PT/Speech & language
therapy
• Nutrition services
• Behavior Supports
Services
• Registered Nursing
Services
• Support Coordination
(including Intensive SC)
• Supported Employment
(limited scope)
Temporarily allows
telehealth for:
For specific details, contact GA Dept. of Community Health or your
caseworker
24. Temporary changes to Medicaid waiver
services:I/DD services
Annual caps are
temporarily removed
for:
• Community living
supports
• Respite services
• Specialized medical
supplies
• Community Access
Family member
caregivers can be paid
to deliver these
services to their family
member:
• Community Living
Supports
• Respite services (in-
home and out-of-
home)
• Community Access
For specific details, contact GA Dept. of Community Health or your
caseworker
25. Medicaid: A first-responder during COVID-
19
• Federal govt increased Medicaid funding to
states to assist with budget short-falls,
pandemic response costs
• Medicaid covers costs of testing for
uninsured
• Emergency waivers allow Georgia to:
• Increase # of Medicaid providers
• Increase flexibility for telehealth services
• Keeping kids, families, new mothers enrolled
• Expand hospital capacity
• Increase the pay of home health workers
• Pay some health/service providers who cannot
provide services right now (ex: day programs)
26. COVID-19:
Legal assistance for your Medicaid
coverage
• If you:
– Lost your Medicaid coverage
– Have complication with Medicaid waivers (NOW,
COMP, etc)
– Attended a day program that is now closed
– Rely on aide who is no longer showing up, or coming
less
• Atlanta Legal Aid serves Fulton, DeKalb, Cobb,
Gwinnett, and Clayton counties: Call 404-377-
0707
• Georgia Legal Services Program serves
Georgians in all other counties: Call 833-457-
27. Georgians becoming uninsured due to job
loss
• More than 2,342,772
Georgians filed for
unemployment between
March 1st and May
30, 2020
• Unemployment may lead
to loss of health insurance
for individuals who get
health coverage through
their job
• Many are eligible for other
kinds of coverage
Medicaid,
376,000
Coverage
gap, 24000
ACA with financial
help, 775,000
ACA without
financial help,
268,000
Source: Kaiser Family Foundation, Eligibility for ACA Health
Coverage Following Job Loss, May 13, 2020.
28. COVID-19: Health coverage after job loss
If you or a loved one
loses a job or has a drop
in income, you are likely
eligible for new health
coverage:
• Affordable Care Act
• Medicaid
• COBRA
More information at: healthyfuturega.org/blog, Health Insurance Options
for Georgians during COVID-19
29. Affordable Care Act: Private Insurance
• A special enrollment up to 60 days after losing your job-
based insurance
• Enroll or find free, local enrollment help at healthcare.gov
• Financial help is available!
• ACA coverage covers testing. Covers part or all of costs
related to COVID-19 treatment
You may qualify for financial help if your income falls in these ranges
To receive discount on
monthly premiums
To receive discount on deductible
or other cost-sharing
Family size (100%-400% FPL) (100%-250% FPL)
1 $12,760 --$51,040.00 $12,760 --$31,900.00
2 $17,240--$68,960.00 $17,240--$43,100.00
3 $21,720 --$86,880.00 $21,720 --$54,300.00
4 $26,200 --$104,800.00 $26,200 --$65,500.00
30. Medicaid and PeachCare for Kids
• You can enroll yourself, your
family, or your children in
Medicaid or CHIP at any time!
• Children, pregnant women,
people with disabilities, & very
low-income parents are most
likely to qualify
• Enroll at gateway.ga.gov
• Learn more & find out if you
are eligible a:
healthyfuturega.org/medicaid-
and-peachcare-for-kids/
31. If you cannot find health coverage
You can receive free or low-cost services at:
• Community health centers & charity clinics
– CHCs: gpca.org/locations
– Charity clinics:
CharitableCareNetwork.com/resources/find-a-
clinic/
• Telehealth services: givinghealth.org/how-it-works
or call 866-662-1923
• Financial assistance programs at your local
hospitals
34. Happening Now:
Changes in Health Care for Georgians
• Governor Kemp’s
health care
proposals
• Changes to
Medicaid
• Changes to private
insurance
• How you can help!
35. SB 106: The Patients First Act
• Allows Governor to
submit 1+ “1332 State
Innovation waivers” to
the federal government
• 1332 waivers have been
used to lower health care
costs & expand
consumer choice in other
states
• Trump admin is allowing
them to be used to roll
back ACA protections
• Allows Governor & GA
Dept of Community Health
(DCH) to submit a
“Medicaid 1115 waiver”
• May cover adults with
incomes up to 100% of the
federal poverty level (FPL)
• 1115 waivers have been
used to expand Medicaid
in conservative states
Summary: Allows Governor Kemp to make significant
changes to Medicaid & private insurance in Georgia
Medicaid Private insurance
36. Governor Kemp’s Medicaid plan
• Covers only 50,000 (out of the
430,000) who are low-
income
• Expands coverage to only
those making up to the poverty
line
• Creates illegal paperwork
requirements*
• Requires that enrollees
pay premiums or be
disenrolled*
• Removes transportation for
people who need it to get to
appointments*
• Georgia will pay 3x more per
38. Gov. Kemp’s private insurance proposal
• Threatens comprehensive
coverage for 417,000
Georgians
• Dismantles
healthcare.gov
• Limits the amount of
financial help available for
low- & middle-income
consumers
• Does not require
insurance plans to cover
all essential health
benefits
41. Send an email to Governor
Kemp and your state
legislators in support of
Medicaid expansion
To find out who your
legislators are visit:
HealthyFutureGA.org
“Get Involved” tab
Contact Your
Legislator
Sign up for
email
updates at
CoverGA.org
Share your coverage gap
story
Advocacy opportunities
42. How to talk to your legislators
Tell them who you are, where you
live, and why you are contacting
them
The “ask”—what do
you want your
legislator to do?
Why is this issue
important to you?
43. Advocacy Resources
• Georgians for a Healthy Future— healthyfuturega.org
– Georgia Health Action Network
– Consumer Health Advocates Guide
– FB & Twitter: @healthyfuturega
– Events— healthyfuturega.org/events
• Georgia Health News— georgiahealthnews.com
• Georgia General Assembly— legis.ga.gov
• Georgia Council on Developmental Disabilities
44. Join the Georgia Health
Action Network
Invite us to
present in your
community
Vote!
Share your health care story with
us
Advocacy opportunities
45. Thank you!
50 Hurt Plaza SE, Suite 806
Atlanta, GA 30303
Phone: 404-567-5016
Fax: 404-935-9885
info@healthyfuturega.org
healthyfuturega.org
FOLLOW & SHARE
Alyssa Green
Outreach & Education Manager
agreen@healthyfuturega.org