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Local leaders disagree on how far Medicaid coverage should go as program celebrates 50 years
Problems with reimbursement have some doctors refusing to accept it
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Sophie Galvez, 3, listens to a machine during a hearing test with Elma Street, program assistant in immunization, at the Hall County Public Health Department on Wednesday, July 29, 2015. Today marks the 50th anniversary of Medicaid. - photo by Erin O. Smith

Medicaid in Georgia

Total individuals covered: 1,929,800

Number of children covered: 1,131,700

Number of senior covered:  182,000

Number with disabilities covered: 315,600

Source: Center on Budget and Policy Priorities

Wanda Turpin’s medical problems are so numerous that she would be unable to receive the care she needs without Medicaid coverage.

“It’s a good thing to have,” she said in an understated way.

Turpin, an elderly Gainesville resident, takes copious amounts of medication, suffers complications from diabetes and has chronic obstructive pulmonary disease that makes breathing difficult.

But those illnesses haven’t struck down her friendly, vibrant personality.

Today marks the 50th anniversary of Medicaid, the government health care program supporting low-income families, children, the elderly and disabled, and Turpin is one of nearly 2 million Georgians thankful for its benefits.

The program’s success stems from the vulnerable individuals it supports.

“Medicaid provides access to preventive and treatment services for low-income children and families in Georgia, and has played an essential role in improving child health over the past half-century,” said Cindy Zeldin, executive director of Georgians for a Healthy Future.

But calls to expand Medicaid in Georgia as proposed under the Affordable Care Act have been rebuffed in recent years.

Republican lawmakers have opposed increasing Medicaid rolls because of the financial burden they believe it will place on state coffers.

“It is a cost issue,” said state Rep. Carl Rogers, R-Gainesville. “There’s never enough money. That’s the challenge we have.”

Models for expanding the program through a market-based method, however, have re-energized calls from those in the health care industry to expand the program in Georgia. 

“It will take compromise, and nothing will be perfect,” said Mimi Collins, CEO of The Longstreet Clinic in Gainesville.

The state’s rate of uninsured, one of the highest in the nation, makes it paramount to extend health coverage to those most in need, advocates say.

“You can’t look away from that,” Collins added.

Who benefits and at what cost?

While the federal government sets minimum standards, it gives states some leeway to design their own Medicaid programs and determine who is covered, what benefits are offered and how care is delivered. 

“Mainly, the Medicaid we see is for the children’s services,” said Dave Palmer, spokesman for the District 2 Public Health office, which manages 13 counties in Northeast Georgia, including the Hall County Health Department.

Most health departments accept Medicaid, which becomes more important in communities like Gainesville that have large immigrant, minority and white working-class populations.

Like the county health department, The Longstreet Clinic accepts Medicaid across all its practices, Collins said, but caring for children has always been a priority.

More than 1.1 million children in the state receive health care through Medicaid, according to the Center on Budget and Policy Priorities.

“We really believe that our mission is to care for our entire community and that we have a responsibility to do that,” Collins said. “We have a long history with the (Medicaid) program and are proud to participate and take care of all the children in our community.”

Meanwhile, more than 180,000 seniors in Georgia are supported by Medicaid, as are 315,000 disabled residents.

But nearly one in five Georgians do not have health insurance at all, according to the Georgia Budget & Policy Institute and a Gallup polling report for 2014. 

And many of them would qualify for Medicaid if Georgia expanded the program. 

The federal government will pay the full cost for new Medicaid recipients until 2016 and at least 90 percent going forward if Georgia expands eligibility to those living at 138 percent of the federal poverty level.

That’s an annual income of about $16,000 for an individual and $27,000 for a family of three.

The federal government paid nearly two-thirds of Georgia’s Medicaid costs and more than three-fourths of the costs for PeachCare for Kids in 2014, according to the Georgia Budget & Policy Institute, and the state would pay less than 7 percent of the costs of Medicaid expansion through 2023.

The state could earn about $30 billion in federal funding through an expansion and generate billions more in increased tax revenue, jobs and economic development in the health care industry, according to advocates.

But the state’s portion of the costs is not enough to offset this additional funding and revenue, according to Gov. Nathan Deal.

Georgia spends close to $4 billion annually on health care. The Department of Community Health, which operates the state’s Medicaid and PeachCare programs, has a budget of nearly $3 billion.

Deal has said Medicaid expansion will cost the state an extra $4 billion over 10 years.

“Medicaid expansion is too expensive for Georgia,” said Brian Robinson, Deal’s spokesman.

Collins said the cost of providing health care could be more expensive, however, on the back end if Medicaid isn’t expanded.

Studies consistently draw correlations between health coverage and an individual’s education and income level, she said, and not providing care could be a competitive disadvantage in the long-term.

Moreover, advocates say those who can afford to pay for health insurance could wind up covering costs that result from lack of preventive care for the uninsured, something Medicaid has provided to vulnerable populations.

But the cost challenges remain and are likely to rise in the coming years as health care delivery becomes more expensive, Rogers said.

Some doctors and practices have stopped accepting Medicaid, in part because reimbursements and fee schedules have not been frequently updated.

“The big challenge now is finding doctors who will do the Medicaid work,” Rogers said, adding that this is particularly true for adults who need specialists.

It’s a problem Collins acknowledged, as well.

“If they don’t have access to practices accepting Medicaid, they don’t have access to appropriate primary care, prevention, early diagnosis, treatment, which ends up causing lifelong consequences for children,” she said.

Prospects for Medicaid expansion

Arkansas has accepted additional Medicaid funding from the federal government and will use it to assist low-income individuals in buying private health insurance plans.

It’s a unique approach, one the federal government has OK’d and the Medical Association of Georgia has endorsed.

But it’s not a model that Deal appears to have any appetite for.

“The Arkansas model has proven to be vastly more expensive …” Robinson, Deal’s spokesman, said.

State Rep. Lee Hawkins, R-Gainesville, also believes supplementing the purchase of private insurance won’t prove cost effective for government.

“It’s the same type of problem,” he added. “For us to go off and start trying to (cover) more adults when we’re struggling to take care of the kids” would not be wise.

With the state covering about a third of the cost of Medicaid spending currently, Hawkins said the first thing the federal government needs to do is pony up more money before Georgia can consider expanding the program.

“We’re challenged with taking care of those who cannot take care of themselves,” he said. “If the federal government would actually pay more … for what they promise … it sure would help us. Really what we want to focus on is just taking care of the health of these people.”

Hawkins is talking about people like Laura Haynes, an elderly Gainesville resident whose income and disabilities make her eligible for Medicaid.

Haynes, who sports a warm smile and soft-spoken voice, visits several different specialists and said she would be at a loss without Medicaid.

She hopes others in similar situations who do not yet qualify for Medicaid will one day get the help they need.

“Closing this gap and extending Medicaid coverage to all low-income Georgians would be a powerful tool for improving the health of individuals and families throughout our state,” said Zeldin.

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