Parents, doctors and state stakeholders are waiting to see if PeachCare health insurance funding will return before its reserves are eaten away.
PeachCare started 20 years ago as Georgia’s version of the Children’s Health Insurance Program, which provided coverage to children who do not qualify for Medicaid but live below the poverty line.
The federal funding was provided through fiscal year 2017, which expired Sept. 30.
The Georgia Department of Community Health said this week it is “closely monitoring the program budget to determine when and what action the state will need to take.”
“DCH remains optimistic that Congress will reauthorize the program prior to any detrimental impacts to Georgians,” press secretary Fiona Roberts said.
To qualify for PeachCare, children and pregnant mothers have to be in a household making at or below 247 percent of the poverty level. For a family of four, that is a monthly income of $5,064.
Dr. Eugene Cindea of The Longstreet Clinic said these are often parents who are working entry-level positions.
“It’s not like they’re not employed,” he said. “They’re employed at too high of a rate to qualify for Medicaid, but they’re not employed at a high enough rate, or at a company or with enough hours to get a different kind of coverage.”
Georgia and other states still have some money left over from previous years that can be used until a federal plan is potentially reached. According to the Medicaid and CHIP Payment and Access Commission, Georgia had $147.1 million unspent that would be available in fiscal year 2018 and was projected to receive another $56.6 million after funds were redistributed.
The commission estimated Georgia would exhaust its funding in April.
DCH said more than 131,000 children were covered by the program in fiscal year 2017.
“I just cannot fathom Congress not covering the children’s health care program. Moving them all into Medicaid just creates more hardship for each state,” said state Rep. Lee Hawkins, R-Gainesville.
DCH said it is operating “business as usual” for the time being.
“If there is a change, a 30-day advance notice would be issued to members,” Roberts said.
At The Longstreet Clinic, Cindea said the group estimated more than 5,000 new patients covered under PeachCare each year since 2015.
“I think everybody’s kind of crossing their fingers, hoping that the feds will decide to take it up. It’s a small program compared to a lot of other programs, but it’s a huge program when you talk about pediatrics,” he said.
A PeachCare recipient is covered for wellness checks, immunizations, hospital stays and other services.
“Without that ... there are going to be delays in diagnosis, because parents will have to be paying for it. Delay in diagnosis translates into more cost for treatment,” Cindea said, meaning those costs will fall on consumers and emergency room centers.
House Majority Leader Kevin McCarthy, R-Calif., announced a bill to renew funding would be debated next week, a plan opposed by Minority Whip Steny H. Hoyer, D-Md. Democrats have pushed to delay the House bill until an agreement is reached on a bipartisan solution to pay for it.
“CHIP and community health centers, as the majority leader pointed out, have always been a bipartisan priority. Unfortunately, this bill did not come out of the committee as a bipartisan bill,” Hoyer said. “Negotiations were not fruitful.”
Rep. Doug Collins said the House bill would extend the CHIP program for five years.
“I’m pleased that the legislation put forward by House Republicans charts a more cost effective — and therefore sustainable — path forward for serving some of Georgia’s most vulnerable populations,” Collins said in a statement.
It doesn’t just put children eligible for health insurance at risk, Cindea said.
“If you have an entire population that’s not immunized because they can’t afford it or perceive that they can’t afford it and they don’t get immunized till their school age, you get an entire population that’s sitting out there that could potentially get a disease and pass a disease,” he said.
The Associated Press contributed to this report.