Medicaid

chapter from the publication Guide to the Issues 2022

Overview

Expanding Medicaid to provide health coverage presents several concerns, including the growing inability of Medicaid recipients to see a healthcare provider, the impact of crowding out existing Medicaid recipients, and the funding uncertainty and cost of the program. We believe the government should provide a healthcare safety net for the disadvantaged, but in a more rational manner, like the Georgia Pathways to Coverage program the state proposed in 2019. 

Hundreds of millions of dollars are spent annually in Georgia on uncompensated care for the uninsured. Uninsured Georgians do get sick; one way or another, we all pay for their care in a way that is terribly inefficient.

Money should follow people. While it is important to support the institutions and providers that make up Georgia’s safety net, solutions should be people-centered, not institution-centered. Innovation in the field of healthcare requires flexibility and choice. Micromanaging every detail is a recipe for the status quo.

Recommendations

Create a patient-centered approach to the uninsured

Uninsured, low-income adults would be offered premium assistance (individual amounts risk-adjusted based on age, geography and health status) to enroll in a plan that meets minimum standards for primary care and catastrophic coverage. If no plans are available at this price or the individual chooses not to sign up, a mechanism can be set up to ensure federal funds reach safety-net providers who end up providing the care for these individuals.

Expand Medicaid recipient access to primary care

One immediate way to help the uninsured (and save money) is to provide access to primary care that would replace expensive and unnecessary trips to emergency rooms. Direct Primary Care (DPC) practices generally do not accept health insurance, instead serving patients in exchange for a recurring monthly fee. Along with personalized healthcare, DPC practices offer longer hours and telehealth appointments (phone or video), important to low-income individuals who may be unwilling or unable to skip a work shift to visit a physician.

Many healthcare institutions have established after-hours retail clinics. In addition, the private sector has responded with retail clinics that are often found in grocery stores or other retail settings. These clinics are staffed by nurse practitioners and offer convenient, low-cost primary care services. 

Encourage innovation

Georgia benefited during the pandemic due to a strong legal and regulatory framework already in place for telehealth. Creating additional opportunities for the working poor to benefit from innovative options for convenient care such as telehealth, mobile health, direct pay options and DPC services echoes studies showing that for the working poor, a lack of time may be even more consequential than a lack of money. Telehealth companies are also making use of their equipment in schools to expand healthcare access to the parents of students and to teachers. 

Long-term care (LTC) services should target Georgia’s most vulnerable populations

With a rapidly increasing elderly population, higher numbers of LTC recipients with disabilities or dementia, and a Medicaid program already strained as the principal LTC payer, we should seek ways to target publicly funded LTC to the neediest Georgians.

LTC eligibility criteria should be tightened as much as possible so as to avoid “crowding out” private sources of financing and encourage a privately financed home- and community-based service infrastructure.

Furthermore, middle-class and affluent people should prepay for care or repay from their estates, and waivers should be sought to eliminate or severely reduce the home equity exemption to encourage the use of home equity conversion to privately fund home care, assisted living and nursing home care.

Finally, we should review lien and estate recovery programs under Medicaid, study other states that operate their programs more successfully and maximize non-tax revenues from this source.