How to keep yourself and your family covered in Georgia in 2023
As we’ve been discussing on New Ellijay News over the past few months, the State of Georgia has been removing tens of thousands of people from its Medicaid rolls since the Federal government declared an end to the Covid-19 Public Health Emergency earlier this year. With that in mind, we’re going to take a deeper dive into Medicaid to raise awareness of how the program works, its eligibility requirements, and how to keep you and your family covered.
Medicaid is an assistance program meant to help people who can’t afford medical insurance pay for healthcare services. The federal government sets broad standards for coverage nationwide, but states have the flexibility to choose who and what is covered, how services are delivered, and how much doctors are reimbursed. In Georgia, Medicaid is administered through the Georgia Department of Community Health.
Medicaid is funded by a mixture of federal and state dollars. Federal spending matches state spending according to a metric called the Federal Medical Assistance Percentage, or FMAP. States with lower per-capita income receive a higher percentage match of federal funding. In Georgia, federal funds pay for around 66% of our Medicaid costs.
Medicaid covers a wide array of services, including doctor visits, prescription drugs, preventative dental care and vision for children, lab work, x-rays, physical therapy, inpatient and outpatient mental health services, nursing homes, medical equipment, hospice care, and family planning services.
So, who is eligible to receive Medicare here in Georgia? Recipients must meet one of the following criteria: You must be pregnant, under the age of 19, over the age of 64, legally blind, have a documented disability, or need nursing home care. If you meet one of these criteria, you must also meet household income limits to qualify for coverage:
If you meet one or more of these criteria and are within the state’s income limits, here are a few different options available to apply for Medicaid coverage.
The easiest way to apply is online at gateway.ga.gov. Through your gateway account, you can select from a variety of Federal and State programs you’d like to apply for and send in one application, rather than having to do each individually. These programs include TANF, SNAP, WIC, and all medical assistance programs including Medicaid.
If you don’t have access to the internet, you can use the computers at the Sequoyah Regional Library for free with a library card. You can also call 877-423-4746 and apply via telephone or apply in person at your local DCFS office (Gilmer county’s is located at 222 Highland Crossing). The computers here at the Ellijay Makerspace are also available for free use for applying for aid or registering to vote. We’re located at 54 Kiker Street behind the Budget Inn on River Street.
You can also apply by mail, by calling 877-423-4746 and requesting that the mail-in forms be mailed to you.
Here are a list of forms you can submit with your application to prove residency and household income:
If you need help accessing any of this information, you can call 877-423-4746 or 877-427-3224 for assistance.
In addition to traditional medicaid coverage, there are a few programs available to those who meet certain income requirements but do not meet requirements to receive medicaid.
Peachcare for Kids is available for people under the age of 19 whose families make more than the regular income limits for Medicaid eligibility. The income requirements are listed in the table above and are also available on the Department of Community Health’s website at dc.georgia.gov. Children’s eligibility is not contingent on the legal status of their parents.
You can apply for PeachCare for Kids at gateway.ga.gov. Your children will be automatically enrolled in either Medicaid or PeachCare for Kids based on your reported income levels.
Planning for Healthy Babies is another resource available to Georgia residents between the ages of 18 and 44 who are able to become pregnant and meet certain income requirements. Coverage inclues annual physical exams, pap smears, birth control, family planning counseling, primary care and dental services during pregnancy, and mental health services. Apply online at gateway.ga.gov through the Medical Assistance application.
You might be looking at all of this info and thinking, “That’s great, but I don’t qualify for any of these assistance programs and I still really need medical care.” Georgia’s state legislators have consistently voted against participating in the Federal Medicaid Expansion program, which would cover all households with incomes up to 144% of the Federal Poverty line, which in 2023 is about $21,000 for a single person or about $43,000 for a family of 4.
Most people who really need help affording health insurance are not eligible for aid under the current eligibility requirements. However, there are other options available.
One of these is the Premium Tax Credit that was instated through the Affordable Care Act. This is meant to directly lower how much eligible people pay in monthly premiums, co-pays, deductibles, and medication costs by subsidizing these costs directly to insurance companies or through tax refunds paid directly to eligible parties. To find out if you’re eligible for the premium tax credit, apply through the healthcare Marketplace at healthcare.gov during the open enrollment period. The open enrollment period begins November 1st and ends December 15th for coverage to begin on January 1st. Late enrollment runs through January 15, and coverage begins on February 1st.
The Marketplace website will send you through an application that determines your eligibility for the premium tax credit by asking questions about where you live, how much money you make, and who else is in your household. The subsidies pay up to 100% of premium payments and related healthcare costs. Most people don’t qualify for a 100% subsidy, but many people qualify for at least some subsidies. I strongly recommend applying to see what you’re eligible for. This is how I personally have been able to afford health insurance for the past several years.
Another form of aid for those who do not qualify for medical financial assistance are Federally Qualified Healthcare Centers and Community-Based Healthcare Centers. These organizations provide low or no-cost care to uninsured or under-insured people.
We have a few different healthcare centers in Gilmer County offering services on a sliding-scale basis, regardless of your ability to pay. Georgia Mountains Health, located at 80 Cinema Drive, offers both physical and behavioral health services, including gynecological exams, lab work, and medication management. Visit their website at gamtnhealth.org to learn more about what services they offer or call 706-635-6898 to make an appointment.
The Gilmer County North GA Health district provides services to those meeting certain income requirements, including cervical and breast cancer screenings, STD testings, and vaccine administration. They are located at 28 Southside Church St. and can be reached by phone at 706-635-436313.
Piedmont Physicians of East Ellijay and Piedmont Physicians Primary Care of Gilmer offer a full range of services and provide financial assistance to those eligible. Call or visit their offices for more information on what kind of aid you’re eligible for. They’re located at 174 Highlad Crossing and 822 Industrial Blvd Suite 100, respectively. You can reach Piedmont Physicians of East Ellijay at 706-635-1400 and Piedmont Physicians Primary Care at 706-515-7010.
The Bethesda Community Mobile clinic is a mobile clinic from Canton that comes up to Ellijay to offer medical services for free, including primary care, lab work, physicals, medications, chronic disease management, and diabetes management. They normally operate at the Health Department, located at 28 Southside Church St., on the third Wednesday of the month from 10 am til 2 pm. Sometimes they offer services in the parking lot of Faith, Hope, and Charity as well. Find more information on their website at bcccherokee.com.
Another resource is NeedyMeds.com, a non-profit providing healthcare related resources and low or no cost medicine to those with prescriptions, regardless of insurance status. They offer patient assistance programs to cover the cost of medicine, information on sliding-scale clinics and services, diagnosis-based assistance, coupons and rebates for medical equipment and presdcriptions, scholarships based on diagnoses, and drug discount cards. Visit needymeds.com for more information.
According to a 2022 report from the Commonwealth Fund, the U.S. is one of three of the wealthiest countries in the world that does not offer its citizens universal healthcare coverage, despite spending more on healthcare per capita than most other nations and getting worse healthcare outcomes on average.
The American Medical Association estimates the average cost of healthcare in the U.S. per person to be around $12,914 per year. The world’s second highest healthcare per capita spending country is Germany, at just over $7,000 per person, in a system where everyone is covered.
Single-payer healthcare is often presented as a too-costly pipe dream that can’t happen in our country. But an analysis of 22 studies researching the projected costs of implementing single-payer healthcare in the U.S. concluded that significant savings would be had if a single-payer system was adopted. Administrative costs could be reduced by $600 billion a year, and savings on prescriptions could be between $200 and $300 billion.
Copays and deductibles could be lowered or eliminated within most versions of single-payer healthcare plans that have been introduced to congress. Federal and state governments already pay for two-thirds of our national healthcare costs, which are inflated by private insurance companies driving prices up.
Adopting a single-payer system would drive these prices down, increasing the percentage of government funding for healthcare to 100% but significantly lowering the total dollar amount spent nationwide by eliminating the waste created by the private health insurance bureaucracy. That’s more money in your pocket and more quality care available to you.
While this debate plays out at the national level, Georgians are in need of expansion of quality health coverage now, and there are other ways to expand access to Medicaid in our state.
One way would be to bypass Federal Poverty Levels and develop and implement State Poverty Thresholds. Our current poverty levels are way too low and are in no way reflective of who is living in poverty. The formula used to calculate the flawed Federal Poverty Line doesn’t take into account housing costs, car payments, food costs, student loan and other debt payments, fuel and transportation costs, or medical payments.
The federal government should develop a formula that state legislators are beholden to that takes the full cost of living in each state into account when deciding who is eligible for federal and state aid.
We should also expand Medicaid eligibility to people between the ages of 19 and 64, regardless of what state they live in. There are only 10 states that don’t cover people in this age range, and it really doesn’t even need to be possible for them to opt out. If people meet the income requirements, it shouldn’t matter what age they are. If the federal government didn’t have exceptions for states choosing not to insure people due to age, a lot the working people you know would have healthcare that they probably don’t have right now. Everyone needs healthcare.
The bottom line is, you deserve healthcare. Your neighbors deserve healthcare. Your communities deserve healthcare. We live in one of the richest countries in the world. We also live in one of the most resource-poor parts of the country with disproportionate poverty rates and a huge lack of access to healthcare. Rural towns like Ellijay deserve healthcare.
If any of the forms of aid we talked about today are available to you, please utilize them. If they aren’t, they should. Talk about this issue with your families, neighbors, and co-workers. Put pressure on state legislators. The Declaration of Independence compels our government to guarantee life, liberty, and the pursuit of happiness. It’s impossible to secure any of those three things without healthcare.
-Jadie Lee