This blog is part of our Working Better Together series and was authored by Maria Arguelles, Development and Communications Coordinator at the Atlanta Legal Aid Society. This blog series is intended to provide our advocacy partners with a platform to highlight successes, challenges, and innovative approaches to furthering health access and health equity in the states where they work.
The “Medicaid Experiences” project referenced in this blog series is a collaborative endeavor of the National Health Law Program and eight state-based legal aid organizations. The purpose is to better understand the direct experience of individuals as enrollees and applicants for Medicaid and advocate for improvements.
In this blog post, we delve into the barriers to enrollment and the unwinding of Medicaid for Georgia residents with Candice Priest, a Senior Health Law Attorney here at Atlanta Legal Aid. Candice joined the team in 2021 and her work focuses on providing free legal services to individuals currently dealing with specific health conditions, such as HIV, cancer, ALS, and traumatic incidents like gunshot wounds. She works closely with healthcare professionals—doctors, nurses, social workers, and community health workers—to identify and assist patients confronting social determinants of health that can potentially be addressed through civil legal remedies.
Candice’s expertise provides valuable insight into the challenges highlighted by our storytellers for this project, including issues like termination notices, benefit ineligibility, and unclear communication. In her role, she engages not only with Medicaid applicants and enrollees, who directly experience these challenges, but also with the agencies and systems integral to the process.
Barriers to Application
Q: Candice, thank you for taking the time to share your expertise with us. Let’s start by talking about some of the common barriers that people face when applying for Medicaid in Georgia.
A: I would say the biggest barrier in this state is that we have failed to expand Medicaid, unlike the vast majority of other states. Therefore, there is a very limited number of people who qualify for Medicaid in Georgia. This means that many low-income individuals lack access to health insurance entirely because they do not meet specific criteria: having young children, being pregnant, planning for pregnancy, enrolled in Medicare, receiving social security benefits, or qualifying for Supplemental Security Income.
Another barrier is that the Department of Family and Children Services (DFCS) is very difficult to contact. We hear from our clients that it is challenging to reach a person on the phone, which complicates both application submission and interview scheduling. Many clients say they never receive a call back after applying online for Medicaid, or they miss unexpected calls for interviews. Attempts to reschedule fail because they cannot reach anyone on the phone, leading to denied coverage. Even applying in-person at a DFCS office does not improve the situation. Clients are instructed to leave their application in a Dropbox and wait for DFCS to follow up, but they often do not hear back.
Medicaid Notices Issue
Q: This is a situation that storytellers have told us about time and time again, particularly since the unwinding started at the beginning of 2023. What have been some of the biggest challenges you have seen during this period?
A: One of the major challenges has been that people have not been notified that their Medicaid is going to be terminated. In some cases, they did not receive the notification in a timely manner, and in other cases, they did not receive it at all. We have a couple of examples where individuals only found out when they took their young children to the doctor and were told that they could not be seen because their Medicaid had been terminated. In a few instances, we filed appeals on behalf of these individuals, and fortunately, they were reinstated.
Q: Could you share some examples?
A: I have two specific examples to discuss regarding this issue. In the first case, an adult qualified for Medicaid due to extremely low income and having young children eligible for the program. In the second case, a mother whose child’s Medicaid coverage was terminated. Neither of these individuals received any notice of the termination. One of them took proactive steps by updating their address in the system to ensure receipt of notifications about their status and income. Despite these efforts, both only learned about their terminated Medicaid when seeking medical care. They were referred to our program where we assisted them in filing a fair hearing request. In both instances, it was clear they were wrongfully terminated and should have received proper notice.
However, I am concerned about how many people did not receive a termination notice, were informed of their termination, and did not know what steps to take to get reinstated.
Q: How has this impacted individuals and families in Georgia?
A: Something that comes to mind is low-income moms who are telling us that they go to the doctor with their children, and they’re told that their child can’t have a wellness visit because they don’t have Medicaid. This is a really heartbreaking situation. These mothers are trying to provide preventative care for their children, having no notice that they don’t have insurance.
There is a group of elderly individuals who have recently seen their Social Security Disability Income increase just enough to disqualify them from Medicare Savings Programs. They now have to pay premiums for their Medicare coverage, leading to significant out-of-pocket expenses. I have spoken with several seniors who expressed over the phone, “I genuinely can’t afford these payments anymore. What should I do?”
Another thing we see a lot are folks who have a disability telling us they need to qualify for Supplemental Security Income or for Social Security Disability Insurance. You have to have a medical record that shows you are disabled. If you can’t get healthcare coverage to see the doctor, then you can’t verify your disability. So this is a repeated issue. Folks who really are very sick, but they can’t access healthcare to prove they are sick to get social security benefits. It is really heartbreaking, particularly mental health care cases where folks are having significant mental health care issues, but they do not have that health insurance to verify that. It doesn’t make sense. It really is an unfortunate situation.
Helpful Tips
Q: What do you think Georgians should know about the Medicaid enrollment process?
A: That burden to get in contact with our state agency should not be on individuals, but, unfortunately, with our system right now, it is. Navigating the Medicaid enrollment process requires persistence and patience, especially since the system can be overloaded. If you meet the eligibility criteria, it is crucial to gather all necessary paperwork to demonstrate that you qualify. In case of delays in receiving a response to your application, filing for a fair hearing is recommended after 45 days from the day of submitting the application.
Q: Finally, do you have any advice to people seeking to apply for or renew their Medicaid on how to mitigate barriers to enrollment?
A: Updating your income and contact details proactively through the Gateway portal is highly beneficial. Keeping screenshots of uploaded documents and staying in touch with DFCS regularly are also important steps, and paying close attention to both physical mail and updates on the Gateway platform is essential to stay informed throughout the Medicaid enrollment process.
