Medical Assistance Fact Check Presentation to: Fiscal Management Council Presented by: Kate Pfirman, Deputy Commissioner Date

Mission The Georgia Department of Community Health We will provide Georgians with access to affordable, quality health care through effective planning, purchasing and oversight. We are dedicated to A Healthy Georgia.

Medical Assistance Fact Check TRUE OR FALSE: Medicaid is a Federal program that is the same across every state in the country.

Medical Assistance Fact Check Medicaid is a joint federal-state program which has certain options States may choose to participate in or not. Medicaid is NOT transferable from state to state.

Medical Assistance Fact Check TRUE OR FALSE: A 54 year old man who has Stage 2 Esophageal Cancer, making minimum wage, who is not disabled and has no children is eligible for Medicaid.

Medical Assistance Fact Check Being sick does not automatically qualify someone for Medicaid in Georgia. There are specific criteria that must be met.

Medical Assistance Fact Check TRUE OR FALSE: : Just being poor in Georgia does NOT mean Medicaid will cover your health care needs.

Medical Assistance Fact Check To be eligible for coverage, individuals must fall below certain income limits and also fall into specific categories, such as having dependent children, or being pregnant or disabled.

Who is covered? Pregnant Women Parents and Caretakers with children under 19 Aged (65+), Blind or Disabled Children under 19

Must also meet basic criteria: Who is covered… Must also meet basic criteria: Is a US Citizen or qualified alien Is a Georgia Resident Is under specific income levels Is under certain asset levels

Income Limits 2017 100% FPL – $ 1,005 monthly $12,060 annually

Medical Assistance Fact Check TRUE OR FALSE: Almost half of all children in Georgia are covered by Medicaid or PeachCare for Kids®.

Medical Assistance Fact Check 48% of Georgians ages 0 to 19 have access to health insurance either through Medicaid or PeachCare for Kids. In addition, Medicaid pays for 54% of all births in Georgia.

One in four Georgians is a direct beneficiary of DCH Programs FY2017 Budget Highlights - Georgia Beneficiaries of DCH Programs Programs 2017 YTD % Medicaid 1,837,237 70% Aged, Blind and Disabled (ABD) 503,067 19% Low-Income Medicaid (LIM) 1,334,170 51% PeachCare (PCK) 131,635 5% Subtotal 1,968,872 75% State Health Benefit Plan (SHBP) 642,990 25% Total Beneficiaries 2,611,862 100% One in four Georgians is a direct beneficiary of DCH Programs

GA Children Population* DCH Beneficiaries (ages 0-19)** FY2017 Budget Highlights Georgia Beneficiaries of DCH Programs DCH Program GA Children Population* DCH Beneficiaries (ages 0-19)** % Medicaid and PeachCare 1,300,843 47% State Health Benefit Plan 127,428 5% Total Children 2,784,116 1,428,271 52% 52% of Georgia’s children (ages 0 to 19) have access to health insurance through a DCH Program. *GA Population based on estimated 2015 population figures from census.gov. **DCH Beneficiaries based on average monthly enrollment for FY2017.

Medical Assistance Fact Check TRUE OR FALSE: Most Medicaid enrollees are children and their parents.

Medical Assistance Fact Check About 75 percent of all enrollees in Georgia are children and their parents. And approximately 47% of people on Medicaid and PCK are members of working families.

Medical Assistance Fact Check TRUE OR FALSE: Most Medicaid spending is on medical services for children and their parents.

Medical Assistance Fact Check 52% of spending in Georgia is for the elderly and disabled, even though these two groups make up only 25% of Medicaid enrollees.

FY2017 Budget Highlights State Fund Expenditures by Program* Total Funds: $14,329,138,287 State Funds: $3,001,353,963 97% of all DCH State Funds were expended directly in Medicaid *Does not include attached agencies or the State Health Benefit Plan.

Medical Assistance Fact Check TRUE OR FALSE: Medicare pays for long term residence in a Nursing Home.

Medical Assistance Fact Check Medicare only covers skilled Nursing Care for up to 100 days AFTER a hospitalization (and the full cost for only the first 20 days). Since Medicare provides such little coverage for long-term care, many elderly rely on Medicaid to pay nursing home costs.

Medical Assistance Fact Check True or False: I don’t need to think about getting Long Term Care insurance since even though I am on Medicare, I can apply for Medicaid if I have to go into a Nursing facility.

Medical Assistance Fact Check While Medicaid does cover nursing home stays, individuals with substantial assets may be over the asset limit and not qualify. Even if under the asset limit, estates valued at $25K and above are required to reimburse the taxpayers for long term care and home and community-based services provided through Medicaid. Funds are recovered from the member's estate, after death, for the cost of these services through Georgia’s Estate Recovery program. This is a Federal requirement.

Medical Assistance Fact Check TRUE OR FALSE: Parents of a disabled child who meets a nursing facility level of care but gets home based services can get Medicaid coverage for their child regardless of their income and resources.

Medical Assistance Fact Check Katie Beckett Medicaid covers medical services for children in the home, regardless of the parents' income, in cases where home-based treatment will cost less than or the same as treatment in a hospital.

Medical Assistance Fact Check TRUE OR FALSE: You have to go into a DFCS office to apply for Medical Assistance.

Medical Assistance Fact Check There are multiple ways individuals may apply for Medical Assistance: On Georgia Gateway – www.gateway.ga.gov At local DFCS or RSM Group office By mail Telephone Fax In some instances you may even apply at designated agencies, such as Public Health Departments or Hospitals

Questions?