More than 500,000 Georgians could begin to lose health coverage by spring if pandemic-era Medicaid relief ends

Hundreds of thousands of Georgians who have had health insurance through Medicaid during the pandemic could begin to lose their coverage this coming spring under the proposed federal spending bill unveiled this week.

The congressional proposal would end the pandemic-era rule requiring states to continue covering Medicaid enrollees even if they no longer qualify under a state's eligibility rules. The requirement was packed into federal coronavirus legislation passed in March 2020.

Under the terms in the $1.7 trillion spending package, millions of people could lose coverage nationally — including about 545,000 Georgians, according to one state estimate — under a process that could start as soon as April 1 if Congress passes the federal spending bill.

A group of Republican governors, including Georgia Gov. Brian Kemp, sent President Joe Biden a letter this week asking him not to renew the public health emergency declaration beyond April so states could start whittling down their inflated Medicaid rolls, citing the costs.

The governors' plea was made even as states continue to wrestle with a "tripledemic" of rising COVID-19, flu and RSV cases that threaten to strain their hospitals this winter.

"While the virus will be with us for some time, the emergency phase of the pandemic is behind us," the 25 governors wrote in a Dec. 19 letter to Biden. "We have come so far since the beginning of the pandemic — we now have the tools and information necessary to help protect our communities from COVID-19."

The emergency declaration is set to expire Jan. 15, but the Biden administration is expected to extend it again, continuing it through at least April. But the proposed spending bill would untether the so-called Medicaid unwinding process from the federal emergency declaration.

In Georgia, Medicaid enrollment has grown to about 2.6 million people, up from about 1.8 million before the pandemic.

That increase has come with extra federal funding that helped state budget writers navigate the public health crisis, delivering Georgia about $2.2 billion in fiscal relief — or more than twice the amount the state spent on additional enrollees, according to an analysis from the Kaiser Family Foundation.

The state closed out the last fiscal year with a $6.6 billion surplus, and revenues for the first five months of the new budget year were up 6.2% — or $741.7 million — above this time last year.

But even with the federal boost, GOP leaders argue the rule has cost states "hundreds of millions of dollars," the letter said.

There won't be a clear picture of the cost until states are able to go through the process of identifying those who are no longer eligible for coverage because, for example, they have aged out of the program or their income level has changed, said Kemp's spokesman, Andrew Isenhour.

All told, though, the state has spent about $37.5 billion on Medicaid enrollee benefits since the beginning of the pandemic, Isenhour said.