The Number of Uninsured Children ere in Georgia Has Declined Thanks to S Health Policy Institute Federal Law But May Rise Soon eer) The state of Georgia has the fourth highest number of uninsured children with an estimated 176,000 Georgia children going Figure 1. Rates of Uninsured Children in without health coverage. Georgia performs poorly in comparison the Deep South, 2021 to its neighbors in the deep south. All of Georgia's neighboring states -with the exception of Florida-have better child uninsured rates (see Figure 1). Children without health insurance have worse educational and health outcomes' and their families can be exposed to large medical bills if a child goes without insurance even for a short period of time. The majority of uninsured children in the United States are uninsured despite the fact that they are eligible for public coverage- either Medicaid or the Children's Health Insurance Program (known as PeachCare in Georgia). A number of factors contribute to eligible children being uninsured. Families may not be aware that their children are eligible, . . . : paperwork could get lost in the mail during renewal, or parent's Source: Georgetown University Center for Children and Families analysis efforts to enroll their children may be thwarted by the complex of the 2021 U.S. Census American Community Survey (ACS) Table HIC-5, fred Health Insurance Status and Type of Coverage by State - Children Under maze oT re tape. 19, Health Insurance Historical Tables. Prior to the onset of the COVID-19 pandemic, the number and rate of uninsured children in Georgia (and the nation) had been going New data from the U.S. Census Bureau from 2021 finds that the up for the first time in decades." However, a change in federal number of uninsured children has gone down nationally largely law ensured that children and others enrolled in Medicaid cannot _ thanks to this protection for children enrolled in Medicaid.® be terminated involuntarily by any state during the federally- Georgia's children have seen some of the most significant declared COVID-19 Public Health Emergency (PHE)-which benefits in the country from this continuous coverage protection. remains in effect at this writing.* Georgia and other states were Georgia's child uninsured rate dropped to 6.6 percent in 2021, given increased federal funding to help them fulfill this obligation its lowest level in recent history. This represents a 19 percent designed to prevent health coverage loss during the pandemic.* decline from a recent peak of 8.1 percent in 2018 (see Figure 2). Figure 2. Rate of Uninsured Children in Georgia, 2011-2021 10.2% 10.1%* 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020 2021 Source: Georgetown University Center for Children and Families analysis of the 2011-2021 U.S. Census American Community Survey (ACS) Table HIC-5, Health Insurance Status and Type of Coverage by State - Children Under 19, Health Insurance Historical Tables. * Change is significant at the 90% confidence level relative to the prior year indicated. ** Due to data quality issues related to the pandemic, the U.S. Census Bureau did not release standard 1-year ACS estimates in 2020. See methodology section for more information. Which children in Georgia have seen the biggest gains in coverage? Children in families with the lowest incomes (below $31,781 per month for a family of 3) have seen the biggest improvements in coverage-with the uninsured rate dropping approximately 19 percent. Children in the highest income families, who have low uninsured rates, have seen little change. School aged children had bigger declines compared to younger children-likely because they had higher uninsured rates to begin with. Looking at race and ethnicity, multi-racial and White children have seen considerable improvements in their uninsured rates; Black children and Asian/Pacific Islander children did not see any statistically significant changes in their rates (see Figure 3). Figure 3. Rate of Uninsured Children in Georgia by Race, 2019-2021 14% 2019 Ml 2021 12.5% 12% 10.1%* 10% 7.6% 8% 6.9% 6.2% 6% 5.3%" 5.8% 5.7% : 4% 2% 0% White Asian/Native Black/African Other/ Hawaiian/Pacific Islander American Multiracial Source: Georgetown University Center for Children and Families analysis of the U.S. Census 2019-2021 American Community Survey (ACS), Tables C27001A-I. Note: Hispanic/Latino refers to a person's ethnicity, therefore Hispanic individuals may be of any race. * Change is significant at the 90% confidence level relative to the prior year indicated. The uninsured rate improved by 20 percent for Hispanic/Latino children who can be of any race and tend to have very high uninsured rates (see Figure 4). Figure 4. Rate of Uninsured Children in Georgia by Ethnicity, 2019-2021 20% 15.9% 15% : 2019 Ml 2021 12.7%* 10% 5.9% 5.5% ; | 0% Hispanic/Latino Not Hispanic/Latino Source: Georgetown University Center for Children and Families analysis of the U.S. Census 2019-2021 American Community Survey (ACS), Tables C27001A-I. Note: Hispanic/Latino refers to a person's ethnicity, therefore Hispanic individuals may be of any race. * Change is significant at the 90% confidence level relative to the prior year indicated. October 2022 CCF.GEORGETOWN.EDU UNINSURED CHILDREN IN GEORGIA 2 Conclusion The significant improvement in children's coverage status has been a silver lining of the pandemic for Georgia families. Having Medicaid ensures that a child can get needed primary and preventive care without cost barriers. For example, a child with asthma can see the doctor, get needed prescriptions, and be ready to learn in school-rather than winding up in the emergency room. However, this progress is at risk when federal Medicaid continuous coverage protections lift-which could be as soon as January, 2023. At that time, regular state procedures will resume and many children will be likely to lose coverage due to red tape barriers even though most of them will still be eligible. Children are at greatest risk of this kind of administrative churn.® Georgia is one of six states nationwide identified as having the greatest number of risk factors due to state policies and procedures in place that increase the likelihood that children will become uninsured.' These state choices include the lack of 12-month continuous eligibility for children in Medicaid/CHIP, which creates more paperwork for families to maintain their child's coverage, and a separate CHIP program (PeachCare) that charges premiums. If Georgia reinstates premiums when the public health emergency ends, it will make it harder for families whose income has increased slightly to enroll their child in PeachCare. These premiums have been suspended during the public health emergency but the state describes this suspension as "temporary" so they are likely to be reinstated.* Finally, Georgia could do a much better job of automating coverage renewals. CMS recently approved Georgia's application to implement Express Lane Eligibility, allowing the state to use SNAP and TANF application data to automatically determine Medicaid eligibility, starting in October. If properly implemented, this policy could help to relieve the renewal paperwork burden for a large portion of children currently enrolled in Medicaid, who will undergo redeterminations after the PHE ends. This factsheet was written by Joan Alker and Aubrianna Osorio. The authors would like to thank Catherine Hope for her assistance. Design and layout provided by Nancy Magill. The Georgetown University Center for Children and Families (CCF) is an independent, nonpartisan policy and research center founded in 2005 with a mission to expand and improve high-quality, affordable health coverage for America's children and families. CCF is based at the McCourt School of Public Policy's Health Policy Institute. Endnotes 1 Park, E., Alker, J., and Corcoran, A., "Jeopardizing a Sound Investment: Why Short-Term Cuts to Medicaid Coverage During Pregnancy and Childhood Could Result in Long-Term Harm" (Commonwealth Fund, December 2020), available at https://www. commonwealmine. org/ ief harm. 2 Alker, J. and Corcoran, A., "Children's Uninsured Rate Rises by Largest Annual Jump in More Than A Decade" (Georgetown University of Children and Families, October 2020), available at https://ccf, georgetown.edu/wpcontent/uploads/2020/10/ACS-Uninsured-Kids- 2020 10-06-edit-3.paf. 3 It is unclear when the Biden Administration will terminate the COVID-19 public health emergency -the earliest date would be mid January 2023. 4 Williams E. at al., "Fiscal and Enrollment Implications of Medicaid Continuous Coverage Requirement During and After the PHE Ends" (Walser ray Foundation, May 2022) available at https: Jiwww. a oral ief/ti continuous. "coverage-reauirement-during-and- after-the-ph he-ende/ October 2022 5 United States Census Bureau, "Uninsured Rate of U.S. Children Fell to 5.0% in 2021" (United States Census Bureau, September 2022), available at https:/Awww.census.gov/library/stories/2022/09/uninsured-rate-of- children-declines, html. 8 Office of the Assistant Secretary for Planning and Evaluation, "Unwinding the Medicaid Continuous Enrollment Provision: Projected Enrollment Effects and Policy Approaches" (Office of the Assistant Secretary for Planning and Evaluation, August 2022), available at https:// aspe.hhs.gov/reports/unwinding-medicaid-continuous-enrollment- provision. 7 Alker, J. and Brooks, T. "Millions of Children May Lose Medicaid: What Can Be Done to Help Prevent Them from Becoming Uninsured?" (Georgetown Center for Children and Families, February 2022) available at https://ccf.qeorgetown.edu/2022/02/17/millions-of-children-may-lose- medicaid-what-can-be-done-to-help-prevent-them-from-becoming- uninsured/. 8 Georgia Department of Community Health, "PeachCare for Kids," available at https://dch.georgia.gov/peachcare-kids. CCF.GEORGETOWN.EDU UNINSURED CHILDREN IN GEORGIA 3