The "Personal Responsibility and Work Opportunity Reconciliation Act of 1996", commonly known as Welfare Reform, was signed into law on August 22, 1996. As a result of this legislation, tremendous changes in the Medicaid recipient base occurred in Georgia.
The purpose of the Welfare Reform was two-fold: First, to decrease cash benefits to non-citizens and establish time limitations for cash payments to AFDC recipients. Secondly, establishment of a stronger bond between welfare and the Medicaid link that existed under block grants. However, hidden in the bill is a payment methodology for $51 benefits that eliminates Medicaid for the month of filing for SSI. This meant that literally millions of dollars of uncompensated care could not be covered by Medicaid. For example:
11/9/96 - John Doe, a 25 year-old single male, presents to the Emergency Department at John Doe Hospital, a victim of a gunshot wound to the chest. He is an uninsured day laborer making minimum wage.
11/15/96 - A claim is filed on Mr. Doe's behalf for Supplemental Security Income/Medicaid for disability benefits.
11/50/96 - Mr. Doe is discharged to his physician's care and further follow-up.
3/15/97 - Mr. Doe's claim for SSI/Medicaid coverage is approved retroactive to December 1996.
NOTE: Mr. Doe has total charges in bills in excess of $40,000. Mr. Doe does not receive Medicaid for November. 1996, the month of his hospitalization. (Annually, nationwide, GHA estimated $300 million in lost coverage.). Therefore, the cost of his care is sent to Bad Debt.
In an effort to correct this situation, over 1,000 hearings were filed by Medicaid recipients for lost coverage. Their hearings are currently pending a final ruling from HCFA regarding the SSI month of filing and its relationship to Medicaid. Additionally, a class action suit was flied against Georgia and the Department of Medical Assistance by six Medicaid recipients. In addition to questioning the legality of the actions taken by the State in response to the legislation, the suit also raises the issue of civil rights discrimination. By interpretation, Georgia provided emergency medical assistance to aliens within its borders for the month of hospitalization, while denying coverage to its citizens.
In May, HCFA issued instructions to the States suggesting that the States utilize the regulation for retroactive (3 month prior) Medicaid to cover this missing Medicaid month.
At the present time, Georgia is in the process of correcting their current action plans and covering the missing months, however, it does mean that SSI recipients will only have two months of retroactive eligibility while AFDC has three months.