Georgia saves up to $56 million booting ineligibles from health plan


The state is hoping to save up to $56 million a year by removing ineligible family members of those enrolled in the State Health Benefit Plan from the program.

The state Department of Community Health, which administers Medicaid as well as the State Health Benefit Plan for teachers, state employees, retirees and their dependents, announced last year that it would do an audit to determine whether there were people receiving the government-subsidized medical coverage who shouldn’t be.

A similar audit more than a decade ago kicked enough ineligible dependents off the rolls that the state saved an estimated $30 million a year.

DCH officials audited employees and dependents on the plan, which covers 640,000 Georgians. It found that almost 16,000 dependents of plan members were receiving coverage even though they were ineligible.

“It is important for us to ensure that eligible employees are enrolled in the plan,” said Jeff Rickman, the head of the program. “It has been some time since we did this, and we realize we need to go through the process.”

Rickman said the agency asked plan members to provide proof of eligibility. He said Georgians being audited could have gotten up to five different letters before the agency declared anyone in the family ineligible.

In most cases, those dumped from the rolls were adults who were divorced from eligible plan members or children of employees who were still being covered even though they had become too old to be eligible. Such dependent children are eligible to remain on their parent’s coverage until age 26.

Kelly McCutchen, president of the Georgia Public Policy Foundation, said the state shouldn’t wait another decade to audit such programs.

“Whenever somebody who is ineligible is getting a benefit, it means they are taking money away from people who need the benefit,” McCutchen said. “The state, particularly when its tax dollars are at stake, should be doing these enrollment audits at least every year.”

State officials announced last year that they hoped to save more than $200 million through a series of cost-cutting moves. The audit was one of those efforts.

DCH officials said the moves were designed to cut into future shortfalls projected in the $3 billion program. Some of the shortfalls the state has projected in recent years haven’t materialized because costs haven’t risen as quickly as expected. Premium increases have been minimal, although teachers, employees and retirees have complained that they have had to pay more out of pocket for medical care.

The General Assembly has also shifted about $160 million in annual costs to local school districts over the past three years to fund health coverage for school bus drivers, cafeteria workers and others staffers.


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