Marrow Woods is a Wesleyan College student organizer with the Georgia Youth Justice Coalition.

 Leah Chan is a Senior Health Analyst with the Georgia Budget and Policy Institute. 

During high school, I was diagnosed with Hurley Stage 3 Hidradenitis Suppurativa, which shifted how I viewed Medicaid and healthcare access in my home state of Georgia. Although I have been sick with various chronic illnesses for a lifetime, Medicaid was a life raft after my diagnosis.

I relied on immunosuppressive medication to control and stop my symptoms from worsening, but eventually, even those drugs were not enough. The months between high school and college, usually an exciting and hopeful time for students, I spent bedridden and dependent on mobility aids to get around.

Eventually, I found a new medication that fully relieved my symptoms. Although I had physical relief, I had to sacrifice my emotional well-being by going through the draining process of fighting for adequate healthcare access. As a 20-year-old living alone, I found it challenging to continue being a full-time university student, finding enough time to have a social life in college as a disabled person, and navigating the intricacies of the Medicaid system. I was constantly worried about being unable to afford my medication. This was when I felt at my weakest, yet the Medicaid administrative process still expected me to bend over backward to prove myself worthy of necessary and life-changing healthcare.

Georgia youth should never feel that their lives are limited or derailed by a lack of health access. Medicaid relieved so many of my health struggles. I would not be here without my medication giving me opportunities back that a chronic illness took away from me. I can now walk again and live independently as a full-time college student. For once in a long time, I have hope for a healthy life in the future. We all deserve to feel hope and stability when it comes to healthcare access.

Thanks to a pandemic-era federal policy, all states, including Georgia, have suspended annual renewals since early 2020 and kept their Medicaid-eligible population enrolled in coverage. The end of this Medicaid continuous enrollment is known as the ‘Medicaid unwinding’. Starting in April, Georgia has 14 months to re-determine the eligibility of all 2.7 million children and adults who, like me, are enrolled in our healthcare safety net.

This unwinding will be an unprecedented healthcare event in our state—placing pressure on our state agencies and our healthcare system and jeopardizing the health and financial security of Georgians with lower incomes. It is estimated that about 545,000 Georgians will lose coverage—either because they are no longer eligible or because of a potentially avoidable procedural reason, like the form is sent to the wrong address. The burden of this healthcare coverage loss will fall heaviest on children, young adults, and communities of color.

The current healthcare system in Georgia is failing young people, and it is time for a change. Fully expanding Medicaid now could help keep Georgians covered and minimize the human and fiscal costs of Medicaid unwinding. However, starting this July, our state will begin the implementation of the Governor’s partial Medicaid expansion, known as the Pathways to Coverage program. This program will expand Medicaid eligibility to some Georgians who have lower incomes and who complete 80 hours per month of qualifying activities like work, higher education, or volunteering. The Department of Community Health estimates that there are about a quarter of a million Georgians who gained coverage over the past three years thanks to the Medicaid continuous enrollment policy and who are no longer eligible for traditional Medicaid but may be eligible for the Pathways to Coverage program. This group includes Georgians who turned 19, 20, or 21 years old while this pandemic-era policy has been in place, but will be aging out of traditional Medicaid or PeachCare when their eligibility is re-determined. These are also Georgians who, before the pandemic, would likely fall into the coverage gap and be uninsured.

Transitioning just those 250,000 Georgians to the Pathways to Coverage program would cost the state about $610 million dollars.1 In comparison, if the state were to fully expand Medicaid now and extend eligibility beyond the limits of the Pathways to Coverage program, the state cost per enrollee would be five times lower. On balance, the state cost of full Medicaid expansion would be completely offset by federal funding for at least the first two years thanks to the new financial incentives offered under the American Rescue Plan. Moreover, young adults–including those 19, 20, and 21-year-olds who will be losing coverage during Medicaid unwinding–are the age group with the most to gain from full Medicaid expansion and would make up more than 50% of those gaining access to health insurance. Medicaid unwinding threatens healthcare access for people like me and could make it nearly impossible to afford medication or see the doctor. Rather than rolling out the costly and restrictive Pathways to Coverage program, federal financial incentives should be used to expand Medicaid eligibility to more young people in need. My story doesn’t have to be everyone’s reality. A future where youth do not experience the overbearing struggle to get health care is possible through full Medicaid expansion. 

GBPI analysis by L. Chan of estimated Pathways to Coverage-eligible population currently covered under Medicaid continuous enrollment provision and estimated per member per month cost in Pathways to Coverage approval.