ATLANTA — Georgia dropped more than 300,000 children from the Medicaid and PeachCare for Kids health insurance program, with one of the worst child disenrollment rates in the nation, according to a new study from Georgetown University. The study authors fear the majority of them are now uninsured and might decide they cannot afford health care as a result.

Georgia and all states are re-evaluating all Medicaid case files in a year-long national culling process, after case rolls swelled during the pandemic. The process is scheduled to finish soon.

Georgia’s number of children kicked off Medicaid was bigger by December than the entire population of Augusta or Columbus. Georgia disenrolled far more children than California, a state that started with more than double the child Medicaid enrollment of Georgia, the report found.

Pediatricians in Georgia have seen the experience in person as families show up to find out they’re not covered, and turn around and leave without care. “It’s so hard,” said Dr. Anu Sheth, a Lawrenceville pediatrician and board member of the Georgia Chapter of the American Academy of Pediatrics. “It’s heartbreaking for the kids.”

There is no way to track exactly where those children wound up. Despite Georgia officials’ suggestion that many might have gone on to better insurance, the researchers say disheartening signs indicate that the vast majority may have simply lost insurance and perhaps gone without care, the study’s authors said.

“It’s very likely that a substantial share of children losing Medicaid, especially those disenrolled for (missing paperwork) reasons, likely ended up uninsured,” said Edwin Park, one of the study’s authors, addressing the Georgia data. Missing paperwork is the most common reason behind Georgia’s disenrollments.

Medicaid is the government health insurance program for poor children and some poor adults, such as some who are elderly, disabled. Some may meet eligibility requirements by working at least 80 hours a month.

During the pandemic, everybody who got on Medicaid stayed on, and didn’t have to do the annual paperwork to show they still qualified. In Georgia the rolls swelled to one-quarter of the state’s population, 2.8 million people. But now that federal pandemic emergencies have ended, the federal government is requiring every state to go back through all their case files over the course of a year to evaluate each one and make sure they still qualify. The process is called redetermination, or undwinding.

Georgia has made “concerted efforts ... to ensure that children retain health care coverage,” a spokeswoman for the state Department of Community Health said in a written statement. And those have increased as the process went on, which may mean that the numbers improved after the study’s data gathering stopped.

In the period of the study, up to December, the research showed some states were doing better than others. Georgia was among the worst, what study author Joan Alker called “the big three.”

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