Federal government approves Georgia's alternative to full Medicaid expansion

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President Donald Trump’s administration will approve Georgia’s waiver requests to the Affordable Care Act, Gov. Brian Kemp and Centers for Medicare & Medicaid Services Administrator Seema Verma announced Thursday.

Kemp said the waivers will reform health care in the state, which has one of the country’s highest uninsured rates at 14.8%. The proposal – Georgia Pathways and Access – will help close the coverage gap for hundreds of thousands of Georgians, the governor said.

“Georgia Pathways and Access will provide access to health care insurance for thousands of hardworking Georgians and lower premiums for millions more,” Kemp said. “This bold, innovative approach will lower the uninsured rate, spur competition in the marketplace, enhance the shopping experience for consumers, and improve health outcomes.”

Kemp signed the Patients First Act, which authorized the Georgia Department of Community Health to submit waivers to the ACA, into law in March 2019.

The ACA gives states the option to raise the income eligibility requirement for Medicaid to open the taxpayer-funded program to more participants. The ACA allows for an income limit of 138% of the federal poverty level, or $17,000 for an individual. About 3 million Georgians live under 200% of the federal poverty line, according to a report by the Kaiser Family Foundation.

Georgia Pathways and Access will extend the Medicaid income eligibility to up to a maximum of 100 percent of the federal poverty line, or a little more than $12,000 annually.

As of December, Georgia’s Medicaid program had enrolled over 1 million individuals through its managed care Medicaid program, which provides health care to nondisabled adults and children. According to the waiver, an additional 470,500 disabled and low-income Georgians are enrolled in the state’s fee-for-service Medicaid program.

Under the waivers, Georgians would have to complete a minimum of 80 hours of work per month or other activities, such as training or education, to qualify for the program. The plan, which starts July 1, 2021, will cover Georgians who do not qualify for Medicaid and can’t afford the federal marketplace premium-based plans.

“Today, we are taking another critical step in driving down the cost of health care in Georgia,” Lt. Gov. Geoff Duncan said. “The ability to craft innovative solutions to Georgia-specific health care issues provides the flexibility necessary to improve our healthcare delivery systems.”

The waivers will allow the state to create its own model for health care access for more than 1.4 million Georgians, Kemp said.

The state plans to help cover employee copays and premium costs through the program for low-income Georgians. Instead of other Georgians relying on the federal marketplace for insurance, Georgia Pathways and Access will give them more private options for health care coverage, starting January 2022.

Georgia will invest in a reinsurance program, starting in January 2023, that Kemp said also would reduce marketplace premiums, for those who qualify, by an average of 10%.

Georgia Pathways and Access costs $329 million less per year than a full Medicaid expansion, Kemp’s office said. A full expansion of the partially federal-funded program would cost the state $547 million a year.

Critics of the plan said it does little to help low-income Georgians. While Kemp’s administration said the plans would provide health insurance for more than 400,000 uninsured people, Georgia Budget and Policy Institute health policy analyst Laura Harker said it would cover only 50,000 people.

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