In 2019, Gov. Brian Kemp proposed a plan that would limit new Medicaid coverage to a much more restricted number of Georgians. The Governor’s plan would impose debunked “proof of work” requirements and require unaffordable premiums for some enrollees. The Trump administration approved the complete plan in 2020. In December 2021 the Biden administration changed its approval to disallow the burdensome work requirements and premiums. You can read more about the back-and-forth over the Governor’s plan in this blog and on our waiver timeline. 

Background

In 2019, Georgia put forward a plan to expand Medicaid to a limited group of Georgians. Under the “Georgia Pathways” plan, the state would allow adults with incomes below the poverty line ($12,880 for an individual and $17,420 for a family of 2) to qualify for Medicaid health insurance. The Georgia Pathways plan also required these newly eligible adults to complete and document 80 hours of work (or other “qualifying activities”) each month to enroll in and keep their coverage. Some enrollees would also be required to pay a monthly premium to stay covered. 

In 2020, the Trump administration approved the Pathways plan and implementation was set to begin in the summer of 2021. However, when the Biden Administration took over in the spring of 2021, they paused the approval to allow the new administration more time to review the Pathways plan. The Biden administration was particularly interested in the work requirements and premium payments and whether these additions violated the spirit and goals of the Medicaid program.

At the end of 2021, the Centers for Medicare and Medicaid Services (CMS) approved the Georgia Pathways plan, allowing Georgia to extend Medicaid coverage to Georgians making up to the poverty line (or 100% FPL). However, CMS denied the state’s request to include work requirements and premium payments as a condition of enrolling in and maintaining Medicaid coverage. CMS cited concerns about the devastating impact the COVID-19 pandemic has had on both the health and economic security of Georgians as the reason for denying these provisions. You can learn more about the Georgia Pathways program and the approval timeline here.

Recent Updates

Following this final approval of the Pathway’s plan and denial of the request to include work requirements and premium payments, Governor Kemp was left with four options. He could do nothing and continue to let low-income Georgians remain uninsured, appeal CMS’s decision, implement the Pathways waiver without the work and premium requirements, or fully expand Medicaid to cover as many as 500,000 low-income Georgians (you can learn more about the options available following the waiver approval here). Governor Kemp chose the second option and appealed CMS’s decision to deny the inclusion of work requirements and premium payments.

In August 2022, a judge issued a ruling on the appeal of CMS’s decision. The judge ruled that the Biden Administration could not deny the previously approved work requirements and premium payments from the original Georgia Pathways plan. This decision means the state can move forward with implementation of the waiver as originally approved in 2020. CMS has yet to respond to this ruling, but does have the option to appeal the decision to a federal appeals court.

What does this court decision mean for Georgians?

Governor Kemp can carry out his Medicaid plan as he intended. If the program goes into effect, Georgia adults with incomes below the poverty line would become eligible for Medicaid. They would only be able to enroll if they complete monthly paperwork to prove they are working at least half-time. Some would also be required to pay premiums. Governor Kemp’s administration estimates that only about 50,000 Georgians (out of 500,000) would successfully gain coverage.

Most otherwise-eligible Georgians will be unable to enroll in or keep their Medicaid coverage because of the work requirements or premium payments.

The work requirements do not work for many uninsured Georgians. Georgians who are full-time caregivers, people in mental health & addiction recovery programs, and people living in areas where good jobs are harder to come by would not meet the work requirements. That means rural residents, people living in low-income communities, and communities of color are more likely to be left uninsured.

Georgia leaders can choose a better path

With this most recent court decision, Governor Kemp and the Georgia legislature once again face a choice about how to best connect low-income Georgians to health coverage and care. 

Their options are: 

Medicaid expansion is still the best option for Georgians

Full Medicaid expansion still makes the most sense for Georgia. Medicaid expansion would boost the health of Georgians by increasing early detection for diseases like cancer and heart disease. The expanded coverage would relieve the burden on rural hospitals, ensuring that their communities continue to have access to care. Medicaid expansion would close long-standing health gaps that unfairly cut short the lives of Black and brown Georgians.

Too many Georgians have been left without coverage for far too long. Our state leaders must choose the best way forward for our state. Medicaid expansion is the best way forward.

Medicaid has been a fundamental part of Georgia’s health care system for 54 years. Medicaid covers half of Georgia kids, half of births in the state, and three out of four Georgians in long-term care (like nursing homes). Without Medicaid, low-income Georgia families would have no access to affordable, quality health care.

Want to do more to celebrate Medicaid?

Cover Georgia celebrates Medicaid Awareness Month all throughout April. You can party with us all month long!

Learn more about Medicaid. Find out who is already covered by Medicaid in Georgia, how Medicaid benefits our health care system, and much more with these resources:

• Medicaid in Georgia
• Fast Facts for Medicaid Expansion
• Medicaid Matters for Georgia fact sheet
• Medicaid Matters to Georgia storybook

Spread the word on social media! Share one of our Facebook or Twitter posts and let others know that it’s time to take action on Medicaid expansion!

Background: In 2019, Georgia submitted a plan to the Centers Medicare and Medicaid Services (CMS) to expand Medicaid to a certain subset of Georgians. Under the plan, called the Georgia Pathways waiver, the state planned to allow individuals aged 19-64 making up to 100% of the federal poverty line (FPL) ($12,880 for an individual and $17,420 for a family of 2) to apply for Medicaid coverage. The Georgia Pathways plan also required these newly eligible adults to complete and document 80 hours of work or other “qualifying activities” each month to enroll in and maintain coverage. The plan further required some enrollees (those making 50-100% FPL)  to pay a monthly premium to maintain their coverage, which is not required for traditional Medicaid.

In late 2020, the Trump Administration approved the Georgia Pathways plan and implementation was slated for the following July. In spring 2021, the Biden Administration changed the status of Georgia’s plan from “approved” to “pending” and stated they needed to review the plan, specifically the work and premium requirements, to ensure they were in keeping with the spirit, goals, and intent of the Medicaid program. You can learn more about the Georgia Pathways program and the approval timeline here.

On December 23^rd, 2021, CMS approved the Georgia Pathways plan and will allow Georgia to extend Medicaid coverage to Georgians making up to the poverty line (or 100% FPL). However, CMS denied the state’s request to include work requirements and premium payments as a condition of enrolling in and maintaining Medicaid coverage. CMS cited concerns about the devastating impact the COVID-19 pandemic has had on both the health and economic security of Georgians as the reason for denying these provisions.

Now that CMS has issued its decision, Governor Kemp and the Georgia legislature must decide how to proceed, choosing one of these four options:

1. Do nothing. Even though CMS approved a modified version of the Georgia Pathways waiver, Georgia is under no obligation to implement it. This action would mean the coverage gap remains in place and vulnerable low-income Georgians would largely remain uninsured.
2. Appeal CMS’s decision on the work and premium requirements. On Jan. 22, 2022, Gov. Kemp initiated an appeal beginning a lengthy process with CMS (a process made even slower by the pandemic). While the state pursues the appeal, thousands of Georgians will remain without coverage. State leaders can move forward with the following two options even while the appeal is in process.
3. Move forward with the Georgia Pathways plan as approved. Under this option, Georgians making less than 100% FPL would be eligible for Medicaid. An estimated 269,000 uninsured Georgians would gain coverage. This plan would cost the state 2.5 times more to implement than the following option.
4. Expand Medicaid to cover more people at a lower cost. Under a full Medicaid expansion, individuals and families making up to (138% FPL) would be eligible for coverage. As many as 500,000 Georgians would be covered and the state would qualify for a 90% cost match from the federal government. Georgia would save millions of dollars annually over the Pathways waiver and earn a $1.3 billion bonus in the first two years.

With CMS’s approval of the Georgia Pathways program, the state is at a crossroads. Our state leaders can choose to meet the pressing health care needs of the state through Medicaid expansion, or they can choose to help fewer Georgians at a higher cost under the Pathways program.

Our state leaders cannot and should not choose to do nothing because Georgians can’t wait. Too many Georgians are without health coverage and the positive effects that come with coverage. It is far past time to act and the onus lies with our state leaders to decide the way forward. Click HERE to take action!

Georgia Democrats have campaigned for Medicaid expansion over the past decade, with strong support among their voters. Georgia Republicans have been more hesitant to embrace the policy, which would allow low-income adults and parents to access health care through Medicaid. New polling commissioned by Georgians for a Healthy Future finds that the support for expansion today goes far beyond Democrats. A strong majority supports expansion, suggesting that expansion in 2022 would benefit incumbents running for re-election.

For starters, 88 percent of Georgians say that all residents of our state should have access to health insurance coverage. Of course that means different things to different people, and support for Medicaid expansion doesn’t reach that level, but GHF’s polling found that the more Georgians know about expansion, the greater the support.

With no additional information provided, 59 percent of Georgians support expansion. But that number rises to 77 percent when respondents were asked: Do you favor or oppose expanding health insurance coverage for a family of three making roughly $30,000? Once they realize how the program targets our neediest citizens, Georgians respond more favorably.

Currently, Gov. Brian Kemp has a plan pending federal approval that would expand Medicaid in Georgia on a much more limited basis. Instead of covering 500,000 Georgians, it would cover only 50,000 Georgians at even lower income thresholds.

This plan has support across party lines. But again, once Georgians find out more details, support for full expansion far surpasses that of Kemp’s more limited plan.

When voters find out that Kemp’s plan would cover families of 3 making less than $22,000, but full expansion would cover the family making up to $30,000, Georgians favor full expansion 49-32. The same is true when voters learn that under Kemp’s plan, the federal government would cover only 66 percent of the cost — leaving state taxpayers with the rest of the bill — but that under full expansion the federal government would cover 90 percent of the costs. (Today, our tax dollars are going to OTHER states to cover 90 percent of healthcare costs for many of their residents but not for our own!)

What really tilts the scales toward full expansion is the cost per person. Under Kemp’s plan, the state would pay $2,420 per person. Under full expansion the state’s tab is only $496 per person.

As Georgia’s elected leaders look toward another razor-thin election in 2022, they may consider which policies are electorally popular. Medicaid expansion is a policy that could benefit candidates across parties. Even a majority of GOP voters supports expansion when they hear its benefits. Polling particularly strongly amongst Republicans were providing low-income people with preventative care and helping keep rural hospitals open by increasing their number of paying patients. GOP voters also responded favorably to covering Georgians with mental health and substance abuse disorders. This group makes up about 25 percent of newly eligible beneficiaries under expansion.

Regardless of what state leaders decide to do between now and November 2022, we know that statewide candidates favoring expansion will enjoy a distinct advantage at the polls. Medicaid expansion is good for Georgians’ health — but its also good politics.

This month marks the 56th anniversary of President Lyndon B. Johnson signing Medicaid and Medicare into law through the Social Security Act of 1965. Over the past five decades, Medicaid has become a bedrock of Georgia’s health care system, promoting the health and well-being of Georgians. Because of Medicaid, Georgians like Travis are afforded access to essential medical care and long-term health benefits.

Today, let’s celebrate Medicaid and all it has done and continues to do to help Georgians live healthier and better lives. Happy birthday, Medicaid!

To learn more about Medicaid, and to see if you or a loved one may qualify visit gateway.ga.gov!

Reposted from Georgians for a Healthy Future: https://healthyfuturega.org/2021/06/16/cms-requests-more-information-about-georgias-proposed-changes-to-private-insurance/

On June 3^rd, 2021, the Centers for Medicaid and Medicare Services (CMS) sent a letter to Governor Kemp requesting additional data on the potential impacts of the Georgia Access Model. The Georgia Access Model was put forward by Kemp in his 1332 private insurance waiver, and the model would end access to healthcare.gov for Georgia consumers.

CMS is requesting additional data from the state because they believe recent changes made by President Biden’s administration to the Affordable Care Act’s health insurance marketplace have made the state’s previous analysis outdated or inaccurate. The Biden administration’s changes include:

• The COVID Special Enrollment Period (SEP)—through August 15, 2021, almost any American who does not have health insurance through their job can enroll in health coverage at healthcare.gov or by phone at 1-800-318-2596;
• More generous and expanded eligibility for Premium Tax Credits (PTCs)—almost anyone who qualifies for coverage through the ACA is now eligible for a discount on their monthly premium; and
• Increased funding for outreach and marketing for the ACA marketplace and enrollment opportunities.

These actions have led to more Americans, and Georgians, enrolling in Marketplace coverage. In addition, CMS believes that ACA enrollment would likely remain higher through 2023, when the Georgia Access Model is slated to begin.

In the letter, CMS also reasons the increase in enrollment could change insurance market dynamics enough to reduce the private sector’s incentive to enroll consumers. CMS believes with fewer uninsured people to enroll, the private sector may be less motivated to reach uninsured individuals. The idea that the private sector will be incentivized to enroll consumers once the competition of healthcare.gov is gone is a crucial assumption of Kemp’s waiver.

Georgia must now respond with updated data that takes into account the new federal changes. The new data will allow CMS to ensure the Georgia Access Model meets the protections specified in Section 1332 of the Affordable Care Act. These protections are:

1. Coverage must be at least as comprehensive as Marketplace coverage;
2. Coverage and protections against high costs must be as affordable as Marketplace coverage;
3. A similar number of people must have coverage under the waiver as without it; and
4. The waiver can’t add to the federal deficit.

The state may also request to adjust the Georgia Access Model, as needed, to meet waiver requirements in light of the new federal policies.

Once Georgia submits the new data about the Georgia Access Model, Georgia consumers, health advocates, and other stakeholders will have a chance to comment on the proposal again. CMS announced in their letter that they will hold a 30-day comment period after they receive Georgia’s new data. GHF expects the comment period will begin in early July. We will be working with our Cover Georgia partners to help Georgia individuals, organizations, and advocates comment. Stay tuned for your opportunity to weigh in again!

Georgia is one of 12 states that has not yet taken up Medicaid expansion, denying hundreds of thousands of working adults access to quality, affordable health care. If the state expanded Medicaid coverage, approximately 452,600 uninsured adults, or 39 percent of the state’s uninsured adult population, could gain health insurance.

Thanks to a new report from our partners at Georgetown University Center for Children and Families, we know that 44 percent of those working without insurance are employed in the hospitality, retail, and administrative, support, and waste management industries. These are cashiers, cooks, maids and housekeeping staff, waiters/waitresses, and freight and stock laborers who earn too much to qualify for current Medicaid coverage and too little to buy private insurance. 

Many of them are essential workers that we have relied upon in some way during the pandemic. Now it’s our turn to help them get reliable, affordable health insurance so they can continue to do their jobs and care for their families. It’s time for Georgia to accept generous federal funding to expand Medicaid to our state’s uninsured workers.

Where Do Georgia’s Uninsured Workers Live?

The map below shows that the uninsured rate for all non-elderly adult workers varies considerably across the state of Georgia, ranging from 6.8 percent in Harris County to 35.1 percent in Atkinson County. Hover over the map to check out the uninsured rate for working adults in your county.

Our state leaders have a new opportunity to support the health of Georgians across the state! Under the recently passed American Rescue Plan, Georgia is eligible to receive a sizable financial payment for finally expanding Medicaid. Medicaid expansion would bring peace of mind to more than 500,000 adults with low incomes who are uninsured or struggling to afford health coverage. This is a deal too good to pass up! 

Through the American Rescue Plan, Georgia is eligible to receive a $1.3 Billion incentive for expanding Medicaid coverage to low-income adults. These savings could cover the costs of the Medicaid expansion program ($640 million over two years). The remainder ($710 million) could put towards other state priorities, like increased funding for schools or expanding broadband to marginalized communities.

Over half a million Georgians do not have meaningful access to health care because Georgia leaders have refused to expand Medicaid. With one move, our state could provide coverage to Georgia’s low-income families, speed up our state’s economic recovery after COVID-19, stabilize rural hospitals, reduce racial health disparities, and address top state priorities. 

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In July 2020, Governor Brian Kemp asked the federal government to approve a plan that would make several changes to private insurance in Georgia. The Governor’s plan is made up of two parts: 1) Reinsurance—which would help to lower premiums for some Georgians; and 2) the Georgia Access model—which would force consumers to enroll in coverage through for-profit insurance companies and web brokers instead of the unbiased and centralized enrollment platform that consumers know and trust (healthcare.gov). Federal health officials are asking Georgians like you to weigh in on the Governor’s plan. The deadline to comment is September 16, 2020. Don’t miss your chance to say how this plan will affect you, your loved ones, and Georgians across the state. After you read this short blog, tell health officials what you think.

What’s in the plan

Reinsurance

Reinsurance is a tool that some other states have used to lower premiums for consumers and attract more insurers to their marketplaces. Georgia’s proposed reinsurance program is designed so that it would lower premiums more in regions that have higher insurance premiums. Southwest Georgia consistently has some of the highest premiums in the U.S. Georgia’s plan predicts that premiums may drop by 10% across the state, with rural areas seeing bigger drops than urban areas.

Georgia Access Model

In the second part of his plan, Gov. Kemp proposes to dismantle the Affordable Care Act’s (ACA) health insurance marketplace (healthcare.gov). Georgians would no longer be able to enroll in health coverage through healthcare.gov. Instead individuals would be forced to enroll through a health insurer, web-broker, or a traditional broker.

Healthcare.gov is the most widely used and only unbiased place that consumers can shop for comprehensive health coverage. Consumers know all available plans will cover their health needs and they are offered financial help if they qualify and notified of their eligibility for Medicaid or other public coverage programs.

Under the Governor’s plan, Georgia consumers would be the only people in the U.S. forced to go without healthcare.gov, and instead rely on private entities for shopping and enrollment. For-profit insurance companies, online brokers, and even some insurance agents will display comprehensive, ACA-compliant plans alongside short-term plans or plans that do not cover all health services (like mental health and substance use services).

Impacts on Georgians with mental health & substance use conditions (and those in recovery)

Reinsurance: Could help make treatment & recovery services more affordable

The expected drop in premiums from the proposed reinsurance program will help to lower premiums for comprehensive health coverage (which cover mental health (MH) & substance use (SU) services), especially for rural consumers and consumers with incomes too high to qualify for the ACA’s financial help (>400% FPL). For consumers who need their coverage to access treatment services or to support their recovery, lower premiums will make it easier to afford their premiums and to cover their deductibles and other costs.

Georgia Access: Leaves consumers without access to treatment or recovery services

Under this plan, Georgia consumers will lose access to the most widely used enrollment pathway and its attached consumer assistance but will gain no additional enrollment options. Georgians are already permitted to enroll through insurers, web brokers, and agents.

Under an existing enrollment program run by the federal government, insurers and web-brokers have developed a track record of steering consumers toward substandard plans that expose them to catastrophic costs if they get sick; failing to alert or assist consumers when they are eligible for Medicaid; and making it difficult to compare plans. Because these companies are allowed to show substandard plans alongside comprehensive plans, the Georgia Access model will encourage Georgia consumers to enroll in substandard plans. Substandard plans are dangerous for Georgians with mental health and substance use needs because most do not cover mental health, and many do not offer substance use or prescription drug benefits. On top of that, substandard plans are allowed to exclude coverage for pre-existing conditions and charge more for people with pre-existing conditions like a history of mental illness or substance use.

The Georgia Access model puts Georgians at risk of getting lost in a confusing new enrollment process and becoming uninsured altogether. Georgians with little or no experience buying or using health insurance (e.g. young people), those with limited English proficiency, Georgians with low health literacy skills, and people with intellectual or cognitive disabilities would be at greatest risk of experiencing adverse consequences from the outlined plan.

Governor Kemp’s plan to change private health insurance in Georgia turns back the clock for Georgians with mental health and substance use conditions. Under this plan, Georgians would be at risk of enrolling in plans that do not cover their health needs and leave them to manage their recoveries with no help. As mental health and substance use issues rise as consequences of COVID-19, this plan moves Georgia in the wrong direction.

For what is likely the last time, health officials are asking for comments from Georgians about the Governor’s plan. The deadline to comment is September 16, 2020. Don’t miss your chance to say how this plan will affect you, your loved ones, and Georgians across the state! Tell health officials what you think today!

In December 2019, Governor Brian Kemp asked the federal government to approve a plan that would make seismic changes to private health insurance in Georgia. In July 2020, Gov. Kemp revised his plan and released it to the public for comment. The revised plan is made up of two parts: 1) Reinsurance—which would help to lower premiums; and 2) the Georgia Access model—which would force consumers to enroll in coverage through for-profit insurance companies and web brokers instead of the unbiased and centralized enrollment platform that consumers know and trust (healthcare.gov).

Federal law allows states to make changes to the Affordable Care Act (ACA) so long as a comparable number of consumers have coverage that is at least as comprehensive and affordable as they would have under the ACA, and the changes do not increase the federal deficit. Unfortunately, the second part of Gov. Kemp’s plan does not meet this standard and poses real risks to families and individuals in Georgia.

Part I: Reinsurance

Reinsurance is a tool that some other states have used to lower premiums for consumers and attract more insurers to their marketplaces. Reinsurance is a system that pays insurance companies for a portion of the costs of consumers who have unusually expensive health needs. When these outlier costs are shared between the state and insurers, insurers are able to lower premiums for everyone.

Georgia’s reinsurance program is designed so that it would lower premiums more in areas of Georgia that have higher insurance premiums. Southwest Georgia has consistently had some of the highest premiums in the U.S. Georgia’s plan predicts that premiums may drop by 10% across the state, with rural areas seeing bigger drops than urban areas.

If approved by the federal government, Georgia’s reinsurance program would go into effect for 2022 insurance plans.

Part II: Georgia Access model—Georgia consumers at a disadvantage

The second part of Gov. Kemp’s plan would make it more difficult for Georgia individuals and families to shop for comprehensive coverage, understand their options, and take advantage of financial help to lower the costs of their plans. It would put insurance companies in the driver’s seat, leaving consumers in the back seat with little control.

Gov. Kemp proposes to dismantle healthcare.gov and instead force Georgians to use profit-driven insurance company websites, e-brokers, or agents to shop for coverage

More than 500,000 Georgians bought affordable, comprehensive coverage through the ACA marketplace (also called healthcare.gov) in 2021. Nine out of ten Georgians who purchased coverage on healthcare.gov received financial help to lower their premiums and other out-of-pocket costs.

The ACA marketplace is the most widely used and only unbiased place that consumers can shop for comprehensive health coverage. Consumers know all available plans will cover their health needs, they are offered financial help if they qualify, and they are notified of their eligibility for Medicaid or other public coverage programs.

Under the Governor’s plan, Georgia consumers would be the only people in the U.S. forced to go without this resource and instead rely on private entities for shopping and enrollment. For-profit insurance companies, online brokers, and even some insurance agents will display comprehensive, ACA-compliant plans alongside short-term plans or plans that do not cover all services.

Under this system, insurance companies and brokers, who are regularly incentivized to enroll consumers in plans that offer the highest commissions, will push consumers to plans that do not fit their health needs or financial situation. They are not obligated or incentivized to help qualified Georgians enroll in Medicaid or PeachCare, or provide other safety net referrals.

This part of the Governor’s plan does not add any new ways for people to shop for health coverage (consumers can already shop with brokers or insurance companies). Instead, it only serves to shut off the most trusted and widely used path for Georgians purchasing their own coverage.

Likely result: Georgia consumers will struggle to navigate a decentralized enrollment system with numerous websites, translate the sales lingo of insurers, and disentangle conflicting information. For many, it may be harder to find a plan that they feel good about. Others will get lost in the process altogether and unintentionally become uninsured.

Governor Kemp’s plan to change private health insurance in Georgia turns back the clock to a time when consumers were at the mercy of health insurance companies. Under this plan, consumers would have a harder time shopping for comprehensive coverage and run a real risk of enrolling in plans that do not cover the essential health benefits or leave them on the hook for tens of thousands of dollars. It is likely that some Georgians would end up uninsured because of the confusing, decentralized system, increasing Georgia’s 3rd in the nation uninsured rate.