On September 5th, Georgia’s Comprehensive Health Coverage Commission (CHCC) held its second meeting. The CHCC, created by state leaders this past spring, is tasked with exploring ways to improve health care access for low-income and uninsured Georgians. 

If you missed the first meeting, you can catch up by reading our July recap blog.

You can watch a recording of the September 5th meeting here. 

Key focus of the meeting: Georgia Pathways to Coverage and enrollment struggles

A presentation from Grant Thomas, Deputy Commissioner of the Georgia Department of Community Health took up the bulk of the September meeting and sparked much of the Commission’s conversation. The presentation covered the state’s Pathways to Coverage program, its struggles to meet enrollment goals and the needs of uninsured Georgians, the new Georgia Access marketplace, and data about the size and scope of Georgia’s uninsured population. The agenda was built on the Commission’s July meeting, which introduced Georgia’s health coverage landscape, including Medicaid and Georgia Access to Commission members. 

What is Georgia Pathways?

Georgia Pathways to Coverage is a relatively new Medicaid program that launched in July 2023. The program offers Medicaid coverage to adults aged 19-64 who have incomes up to 100% of the federal poverty level (FPL) if they can prove that they meet certain work, education, or volunteer requirements. Gov. Kemp’s administration projected that Pathways could potentially cover 30,000 Georgians in the first program year and up to 100,000 at full implementation.

As of July 31, 2024—over a year after its launch—only around 4,300 people are enrolled in the program. This low enrollment, compared to the state’s initial expectations, was a central concern for several Commission members. The Commission discussed the reasons behind these low numbers.

DCH’s Thomas outlined some potential strategies to boost Pathways enrollment, such as a planned outreach campaign (funded by $10 million in state taxpayer dollars) and simplifying the enrollment process. There was also discussion about leveraging data from other programs, like SNAP* and TANF*, to identify eligible participants.

• Supplemental Nutrition Assistance Program or SNAP (aka food stamps)
• Temporary Assistance for Needy Families program (TANF)

Thomas didn’t define what success for the Pathways program looks like currently or what its enrollment goals are following the outreach and marketing campaign. This lack of specificity led some Commission members to question the state’s long-term strategy for Pathways.

Several Commission members, including Dr. John Odum, cautioned that digital outreach alone may not be enough to reach the target populations, especially in rural areas where internet access is limited. The Commission also emphasized the need to improve provider participation across the state’s health care programs, as many enrollees struggle to find providers willing to accept Medicaid or Pathways coverage.

How is Pathways different than Georgia’s Medicaid Program? 

Georgia’s Medicaid eligibility requirements are some of the most restrictive in the nation, limiting health coverage for many low-income adults. Only individuals with low incomes who meet very specific criteria—such as pregnant women, children, seniors, people with disabilities, and some very low-income parents—are eligible. This leaves hundreds of thousands of Georgians without the essential coverage and care they need. 

Georgia’s restrictions in Pathways continue to leave hundreds of thousands in a coverage gap. Georgia Medicaid’s stringent eligibility criteria mean many low-income individuals who do not fall into specific categories cannot get covered. Meanwhile, Pathways’ paperwork requirements to prove work and other activities are major barriers to enrollment, even for those who meet the strict requirements. This further limits coverage options for many low-income Georgians.

Why low Pathways enrollment matters: Coverage Gap and costs

The Pathways program is seen by Gov. Kemp’s administration as an alternative solution to closing Georgia’s health insurance coverage gap, which affects about 240,000 residents according to data presented by DCH’s Thomas. 

Even if Pathways hits its full enrollment goal of 100,000 individuals by late 2025—a figure that is 22 times higher than current enrollment—the program would still cover less than half of the Georgians in need and would cost the state significantly more per person than fully closing Georgia’s coverage gap. 

Georgia’s waiver that established the Pathways program is currently set to expire in September 2025. The Kemp administration has stated that they plan to ask the federal government for permission to renew the program, despite its limited effectiveness and failure (to date) to meet enrollment goals.

Georgia Access: Celebrated success, underlying issues

Thomas’s presentation also spotlighted Georgia Access, the state’s soon-to-be health insurance marketplace. The Kemp administration has touted that the new marketplace already has more than 1.3 million enrollees, including 710,000 Georgians with lower incomes (100-150% FPL, for example, an individual making $15,060 to $22,590).  

However, the state’s claim to this win is incomplete and a bit premature. Georgia Access is set to officially launch on November 1st, 2024. Because Georgia Access isn’t fully live yet, it cannot be the cause of the great enrollment growth among Georgia residents. 

The primary driver for increased enrollment in private insurance over the past several years has been lower premiums. Two policies are helping contribute to lower premiums. 

1. Gov. Kemp’s administration began using a policy tool (called “reinsurance”) that helps to lower premiums, especially for rural Georgians. 
2. In 2021, Congress and the US President passed the American Rescue Plan (ARP) which lowered premiums by providing Georgians (and consumers across the country) with more financial assistance when they purchase health insurance. Since this extra help went into effect, health insurance enrollment through the Affordable Care Act has risen substantially nationwide, and it has doubled in Georgia. \

Enrollment increases among Georgians who are purchasing subsidized health insurance is incredibly exciting because it means more Georgians can use their insurance to access health care when they are sick, purchase affordable medicines, and stay healthy before developing a serious health issue. 

However, Georgia’s progress is at risk. The federal subsidies that lower Georgians’ premiums are set to expire in 2025 unless Congress acts to renew them. Without these subsidies, Georgians would see their premiums rise by 85% on average, and the number of Georgians enrolled in coverage through Georgia Access is likely to drop by half. All 1.3 million Georgians who purchase their coverage through healthcare.gov (and GeorgiaAccess.gov starting this fall) would be impacted by these premium increases and would need to make decisions about whether they can afford to keep their coverage.

The state’s enrollment goal vs. reality

The Commission also heard DCH’s Thomas review 2022 census data about the number of uninsured Georgians. While this data is important for understanding which Georgians are uninsured and/or low-income, the presentation did not account for the Georgians who may have lost health coverage during the Medicaid unwinding. The 2022 level of uninsured Georgia children and adults presented to the Commission likely represents the lowest (and best) number our state has achieved in recent years. When 2024 data is analyzed and released, our state’s uninsured rate will almost certainly be worse.

Georgia has one of the highest uninsured rates in the country and a recent policy brief from the Georgia Health Initiative estimates that 434,000 Georgians could gain health coverage if the state fully closes the health insurance coverage gap.

While Georgia Access and Pathways may help at the margins, these programs do not and cannot fully close our state’s coverage gap.

Stay engaged with Cover Georgia—your voice matters!

The Commission needs to hear from people directly affected by these issues, especially as it prepares to report to state leaders.

Cover Georgia is creating a petition for you to share ideas on closing the coverage gap. Sign up for Cover Georgia emails to stay informed and share your thoughts. We’ll keep tracking the Commission’s progress and provide opportunities for you to advocate for the health solutions that all Georgians need.

Stay tuned for more updates!

This Veterans Day, let’s talk about our military heroes and their health. It’s the least we can do for those who sacrificed to serve our country and protect our freedom. But not all Veterans can get the affordable, quality health coverage that they need and deserve – and many are being left behind. As of 2020, across the country, there are more than 1 million Veterans who can’t access the critical physical and mental health care they need. In Georgia, 14,000 veterans cannot access care because our state lawmakers are refusing to close the coverage gap. 

As we come together to honor our Veterans and the sacrifices they made to keep us safe, we must urge our elected leaders to bridge the coverage gap by expanding Medicaid. One in every five uninsured Georgia Veterans (and their families) would be able to get the essential health coverage they need to stay healthy and thrive.

Contrary to the wide-spread misconception that all veterans receive health services at the Veteran’s Administration (VA), veterans can be uninsured for several reasons. Those who serve for less than two years, or have an “other than honorable” discharge, may not be eligible for VA benefits. Moreover, eligibility status is prioritized according to a history of service-related injuries and income, among other factors; those in lower priority groups may be denied services. Some veterans may also be unaware of their current eligibility for VA benefits, either because they have never applied, or because they have been rejected in the past.

Medicaid expansion has made a significant difference in communities across the country by allowing residents to secure affordable, high-quality health coverage for themselves and their loved ones. 

Veterans and their families deserve access to quality care. It has been reported that less than half of returning Veterans receive the mental health support and treatment they need. With Medicaid, vital mental health services like therapy, inpatient treatment, and prescription medication are all covered. Expanding Medicaid and closing the coverage gap would allow more Veterans and their families to access essential and potentially life-saving mental health services.

Georgia Veterans protected our freedom and served our country. This Veterans Day, let’s honor them by fighting for Medicaid expansion. It’s past time for state lawmakers to act so all Veterans and their families have access to the healthcare they need and deserve. 

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.

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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!

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!

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 December 2019, Georgia’s Governor asked federal officials to approve changes to the state’s Medicaid program. Medicaid is a public health insurance program that currently covers half of Georgia’s children, some low-income seniors and people with disabilities, low- and moderate-income pregnant women, and very low-income parents. 

The Affordable Care Act (ACA) gave states the option to expand Medicaid to cover adults making slightly more than poverty-level wages (about $16,700 for an individual and $35,900 for a family of four). Unfortunately, Georgia is one of only 14 states who have so far refused to extend health insurance to these low-income Georgians. That leaves 408,000 uninsured Georgians ineligible for Medicaid, and at the same time, their incomes remain too low to qualify for financial help to buy coverage through the ACA’s health insurance marketplace.

Governor Kemp’s plan to change Medicaid, called Georgia Pathways, will do little to close this coverage gap. The state estimates the plan will cover only about 50,000 low-income Georgians because of the unwarranted complications that it puts in place. The Governor’s plan ultimately leaves thousands of low-income Georgians uninsured and ignores the most cost-effective solution available: Medicaid expansion.

Some low-income Georgians would be allowed to enroll in Medicaid

The Governor’s plan would allow Georgians with incomes up to the poverty line (or those with incomes of less than $12,700 for an individual or $26,000 for a family of four) to enroll in Medicaid. 

This change, sometimes called a “partial Medicaid expansion,” falls short of the ACA’s Medicaid expansion which envisioned that states would cover adults making slightly more than poverty-level income. Under the Governor’s plan, 408,000 Georgians could qualify for coverage—if they can meet the stringent requirements described below.  Under a full Medicaid expansion, Georgia could cover 567,000 low-income adults. 

Georgians would be subjected to illegal paperwork requirements to enroll in coverage

Under the Governor’s plan, Georgia adults who may qualify for coverage must prove they are working or performing certain activities for at least 80 hours a month. Work and qualifying activities include full or part-time employment, community service, vocational readiness, certain education activities, or job readiness. Qualifying activities do not include caregiving and participating in substance use recovery programs; Georgians who are homeless or have limited access to the internet would not be excused from the reporting requirements.

If the Governor’s plan is approved, Georgians would be required to complete bureaucratic paperwork to prove they are spending 80 hours a month participating in an eligible activity before they can enroll in Medicaid coverage. They must continue to prove their work or other activities to Georgia’s government for at least three months. After that, they would be subject to random requests for proof of continued work. 

Other states have attempted to implement similarly burdensome “work requirements.” In those states, thousands of qualified people lost their health care coverage because they were unable to successfully report their work due to technology barriers, insufficient notice from the state about the requirements, bureaucratic mistakes, and other issues. As a result, work requirements are currently the subject of a federal lawsuit and have been deemed illegal by three federal courts. 

Low-income Georgians must pay premiums and copays to Georgia’s government

The current proposal requires that Georgians making between 50 – 100% of the federal poverty line (between $6300-$12,700 annually for an individual) would be required to pay monthly premiums of $7-$11 per month. If an enrollee misses two months of premium payments, their coverage would be suspended and after three months of missed payments, the person would lose their coverage. When accessing health care services, enrollees would be required to additionally pay copays of up to $30 per visit. 

Traditionally, Medicaid members have not been required to pay premiums or co-pays because their incomes are so low. While the state caps enrollees’ cost-sharing at 5% of a person’s income, that could add up to as much as $600 for an individual and $1300 for a family of four per year, who are surviving on poverty-level wages. 

The plan eliminates the option for low-income Georgians to get transportation to their health appointments 

Under the Governor’s plan, Georgians who enroll in coverage would not have access to some traditional Medicaid benefits like non-emergency medical transportation. Non-emergency medical transportation (NEMT) is a free service that provides transportation to people who are covered by Medicaid who do not have their own way to get to and from health appointments or the pharmacy. The program is especially important for people with disabilities, seniors, rural residents, and people of color. 

Adequate transportation is important to the health of Georgians because in most cases people need to go to a location outside of their homes to receive medical care. Without access to reliable, safe transportation, Georgians may be forced to skip health appointments, go without medication and ultimately, experience worse health outcomes. 

According to the Georgia and Budget Policy Institute, “Cutting out transportation is not likely to significantly reduce state costs but would deeply impact rural Georgians who may live farther away from health facilities. Non-emergency medical transportation is less than two percent of traditional Medicaid spending in Georgia according to GBPI’s budget calculations. A relatively small investment in Medicaid funding could mean a huge difference to Georgians who don’t have reliable access to safe transportation.”

The plan creates a complicated, expensive bureaucracy  

The state’s proposed plan creates complicated restrictions and burdens for low-income Georgians. In addition to the paperwork requirements and required cost-sharing, the Governor’s plan would establish a member rewards account and a point reward system for enrollees. Consumers’ monthly premiums would be deposited into their rewards account, which could be used to pay future copays for health services. The point reward system would “reward” individuals for healthy behaviors and add money to the account based on those behaviors. 

Indiana initially operated a similar reward system as part of their version of Medicaid expansion. The state saw limited participation and no benefits to beneficiaries’ health because of the complexity of the system, which mirrors Georgia’s in many ways. Ultimately, these kinds of systems are expensive and ineffective at keeping Medicaid enrollees enrolled in coverage, facilitating access to comprehensive benefits, or achieving better health outcomes. 

Governor Kemp’s office has not provided an estimate of the costs to the state to operate the rewards systems, track work requirements or collect premiums. The Atlanta Journal-Constitution reported, “Other states that have tried to implement a work requirement reported costs ranging from $6 million to $272 million, according to the federal Government Accountability Office.” The intricacies of Georgia’s plan would require significant spending by the state that is not currently budgeted for in the Governor’s plan.

Georgia would pay three times more per person than needed

The Governor’s plan only expands coverage to Georgians making up to the poverty line, rather than slightly more than the poverty level (138% of the federal poverty level) as intended by the Affordable Care Act (ACA). Because Georgia is not proposing a full Medicaid expansion, the state will have to pay three times more per person to carry out this plan. When states fully expand Medicaid, the federal government covers at least 90% of the costs of the expansion and the state has to pay only 10% of the costs. If Georgia were to full expand Medicaid coverage the state would be eligible for this “enhanced match”. Instead, Georgia will pay 33% of the costs (and the federal government will pay the remaining 67% ) of the Governor’s plan–three times more than needed. 

Conclusion 

Governor Kemp’s plan to change Medicaid in Georgia does not work for Georgians. It would exclude most low-income, uninsured adults and subject those who can enroll to illegal, complicated, and expensive requirements. At the same time, the plan passes up the most cost-effective option to provide coverage to low-income adults in Georgia. 

Our elected officials have the power to ensure that every Georgian, regardless of income, have access to affordable, comprehensive coverage. Leaders of 34 other states have made the choice to expand Medicaid and their states are reaping the benefits. Georgia can join them, but elected officials need to hear from you. Ask Governor Kemp and your state legislators to expand Medicaid. 

Risky Health Proposal Hurtles through Gold Dome

Updated Mar. 25, 2019. Flawed legislation to expand access to health insurance is hurtling through the state legislature, and hundreds of thousands of uninsured Georgians are being left behind. Senate Bill 106, the Patients First Act, passed the Georgia Senate on Feb. 26 and advanced to the House. The proposal could expand health insurance coverage to more Georgians, though an arbitrary restriction in the bill is setting Georgia up for lengthy delays or outright failure. As currently written, the proposal could cost Georgia twice as much as alternate plans while covering only half as many Georgians with health insurance.

Earlier this year, Georgia leaders announced a plan with a risky restriction to seek federal waivers that could extend health care access across the state. Senate Bill (SB) 106, the Patients First Act, aims to partially expand Medicaid in Georgia. This change could impact individuals earning up to 100 percent of the federal poverty level (FPL): about $12,100 a year for an individual or $25,100 for a family of four. About 240,000 Georgians may eventually qualify for Medicaid coverage under the proposal.

However, restricting Medicaid eligibility to those only under the poverty line could strand hundreds of thousands of Georgians without affordable health insurance options while also forfeiting an enhanced funding deal from the federal government. That means SB 106 could cost Georgia twice as much as traditional Medicaid expansion while covering only half as many Georgians. And although the legislation is quickly advancing through the Gold Dome, the state has yet to release any estimates of how many Georgians will gain coverage or how much the plan will cost taxpayers.

How could the Patients First Act cover half as many Georgians while costing twice as much as Medicaid expansion? As part of the Affordable Care Act, the federal government agrees to pay 90 percent of the costs if states expand health care access to people earning less than 138 percent FPL—about $35,000 for a family of four. States can leverage this 9-to-1 funding match through Medicaid expansion or a state plan, called an 1115 waiver, to accomplish similar goals with more tailored approaches. Without the enhanced 90 percent match, states receive a lower funding commitment instead (about 67 percent for Georgia).

By arbitrarily limiting the state’s ability to negotiate coverage, SB 106 represents a risky gamble while Georgia’s worsening health care crisis hangs in the balance. Other states have previously submitted waivers asking for the enhanced funding match while offering to cover people up to 100 percent FPL, similar to SB 106. None were approved. Every 1115 Medicaid waiver approved under the Affordable Care Act for the enhanced match—including the most conservative examples in Arkansas, Indiana and Kentucky—expanded eligibility up to 138 percent of the poverty line. Georgia should too.

State lawmakers can fix SB 106 by allowing Medicaid eligibility up to 138 percent of the federal poverty level.

Key Points

Bottom Line

Senate Bill (SB) 106 is an unnecessarily risky proposal that threatens to leave hundreds of thousands of Georgians out of expanded health coverage and restricts Georgia from negotiating the best possible health plan.

An arbitrary restriction in SB 106 will lock Georgia to a failed approach that deprives state leaders of the flexibility needed to negotiate a strong health plan.

SB 106 may cost Georgia twice as much money while covering half as many people compared to other plans, including traditional Medicaid expansion.

A simple change to SB 106 would give Georgia a clearer, more certain path to success. State lawmakers can amend the bill to allow Medicaid eligibility up to 138 percent of the federal poverty level.

The Legislation

The Patients First Act, Georgia Senate Bill (SB) 106, would authorize the Department of Community Health to negotiate two waivers with the federal government that could improve health care in Georgia.

Senate Bill 106 would allow the Department of Community Health to request waivers to increase Medicaid coverage up to 100 percent of the federal poverty level (FPL)—about $12,000 for an individual or $25,000 for a family of four. This could potentially expand health coverage to about 240,000 Georgians.

SB 106 Leaves Hundreds of Thousands of Georgians Behind

The proposal falls far short of covering all eligible Georgians with incomes up to 138 percent of the federal poverty level (FPL). Many of the Georgians who are left out will remain uninsured and continue to struggle to get the health care they need.

About 230,000 uninsured Georgians earn between 100 to 138 percent FPL and would not receive expanded coverage through Medicaid. Georgians earning more than 100 percent FPL currently qualify for financial support to buy health insurance, but many still struggle to afford coverage.

Georgia has the 4th highest number of uninsured kids in the nation, many of whom are eligible for Medicaid but remain uninsured. When more parents and caregivers are covered, more kids are more likely to be insured too.

Other plans would put health insurance cards in the pockets of almost half a million Georgians while likely still costing less than the plan authorized by SB 106.

The Critical Difference Between 100 and 138 Percent

As part of the Affordable Care Act, the federal government agrees to pay 90 percent of the costs if states expand health care access to people earning less than 138 percent of the federal poverty level (FPL)—about $35,000 for a family of four.

Without this enhanced 90 percent federal match, states receive a lower funding commitment instead. That lower match is about 67 percent for Georgia.

SB 106 Represents Unnecessarily Risky Gamble

SB 106 represents an unnecessarily risky gamble with Georgia’s health crisis in the balance. Georgia’s leaders are putting forward ideas that have previously failed in other states.

Other states have submitted waivers asking for the enhanced match while only proposing to cover people up to 100 percent FPL, similar to SB 106. None were approved.

Every 1115 Medicaid waiver approved under the Affordable Care Act for the enhanced match—including the most conservative examples in Arkansas, Indiana and Kentucky—expanded eligibility up to 138 percent of the federal poverty level. Some states simply expanded Medicaid while others have developed state-specific plans called 1115 waivers to accomplish similar goals with more tailored approaches.

By restricting Medicaid eligibility to 100 percent of the poverty line, the best plan possible will likely cover half as many Georgians while costing twice as much as alternative.

The arbitrary coverage restriction in SB 106 is setting Georgia up for failure. Preventing Georgia’s 1115 waiver from helping Georgians earning up to 138 percent of the federal poverty level (about $35,000 for a family of four) means that our state is unlikely to get a good deal any time soon.

Unclear Proposal Could Result in Massive Changes with Limited Oversight

SB 106 gives Gov. Brian Kemp’s administration broad authority to make extensive changes to health care in Georgia without input from the legislature or public during the drafting stage.

The Governor’s plan offers no guiding principles, assurances of good governance or safeguards for fiscal responsibility.

No fiscal note or cost estimate has been provided for the proposed waivers being authorized even though this bill has been called “the most significant issue” being discussed this year

The governor’s proposal will likely result in covering fewer Georgians at a greater cost to taxpayers.

Simple Solution

There’s a simple solution for this unnecessarily risky gamble: change one number. State lawmakers can amend SB 106 to authorize an 1115 waiver up to 138 percent of the federal poverty level, instead of the current 100 percent.

Or lawmakers can include a back-up plan authorizes Medicaid eligibility up to 138 percent if the current approach is rejected.

Key Questions About SB 106

How many Georgians will gain access to health insurance through the waivers authorized by SB 106?

Georgia’s uninsured rate in 2017 was 13.4 percent. How much will the proposed waivers reduce our growing uninsured rate?

About 240,000 Georgians make too little to get financial help to buy health insurance and do not currently qualify for Medicaid. This coverage gap represents people earning below the poverty line. Will the waiver offer Medicaid eligibility to everyone in this gap?

When can Georgians expect to see expanded access to health insurance from this proposal?

When will Georgians finally get a health insurance card in their pocket from this plan?

What guarantee does Georgia have that an 1115 waiver which only covers people up to the federal poverty level will receive approval from the federal government for the enhanced 9-to-1 funding match? All similar plans that were previously submitted by other states have been rejected.

Why should state lawmakers arbitrarily limit Georgia’s flexibility to negotiate the best deal possible, especially when that restriction is likely to cause significant delays or outright rejection?

If Georgia’s 1115 waiver is not approved for the enhanced federal funding match, will state leaders choose to cover half as many Georgians as traditional Medicaid expansion for twice the cost?

Will the waivers from this proposal protect Georgians with pre-existing conditions?

Will the waivers maintain essential health benefits for Georgians?

What opportunities will Georgia’s legislative branch have to review and inform the waiver proposals?

How will locking Georgia into a risky waiver approach that’s destined for long delays or failure help address our state’s pressing health care crisis?

Health care emerged as the priority issue for voters this election season. Historic voter turnout and engagement have highlighted the universal desire for affordable, quality health care. Every Georgian wants to be able to see a doctor when they get sick. Every community wants to safeguard their hospital and emergency room. Yet too many of Georgia’s rural hospitals have closed in recent years, and too many Georgians can’t afford health care.

Georgia’s newly elected leaders will have the opportunity in 2019 to embrace a bold solution that would put health insurance cards in the pockets of almost half a million Georgians: Medicaid expansion. While elections come and go, the health care crisis confronting Georgia remains. Seven rural hospitals have closed in Georgia since 2013, and more than half of our remaining rural hospitals are financially struggling. Georgia’s uninsured rate of 14.5 percent is one of the highest in the country, and the uninsured rate in rural Georgia could to climb to 25 percent within the next few years. Substance use disorder and the opioid crisis are devastating communities statewide, demanding a sustained, concerted response.

A strong majority of Georgians support Medicaid expansion. At least seven in ten Georgians think our state should expand Medicaid eligibility, according to polls from the Atlanta Journal-Constitution and 11Alive. Every day Georgia refuses expansion, our state loses $8 million in federal funding for health care.

Although Election Day has passed, the civic responsibility to educate leaders and engage neighbors continues. Send a quick email to your lawmakers about the importance of Medicaid expansion and why you care about this issue. Then share your support for Medicaid expansion with media outlets in your community through a letter to the editor. Visit the tools page for information to guide your thoughts and continued engagement on this important issue.