Limited Medicaid expansion proposal poised for federal review

A pair of health care waivers will soon be on their way to Washington for federal consideration. Gov. Brian Kemp is shown here in early November unveiling his plan to partially expand Medicaid coverage. Jill Nolin/Georgia Recorder

State officials made only slight changes to a proposal that would add about 50,000 new Georgians to the Medicaid rolls after hearing from hundreds of groups and people who raised concerns.

More than 800 written comments poured in during a public airing of a proposal that would expand access to Medicaid for low-income adults who complete 80 hours of work, job training, college or community service. Part-time students would be able to satisfy that requirement through a combination of work and school, under a clarification announced Friday.

But for the most part, the federal officials who will examine the state’s application will see the plan much as it was originally unveiled back in November.

The state Department of Community Health’s board heard a summary of the concerns logged during the recent public comment period, which were boiled down into five categories, including one broadly flagged as “other.” Supporters called the plan a step in the right direction.

The board listened the litany of concerns during a teleconference meeting held Friday – the state’s targeted date to submit the proposals to the federal government – and then signed off on the proposal. One board member, Mark Trail, asked about the chances of Georgia snagging the requested 90% match when no other state has succeeded in doing so with anything less than full Medicaid expansion.

Blake Fulenwider, the agency’s chief health policy officer, acknowledged that this is expected to be a “significant issue.” State officials expect a smaller federal contribution but hope for better.

“It would actually be kind of a nice surprise, if you will, for the state to receive the 90%,” Fulenwider. “I don’t see that being an issue that would hamper our progress moving forward.”

Many of the groups and people who submitted feedback criticized Gov. Brian Kemp’s proposal because it stopped well short of covering the 500,000 people who would be eligible for Medicaid under full expansion. Kemp has called full expansion a “a risky, one-size-fits-all approach that costs too much and fails to deliver.”

Critics also urged the state to abandon plans to require participants to complete 80 hours of “qualifying activities” – like work or job training – in order to receive coverage that they argue would help make them healthier to work. They also questioned whether the process of proving eligibility would trip people up – and whether the state had the capacity to adequately track it.

Fulenwider countered that the program – dubbed Georgia Pathways – creates a new avenue for coverage for a group of people who are not eligible for Medicaid today and who do not qualify for federal subsidies.

“This waiver is designed to improve access, affordability and quality of health care through strategies that help individuals rise out of poverty and attain independence while also providing them with a new pathway to enrollment in Medicaid,” he said.

Cover Georgia, which is a coalition of groups advocating for full Medicaid expansion, said the small changes made last week still leave too many people in the state without insurance coverage.

“It still leaves too many Georgians uninsured and does not address the primary concerns raised by commenters, including the need for full Medicaid expansion,” Laura Harker, senior health policy analyst at the Georgia Budget and Policy Institute, said in a statement Friday.

“The plan still leaves billions of federal dollars on the table that would cover hundreds of thousands more Georgians, and it still includes burdensome, costly work reporting requirements that will bar too many from access to care,” Harker said.

Georgia is one of 17 states that have not fully expanded Medicaid under the Affordable Care Act, and a bill that passed earlier this year largely along party lines limited any expansion at 100% of the federal poverty line – or about $12,000 a year – rather than allowing for the full 138%.

Laura Colbert, executive director of Georgians for a Healthy Future, said the limited changes made to the proposal is tantamount to the state dismissing the input from those who argued for full expansion and against rules limiting coverage.

“We encourage Georgians to participate in the federal comment period to come so that federal officials are able to take that feedback into account as they consider approval of this proposal,” Colbert said.

Friday’s vote was set for last week’s DCH board meeting but was delayed a week after some last-minute hiccups during the public comment period.

The DCH board only has say over the Medicaid waiver. A second proposed waiver running on a parallel track would make Georgia the first state to bypass healthcare.gov and instead send consumers directly to insurance companies or brokers. The proposal would also create a reinsurance program designed to lower premiums and combine government subsidies with employer contributions.

Jill Nolin
Jill Nolin has spent nearly 15 years reporting on state and local government in four states, focusing on policy and political stories and tracking public spending. She has spent the last five years chasing stories in the halls of Georgia’s Gold Dome, earning recognition for her work showing the impact of rising opioid addiction on the state’s rural communities. She is a graduate of Troy University.