The federal government wants to hear what Georgians think about a state proposal to subsidize health insurance for more state residents — who work, or are in school or volunteer jobs.
Georgia Gov. Brian Kemp’s office calculates his proposed slight expansion of Medicaid would insure health care costs for about 50,000 low-income Georgians currently without coverage. Alternatively, the state could pay their share of employer-sponsored insurance. Low-income Georgians would become eligible through 80 hours per month spent at work, volunteering or in school. The expectation is that those newly insured people would retain their own insurance after a while and others could join it.
The governor announced the proposals in the form of two federal waiver applications at a press conference in November, kicking off a series of public meetings held around the state and a written comment period conducted by state officials that wrapped up last month. The federal comment period started this month and runs through Feb. 7.
“Georgia Pathways creates a front door for working Georgians to access their employer-sponsored coverage and continue their rise on the economic ladder of success,” Kemp said in a speech to business leaders Wednesday morning.
Still, about 400,000 low-income adult Georgians have no health insurance through Medicaid because they make more than the federal poverty level of about $12,000 per year. Under the Affordable Care Act, Georgia can join the 37 other states that have expanded Medicaid and extend coverage to them.
And the lack of accommodation for the 350,000 Georgians who would remain uninsured is in large part why public comments tended to be negative during the state’s comment period.
Driven in part by both partisan and nonpartisan advocacy groups, many opposition letters have so far argued that the state could actually cover more Georgians at a better price with a full expansion of Medicaid.
Kemp’s team calculates his plan would cost the state $36 million per year. A plan authored by Democratic state lawmakers to expand Medicaid coverage to about 500,000 low-income people would cost roughly $200 million per year, according to a 2019 estimate by state auditors.
Medicaid work requirements similar to the ones Kemp is proposing have also run into legal challenges in other states, including Kentucky and Indiana.
Comments at the federal level become part of a record that judges have consulted in litigation over Medicaid changes in other states.
A federal-state negotiation period over the plan will follow the comment period, said Laura Colbert, executive director of Georgians for a Healthy Future, a consumer health advocacy nonprofit. Colbert said that as other states navigated the waiver process, the federal Centers for Medicare and Medicaid Services have asked for changes based on public comments.
“There is some chance that the waiver itself gets some changes included,” Colbert said. “And then if it were to get approval, that legal record is really important for any litigation.”
The federal Medicaid agency is collecting comments online now.