Now that open enrollment for individuals and family insurance coverage through the Affordable Care Act (ACA) has begun since November 1st, changes are once again coming to Georgia’s health insurance landscape.
The governor of Georgia, Brian P. Kemp, held a news conference on Thursday, October 15, with Center for Medicare and Medicaid Services (CMS) administrator Seema Verma to announce the federal approval of the Georgia healthcare reform package. This federal government waiver provides a limited Medicaid expansion program, called Georgia Pathways and Access.
Using the Section 1115 Medicaid demonstration, waivers provide states with an avenue to test new Medicaid approaches that differ from what is required by federal statutes.
The program will begin on July 1, 2021, for the plan year beginning January 2022. Under the plan, people whose annual income is below $12 000 will be eligible for either Medicaid coverage or financial help from the state with employer-sponsored coverage. In order to qualify, individuals must have at least 80 hours per month of participation in some qualifying activity such as job training, education, or volunteer work.
“Georgia Access,” the state’s 1332 waiver plan, has two phases. The first is a reinsurance plan, through which the state will reimburse insurance providers for a percentage of high-cost claims. These reimbursements are designed to reduce the cost of premiums for Georgia residents and will go into effect in 2022. Kemp stated this 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, according to estimates provided by the governor.
The second phase of “Georgia Access” will redirect insurance consumers from the current federal healthcare.gov to a new Georgia state website, where the residents will be able to directly purchase insurance coverage from private insurance companies and brokers. The website is expected to go online in 2023. However, some plans on that site will not be “qualified health plans” as required by the Affordable Care Act (ACA) to cover things such as pre-existing conditions.
Enthusiastically touting the program, Governor Kemp said the waivers will reform health care in the state, where the uninsured rate is currently 14.8%—one of the country’s highest and well above the national average—making Georgia the state with the nation’s third-highest rate of people without health insurance. The proposal—Georgia Pathways and Access—will help close the coverage gap for hundreds of thousands of Georgians, the governor claimed.
Furthermore, according to Kemp, “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 into law in March 2019, which allowed the Georgia Department of Community Health to submit waivers to the ACA.
As of this past 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.
“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 healthcare access model for more than 1.4 million Georgians, Kemp said.
While Kemp’s administration has said that the plans would provide health insurance for more than 400,000 uninsured people, opponents of the health reform package take exception with this optimistic analysis. For example, Georgia Budget and Policy Institute health policy analyst Laura Harker said it would cover only 50,000 people, which is far less than what the governor is predicting.
So, for Georgians looking for comprehensive expanded Medicaid under the ACA, only time will tell whether it is indeed what it was hyped up to be.
