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CMS grants Medicaid waiver to Georgia; exchange opt-out remains on table

Dive Brief:

  • CMS has approved a waiver granting limited Medicaid expansion in Georgia, and is also considering another waiver that would end the state’s participation in the Healthcare.gov insurance exchange.

  • Although the waivers were praised by Georgia Gov. Brian Kemp and CMS Administrator Seema Verma as a way to expand coverage and lower insurance costs, they received a much cooler reception from advocates of expanding healthcare access in the Peach State.

  • The approved waiver, which would go into effect in mid-2021, comes as the economic fallout from the COVID-19 pandemic prompted the Kaiser Family Foundation to conclude that Medicaid enrollment will grow 8.2% nationwide in fiscal 2021.

Dive Insight:

Red states in recent years have been approving the expansion of Medicaid eligibility under the ACA through voter referendums, as was the case in Utah, Oklahoma, Missouri and Nebraska.

Georgia has taken a different path – a waiver from the Trump administration. And, as a result, it will almost certainly have far fewer of its residents joining the Medicaid rolls.

The 1115 waiver approved by CMS on Thursday is known as “Georgia Pathways.” It will allow Georgians with incomes of up to 100% of the federal poverty level to enroll in Medicaid, a far less generous threshold than the 138% cutoff under the ACA.

Enrollees will also have to pay premiums and be employed at least 80 hours per month to maintain their coverage. 

CMS estimates that about 30,000 Georgians will be able to enroll in Medicaid due to the expanded Medicaid eligibility, while perhaps another 65,000 will enroll with the help of employer-sponsored insurance. The Kaiser Family Foundation estimates that a full Medicaid expansion under the ACA would provide coverage to about 270,000 Georgians.

CMS said it is also close to approving an 1132 waiver that would provide reinsurance to payers that provide individual coverage to Georgians, but also allow the state to exit the Healthcare.gov exchange and allow its individual plan enrollees to obtain subsidized coverage through private brokers.

While Kemp and Verma believe those moves could expand individual enrollments by about 25,000 annually, it would also allow consumers to pick plans without ACA-mandated protections on coverage.

That plan “would eliminate the option for people to easily compare health plans and enroll at HealthCare.gov, as tens of thousands do each year,” Laura Colbert, executive director of the advocacy group Georgians for a Healthy Future, said.

“It would also increase opportunities for insurers to take advantage of consumers,” Colbert said. “The governor is touting lower premiums, but lower premiums are only beneficial if Georgians actually have health insurance.”

It is possible that the waivers will be challenged in court. Previous waivers allowing work mandates and block grants were either withdrawn by states or suspended after lawsuits were filed, and even paused due to COVID-19.

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