Georgia Gets Approval For Medicaid Work-Requirement Plan

Georgia Gov. Brian Kemp, left, and Centers for Medicare and Medicaid Services Administrator Seema Verma sign health care waivers at the state Capitol in Atlanta, Thursday, Oct. 15, 2020.

Updated Friday at 11:27 a.m.

Federal officials have approved part of Gov. Brian Kemp’s plan to reshape the health care landscape in Georgia.

The first part of Kemp’s plan would offer health coverage to people who make up to 100% of the federal poverty level and who work at least 80 hours a month starting July 1 of next year.

“The qualifying activities include employment, or on-the-job training, participation in job readiness activities, vocational education,” Kemp said.

Those who qualify would be enrolled in Medicaid or an employer-sponsored health care plan, with the state paying their out of pocket costs—whichever costs less.

Because Georgia declined to expand Medicaid as laid out under the Affordable Care Act, a large group of people don’t qualify for the state-federal health care program.

For example, a single individual who makes less than $12,000 currently does not have access to coverage. State officials estimate that more than 400,000 Georgians are in that position.

Kemp admitted that his reforms won’t fix every health care problem in the state.

“But this plan is no doubt a big first step on long journey to ensure a safe and healthy future for all Georgians.”

Opponents say Georgia should fully expand Medicaid under the Affordable Care Act to cover more people.  They also say those who may get insurance tied to work requirements often lose it too quickly.

“We’re going to see a lot of people churning in and out of the program, so people may get coverage and then immediately lose that, so that is not good for continuum of care,” said Laura Harker, a health policy analyst with the Georgia Budget and Policy Institute.

The second part of Kemp’s reforms would sever the state’s ties with the federal health care exchange,, by 2023. People looking for Obamacare health plans would be funneled to a state-run portal directing them to private third-party insurance-shopping websites.

Center for Medicare and Medicaid Administrator Seema Verma praised Kemp’s proposal.

“Georgia is going a step forward and moving away from a government-run system and is instead leveraging the private sector in competition to enroll people in coverage, and we applaud this innovative market-driven approach,” she said during a news conference at the state Capitol Thursday.

Georgia would become the first state in the country to break away from

Verma said she expects lawsuits around the proposals, but vowed that President Trump would defend states’ rights to design their own health care programs.

Kemp’s plan would also set up a “re-insurance” program that diverts state money to insurance companies to help cover high-cost claims. Federal officials are in the final review of that proposal.

The idea is that insurers pass those savings on to consumers in the form of lower out-of-pocket costs. His office estimates the program will be running by the start of 2022.

Correction: This reported has been corrected to show that Laura Harker is a health policy analyst with the Georgia Budget and Policy Institute.