Georgia Lawmakers Talk ‘Medicaid Waivers,’ But What Are They?

David Goldman / Associated Press


Since Congress has failed to repeal and replace the Affordable Care Act, Georgia Republican lawmakers are exploring ways to access more federal money under the current law, including Medicaid “waivers.”

State Sen. Renee Unterman, R-Buford, chair of the Senate Health and Human Services Committee, said the state is in a crisis, citing rural hospital closures in recent years and high healthcare costs.

“It’s a crisis and if we take one tool off, and say — ‘Well, we’re not going to look at that, we don’t like that,’ — I think that’s not a good thing. I think that everything should be on the table,” Unterman said.

Unterman said she’s looking into Medicaid waivers to help maternal mortality rates, and to help adults with mental illness.

Medicaid waivers allow states to “waive” certain requirements under the law and allow them flexibility with Medicaid, the government insurance program for the poor, elderly and people with disabilities.

“They’ve been used over many years to allow states an avenue to test new approaches in Medicaid that, of course, differ from the program rules that are part of federal law,” said Robin Rudowitz, associate director of the Kaiser Family Foundation’s Program on Medicaid and the Uninsured.

Georgia already uses a Section 1115 waiver to improve low birth weight rates in babies. But in some other states, leaders have used the waiver to expand Medicaid coverage for residents under the Affordable Care Act.

Before the ACA passed, only certain people could qualify for Medicaid.

“You needed to fit in a certain category. So you needed to be a pregnant woman, someone with a disability, a child — and you needed to meet income requirements. So you had to be poor or even much lower than poverty and fit into one of these categories,” Rudowitz said.

Under the ACA, also known as Obamacare, Medicaid eligibility was broadened to include non-disabled adults without dependent children. The federal government would fund up to 90 percent of the costs for expansion.

Thirty-two states have chosen to expand Medicaid, while Georgia and 18 other states haves refused to expand coverage. Georgia Governor Nathan Deal had said it would cost the state too much money in the long-run.

Meanwhile, seven states, including Indiana and Arkansas, have chosen to expand Medicaid coverage through a waiver. Some states have used the waiver to buy private health insurance for those covered under the expansion – others have implemented incentives for healthy behavior.

Unterman said she’s expecting to see the issue of waivers come up in next year’s legislative session. Two committees in the legislature are currently looking at rural health and healthcare.

“We need to move forward, and we need to be proactive and we need to be ready for the session to start in 2018,” she said.