Georgia officials said they are still working on a July 1 launch of the waiver plan to add more people to the state’s Medicaid program, despite a harsh initial assessment from the Biden administration.

The dispute with the federal government concerns the eligibility conditions proposed by Georgia and approved by the Trump administration. President Joe Biden, who took office in January, and his fellow Democrats have very different views on Medicaid than former President Donald Trump and many Republicans.

Georgia’s waiver states that in order to get Medicaid coverage, a low-income adult must devote 80 hours per month to a job, education program, volunteer organization, or other qualifying activity. He is strongly supported by Governor Brian Kemp, who called him “a helping hand” for Georgians who work hard in our state and who deserve it more than ever. “

A February letter from the federal Centers for Medicare and Medicaid Services (CMS) criticized Georgia’s policies “which make health care coverage conditional on meeting job requirements or other community engagement requirements.”

The Kemp administration hit back at the CMS letter, appealing the new federal position. Georgia’s letter stated that the possible revocation of the waiver by the Biden administration would be “arbitrary and illegal bait and change” and would result in a state challenge in court.

Other states with approved work requirements have received similar federal letters. CMS later sent letters advising Arkansas, Michigan, New Hampshire, and Wisconsin of its final decision to remove work-requirement exemption authorities in those states, according to the Kaiser Family Foundation.

“None of these job requirements have been accepted by the courts,” said Bill Custer, health insurance expert at Georgia State University. “The courts have said this violates Medicaid’s original purpose. “

A CMS spokesperson told GHN on Thursday that the agency is still reviewing the plan for Georgia.

The Georgia Department of Community Health, which manages Medicaid here, said Wednesday it “is still making progress towards implementing Georgia Pathways to Coverage,” the Medicaid exemption plan that is expected to eventually cover 50,000 people.

The launch is in less than a month. Kemp’s health care adviser Ryan Loke told AJC that the governor’s administration has discussed waiver issues with federal health officials.

And CMS sent another letter to Georgia officials on Thursday, raising doubts about a key element of a second Georgia waiver: the elimination of the health insurance portal. health care.gov in favor of a private organization.

Using waiver requests, states seek federal permission to make changes to certain health care programs. But as the situation in Georgia indicates, getting and keeping federal approval can depend on the presidential administration in power.

The waiver drama comes as the federal government offers new incentives for states to pursue a much larger increase in Medicaid enrollment through a standard expansion of the program, as provided for in the Affordable Care Act, which the Most states have already done so. Georgia is one of 12 states that have spoken out against the expansion, with Republican political leaders citing the costs involved.

The expansion of Medicaid is an idea clearly endorsed by the Biden administration. Under a COVID-19 relief law, the federal government has increased incentives for the 12 recalcitrant states to continue a steady expansion of Medicaid.

A standard extension would give Medicaid eligibility to 480,000 to 600,000 people in the state, according to consumer group Georgians for a Healthy Future. It is paid for with 90 percent federal funds, higher than the rest of the Medicaid program, which in Georgia is 67 percent funded by the federal government.

States that expand the program at this point, however, would receive an additional 5 percentage point increase in their regular federal Medicaid matching rate for two years.

So during that time, even taking into account the costs of implementing the expansion, Georgia would earn $ 700 million under the new incentives, according to the Kaiser Family Foundation.

Medicaid currently provides health coverage to low-income and disabled residents, of whom approximately 2 million are in Georgia.

Will the state fight?

If the federal government rejects the waiver requirements, the Kemp administration’s choices include dropping the entire plan or fighting the federal government over the proposal in court, experts say.

Any other choice would result in the total abandonment of work and other requirements, a decision that would likely gain CMS approval. That would mean that the waiver would cover many more adults – possibly up to 300,000 people, far more than the 50,000 envisioned in the original waiver plan. This would have a big impact on the state budget, increasing Georgia’s costs.

And yet another alternative – and also expensive – would be to fund this coverage without any federal funding, running it entirely as a state program.

“If the governor feels the urgency to act and cover Georgians, the fastest and easiest way to do it would be through the expansion of Medicaid,” said Laura Colbert of Georgians for a Healthy Future.

“Any attempt to implement the Pathways waiver without formal approval from CMS could charge Georgia 100% of the cost. This would add up quickly, likely exceeding the costs of expanding Medicaid while covering many, many fewer Georgians. “

The reinsurance plan will be spared

Thursday’s letter from federal officials said Georgia’s proposed insurance waiver contained a provision that would almost certainly gain continued approval.

This is a “reinsurance” program that state officials say will reduce insurance premiums for individual coverage by an average of 10%. Reinsurance aims to stabilize health insurance premiums by capping the costs that insurers incur to cover people with high medical costs.

The reinsurance provision has been passed by both supporters and opponents of the Affordable Care Act.

But the new CMS letter showed concerns over the state’s plan to replace the health care.gov enrollment system with a new online platform that people will use to purchase insurance coverage. Under the plan, individuals would register directly through local insurers, brokers or agents, or through private sector brokerage sites.

The Kemp administration says waiving 1332 access will help promote competition among insurance companies, lower premiums and streamline enrollment for coverage.

But the letter from Chiquita Brooks-LaSure, the administrator of CMS, said the state platform would be funded “by uncertain and unquantified efforts of the private sector, not by the state.”

She added that the regular insurance exchange, with improved grants and an extended enrollment window, is working well nationally and in Georgia. In Georgia, health care.gov welcomed more than 67,000 new registrants in the first 10 weeks of the special registration period, more than three times the number of the previous year.

Laura Harker, senior health policy analyst at the Georgia Budget and Policy Institute, said Friday that “the state’s proposal to remove the most popular option for selecting a health plan—health care.gov– could exacerbate the already high rates of uninsured Georgians in our state and the inadequate health care infrastructure. This CMS letter is a step in the right direction to ensure that no one loses access to care. The state plan is not clear on how much the private sector would invest in targeted outreach to enroll more people or how to ensure enrollees are not referred to short-term or non-ACA-compliant plans. that cover fewer services.

Federal authorities are asking Georgia for an updated actuarial analysis by July 3 for Georgia’s listing model, which is expected to begin in 2023.

Cody Hall, a spokesperson for Kemp, said on Friday that the state was reviewing the new CMS letter.