CMS approves Georgia's partial Medicaid expansion with work requirement - Modern Healthcare

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The federal government approved Georgia's plan to partially expand Medicaid to an additional 65,000 adults on the condition that they work, job-train, volunteer or pursue education for at least 80 hours a month.

CMS on Thursday green-lighted Georgia's five-year 1115 demonstration waiver, titled Georgia Pathways to Coverage, to extend Medicaid coverage to uninsured Georgians who are between ages 19 and 64 with incomes at or below 100% of the federal poverty level, which is about $12,760 for a single-person household.

In addition to working, individuals would have to report their qualifying work activities and hours every month. Most would also be required to pay a monthly premium based on household income. The Medicaid expansion is slated to go live July 1, 2021.

Currently, Georgia, which covers about 1.9 million people in Medicaid and the Children's Health Insurance Program, does not allow non-disabled, childless adults to enroll in the safety-net program.

There are about 400,000 Georgians adults who make below the federal poverty level. Of those, the state projects 30,000 people will enroll during the first year of the demonstration and nearly 65,000 will enroll over five years.

Most of those who enroll would receive Medicaid benefits. Those who are employed will be required to enroll in job-based coverage if it's cost-efficient and will receive premium and cost-sharing assistance through Georgia's health insurance premium program.

Critics have argued that Georgia's plan is too narrow. The Affordable Care Act allows states to expand Medicaid coverage to people up to 138% of the federal poverty level and for states that do, the federal government pays 90% of the total cost of Medicaid expansion. Just 13 states have chosen not to expand Medicaid.

But in Georgia, CMS said it will not authorize enhanced federal funds to pay for the demonstration, and "will continue the existing policy of providing the enhanced federal match rate when the state covers the entire adult expansion group."

Georgia has also pitched a controversial overhaul to its individual health insurance market. Under a proposed Section 1332 waiver, which Georgia modified several times, the state would implement a reinsurance program in 2022 to lower premiums. It would also eliminate the use of the HealthCare.gov federal marketplace but not replace it. Consumers would be required to shop for individual market coverage by going directly to web brokers or insurance companies.

CMS deemed Georgia's waiver application complete in late August. On Thursday, CMS said it completed its review of the waiver request and is working with state and federal partners to finalize the terms and conditions for approval.

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CMS approves Georgia's partial Medicaid expansion with work requirement - Modern Healthcare
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