Georgia's governor announced a plan Monday to extend Medicaid to about 50,000 poor adults with the condition that they work, job train, volunteer or pursue education for at least 80 hours a month.
The plan, dubbed Georgia Pathways, would expand Medicaid or provide access to an employer-sponsored health insurance plan to adults making less than 100% of the federal poverty level, which is about $12,500. Currently, non-disabled adults without children are not eligible for Medicaid in Georgia, which chose not to expand Medicaid under the Affordable Care Act.
Georgians who qualify would also be required to pay a premium for coverage based on a sliding fee scale, which they could use to purchase healthcare necessities, including eyeglasses, prescription drugs and hygiene products, according to the announcement by Republican Gov. Brian Kemp. Enrollees would also be rewarded for healthy behaviors.
About 408,000 Georgia adults make below 100% of the federal poverty level. Of those, an estimated 52,500 Georgians would currently qualify under the plan and cost the state about $64.6 million, according to Kemp's announcement. In contrast, Georgia estimates it would spend $303 million if it were to extend Medicaid to 667,000 residents that make income less than 138% of the federal poverty level.
The state intends to submit a Section 1115 waiver request to the federal government in December 2019 to move forward with its plan, even though federal judges have struck down Medicaid work requirements in other states. During oral arguments in October, a federal appeals court appeared ready to strike down such requirements in Arkansas and Kentucky.
In recent weeks, Arizona and Indiana have voluntarily paused plans to implement Medicaid work requirements, citing the federal court case. But Georgia is charging ahead.
"Right now in our state, there are thousands of people working, training, volunteering, or getting an education who cannot afford employer-sponsored insurance or a plan on the open market," Kemp said in the announcement. "These Georgians need coverage, but they have run out of realistic options. The Georgia Pathways waiver addresses this challenge by providing 408,000 Georgians with access to obtain affordable health insurance."
Georgia's limited Medicaid expansion plan is meant to work in tandem with its proposed Section 1332 waiver, called Georgia Access, which was unveiled last week.
Under that plan, Georgia would lower individual market insurance premiums by establishing a reinsurance program and enabling people to buy coverage directly through web brokers or insurance companies instead of HealthCare.gov.
Georgians would be able to use state subsidies to buy plans that aren't compliant with the ACA, including association health plans, so long as the policies cover pre-existing conditions and are not priced based on health status. The plan would also allow employers to contribute money to health reimbursement arrangements that employees could use to buy coverage on the individual market.
