Georgia seeks partial Medicaid expansion that includes work requirements

Sign that reads "Welcome to Georgia"
Georgia's Republican governor announced his intention to apply for a partial Medicaid expansion that extends coverage to people who satisfy work requirements. (Getty/suesmith2)

Georgia released a plan Monday to partially expand Medicaid but only to people who satisfy work requirements, shrugging off the prospect of legal challenges that have stymied other states.

The proposal for a federal waiver would expand Medicaid to adults who earn less than 100% of the federal poverty level (FPL), which is far below the 138% of FPL that states can cover under the Affordable Care Act (ACA). However, participants who get coverage would have to complete 80 hours a month of working, training, volunteering or educational opportunities.

“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,” said Republican Gov. Brian Kemp in a statement Monday.

Webinar This Week

Optimizing Healthcare Operational Excellence to Drive Care Transformation

Join us in this webinar to learn how organizations have leveraged modern technology to enable transformative innovation and continuous improvement across their operations resulting in overall cost savings, process optimization, and clinical improvements.

Georgia also applied for a reinsurance waiver for the state’s ACA marketplace to help cover high-cost claims for insurers.

Georgia appears to have learned from the mistakes of Utah, which also applied for a partial expansion of Medicaid. The Centers for Medicare & Medicaid Services shot down Utah’s request because the state wanted the full federal match for only a partial expansion population. But Georgia’s waiver will seek a 67% federal match instead of the 90% rate reserved for the full expansion.

RELATED: Another voter-backed Medicaid expansion hits a snag

The waiver would also require residents to pay a monthly premium and would reward healthy behavior with an expense account for prescription drugs or eyeglasses, the state said.

The state said unlike full expansion, which would cost the state $1.5 billion over the first five years, the waiver “enhances eligibility for thousands of Georgians by honoring hard work, protecting families and championing individual responsibility.” But critics charge that the waiver won’t expand coverage.

“It’s full of conservative buzz words but in practice would waste taxpayer $, hardly cover anyone, and walks the state right into costly litigation,” tweeted Joan Alker, executive director of Georgetown University’s Center for Children and Families.

Other states have run afoul of legal trouble when trying to implement their own work requirements.

A federal judge has struck down work requirement programs in New Hampshire, Arkansas and Kentucky. A federal appellate court heard an appeal from the Trump administration to the earlier ruling last month and a decision is expected in the near future. Arkansas did implement its work requirement program and 17,000 people lost coverage as a result. 

RELATED: Tennessee releases proposal to convert federal Medicaid dollars into block grant

Another five states—Indiana, Michigan, Ohio, Utah and Wisconsin—got approval for work requirements but have not implemented them, according to data from the Kaiser Family Foundation as of Oct. 9. Indiana was set to implement its program at the beginning of 2020, but the state held off because of a lawsuit challenging the legality of the requirements. There are also pending applications from nine other states.

Kemp said Georgia is expected to apply for the work requirement in December.

Regarding the reinsurance waiver, Georgia is the latest state to seek federal approval to lower costs on the ACA marketplaces. A recent analysis from consulting firm Avalere Health found that a reinsurance program lowered premiums by nearly 17% on average in its first year of operation.

Suggested Articles

Workers’ contributions to their health plan premiums and deductibles increased at a faster rate than wages over the past decade.

The Trump administration released its regulatory agenda that includes estimates on when major rules on drug prices and interoperability will be out

David Feinberg, M.D., head of Google Health, posted a blog post and video Tuesday to directly address growing concerns about the Ascension data deal.