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.

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.

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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. 

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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.