The administration this week approved Georgia’s waiver request to provide Medicaid coverage to certain low-income residents if they work or participate in other qualifying activities for at least 80 hours a month. It’s the latest state to receive permission to require work as a condition of coverage, though implementation elsewhere has been halted by federal courts or state officials.
The Peach State, which has the nation’s third highest uninsured rate at 13.4%, is the first to seek this enhanced power to reshape its individual market.
Georgia and federal officials say that these efforts will make coverage more available and affordable to residents, but consumer advocates say they are the latest attempts to undercut the law.
“It’s a road map of what they would allow were the ACA to be struck down and were they to win election again,” said Judy Solomon, senior fellow at the Center on Budget and Policy Priorities.
What Georgia wants to do
Georgia is not looking to expand Medicaid under the Affordable Care Act. The waiver only applies to those earning up to the poverty level, or $12,760 for an individual. Many will also have to pay monthly premiums.
The federal approval also allows the state to pick up part of the tab for employer coverage if eligible residents have access.
Implementation will begin July 1. Nearly 65,000 Georgians will gain coverage, according to state estimates.
Nearly 650,000 residents could enroll if the state fully expanded Medicaid to those earning up to 138% of the poverty level, according to an Urban Institute estimate, which does not take into account changes wrought by the coronavirus pandemic.
The administration did not approve the state’s request to receive the more generous federal match that comes with full Medicaid expansion.
Georgia is also seeking to make two changes to its individual market. It is looking to implement a reinsurance program, which typically reduces premiums by protecting insurers from high-cost patients. More than a dozen states have received federal approval to do this.
But the Peach State also wants to shift the platform used for enrollment in the Affordable Care Act individual market from the federal exchange, healthcare.gov, to a private sector one called the Georgia Access Model in 2023.
State officials argue that the move will give residents access to a broader array of options from web brokers, health insurance companies and traditional agents. Advocates, however, fear that it could shift healthier people to less comprehensive, non-Obamacare plans and leave those with pre-existing conditions facing higher premiums for Affordable Care Act policies.