CMS Approves Medicaid Expansion/Work Requirements in Georgia

Last week CMS said it has taken steps to advance a package of state-led reforms that could result in thousands of uninsured Georgians gaining access to coverage. Specifically, CMS announced the approval of Georgia’s new Medicaid section 1115 demonstration called “Pathways to Coverage.”

CMS began implementing work requirements for Medicaid coverage two years ago, a move opposed by those who said it would kick many receiving coverage off of Medicaid’s rolls.

To date, 39 states (including DC) have adopted the Medicaid expansion. Arizona, Arkansas, Indiana, Iowa, Michigan, Montana, New Hampshire, New Mexico, Ohio, and Utah all have approved Section 1115 waivers to operate their Medicaid expansion programs in ways not otherwise allowed under federal law, according to KFF.

AHCCCS recently held a public forum on the topic of Arizona’s Section 1115 Waiver Renewal Request; which is backbone of how the Medicaid program operates. AHCCCS has posted a draft of the Section 1115 Waiver, which allows Arizona to run its unique and successful managed care model and exempts Arizona from certain provisions of the Social Security Act. It also includes expenditure authority for costs not otherwise matched by the federal government. Waiver programs are required to be budget neutral for the federal government − such programs don’t require more federal dollars than without a waiver.

The approval of Georgia’s new Medicaid section 1115 demonstration will require working-age Georgia adults who are currently ineligible for Medicaid to opt into Medicaid coverage by participating in qualifying activities such as work and education, and meet premium and income requirements. Medicaid will be expanded 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. This applies to those between the age of 19 to 64, with income up to and including 100% of the federal poverty level, with implementation beginning July 1, 2021, according to Healthcare Finance.

About 1.9 million people in Georgia are covered by Medicaid and the Children’s Health Insurance Program, but non-disabled, childless adults aren’t able to enroll in the safety-net program. 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, according to Modern Healthcare.

With Medicaid enrollment snowballing and tax revenue falling due to the pandemic, many states are sharply reducing their Medicaid spending to balance their budgets. States could limit benefits and eligibility, modify their Medicaid managed-care contracts or reduce provider payment rates to cut their Medicaid spending. Experts said hospitals can expect lower Medicaid payment rates for the foreseeable future and should plan accordingly, according to Modern Healthcare. The economic turmoil created by the pandemic is still the greatest problem to state Medicaid budgets. States face average budget shortfalls of 10% in 2020 and 20% in 2021.