The stage is set for Georgia to release work requirements for Medicaid

Georgia is set to become the only state with a work requirement for Medicaid coverage.

Republican Gov. Brian Kemp’s reelection — and the Biden administration’s abrupt decision not to appeal a federal court ruling — freed the state to introduce its plan that would allow a limited increase in the pool of low-income residents eligible for Medicaid.

Questions remain about putting forward the Kemp Plan. But it would set Georgia up as a test case for an action clause that several states have proposed and struck down in federal courts and the Biden administration.

Meanwhile, advocacy groups are concerned about barriers to obtaining and maintaining coverage. They also point out that Kemp’s plan will be more expensive per enrollee and will cover a fraction of the people who would get Medicaid under a full expansion. The new eligibility program in Georgia will require a minimum of 80 hours of work or volunteer work per month.

“The best case scenario is that some uninsured Georgians will have coverage for some time,” he said. Laura Colbert, executive director of the consumer advocacy group Georgians for a Healthy Future. “It will be a huge headache for the state and for the people who enroll or try to register.”

Trump administration Medicaid approved work requirements for Georgia and 12 other states. Georgia gained approval under a “waiver,” or federal authorization that allows states to run programs that differ from the standard rules on Medicaid, the state insurance that covers the poor and disabled.

But the Biden White House rejected the Georgia plan.

In August, though, A federal judge ruled in Georgia The Biden administration overstepped its authority, clearing the way for Kemp’s plan to move forward. The federal government allowed the 60-day deadline to appeal to be overturned without any action being taken.

The rationale behind the White House’s decision not to appeal the court’s decision remains murky. “As a matter of policy, CMS does not comment on litigation matters,” said Bruce Alexander, a spokesperson for the Centers for Medicare and Medicaid Services.

He said CMS’ reluctance to appeal may be related to where the case goes next Leonardo Coelho, Research Professor at the Center for Children and Families at Georgetown University’s McCourt School of Public Policy. If appealed, the case would go to a conservative federal court that might be upholding the lower court’s decision — and establishing it as a stronger precedent.

“The decision not to appeal may have been based on a fear that the outcome would be confirmed on appeal, since most of the appeals judges in the Eleventh Circuit are Republican appointees,” he said.

Biden administration officials said they may wait for the plan to be implemented before stepping in Kathryn Mackie, a senior attorney with the National Health Law Program, a nonprofit advocacy program. She said federal health officials “can allow the state to move forward and monitor it, and take action in the future.”

Kemp’s office did not respond to KHN’s requests for comment on the status of the plan, but the governor celebrated the federal court ruling in August. in a series of tweets.

“Despite the left’s efforts to restore good politics to partisan politics, this week the judiciary … ruled the Biden administration wrongly for overturning our innovative healthcare concession that would serve Georgians better than a ‘one-size-fits-all’ Medicaid expansion,” he said. .

The Georgia Department of Community Health, which oversees the state’s Medicaid program, declined an interview to answer questions about the business requirements plan.

But the agency recently posted on its website two pages related to the “Georgia Pathways” programme: one with Information on how to registerAnd the the other with details of plan requirements. Both pages were taken down after KHN asked the agency about them.

“Pathways are not yet operational, so links have been disabled to avoid confusion,” said Fiona Roberts, a spokeswoman for the agency.

Medicaid work requirements have a short history of national implementation.

The only state running a full work requirements program was Arkansas, which launched the rule in 2018. This has resulted in about 18,000 people losing Medicaid coverage. A federal court suspended that requirement the next year.

Kemp’s victory over Democrat Stacey Abrams in this month’s midterm elections also thwarted — at least for the time being — Georgia Democrats’ longstanding push to expand full Medicaid, It is expected to cover an estimated 450000, compared to about 50,000 under the Kemp Plan. On November 8th South Dakota voters approved a ballot to full expansionwhich will cover more than 40,000 additional people in that state.

Colbert said the cost of Georgia’s work requirements program is expected to be at least three times higher than it would be under typical Medicaid expansion.

The federal government would have paid at least 90% of the costs of insuring hundreds of thousands of Georgians under a full expansion. That compares with the expected 67% compliance rate of feds under Kemp’s slimmer plan. And that difference doesn’t explain the Biden administration’s drive for expansion that would net Georgia $710 million, At the discretion of KFF.

Consumer advocates say the administrative hurdles to Kemp’s plan of action would be significant. Full-time caregivers, people with mental health conditions or substance use disorders, and people who are unable to work but do not yet qualify for disability coverage, Colbert said, will have difficulty qualifying.

Other challenges can include a lack of transportation that makes it difficult for registrants to get to work and, for prospective registrants, limited access to computers to register.

Besides volunteering, other eligible activities for coverage in the Kemp Plan include education and job training.

Many people experiencing homelessness in Georgia likely won’t meet work or volunteer limits, said Catherine Lawler, executive director of St. Joseph’s Health System, an Atlanta-based nonprofit. Sixty percent of patients in Mercy Care Community Health Centers She said homeless. She said coverage through the expansion of Medicaid would allow patients to pay for health care and treat chronic conditions and take stress off medical bills.

People who need medical attention are often too ill to go to work, Lawler said, adding that a single mother with three young children could be considered ineligible. She said expanding full Medicaid, by increasing payments to providers, will eventually allow Mercy Care to serve more people in need.

Colbert said CMS’s decision not to appeal “was a little surprising,” but added that another unfavorable court ruling could pose a risk to Medicaid programs in other states, by clearing the way for other business requirements.

And CMS’s inaction could inspire similar bids for labor requirements in other GOP-led states, McKee said.

Meanwhile, Georgia’s plan likely won’t start until the end of the COVID-19 public health emergency, which has provided continued coverage for many Medicaid enrollees during the pandemic, It looks set to continue early next year.

Kaiser Health News

This article has been reprinted from Courtesy of the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization not affiliated with Kaiser Permanente.

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