On December 7th, the Georgia Department of Community Health (DCH) held a public forum about the Georgia Pathways to Coverage program. The forum included an opportunity for Georgians to provide feedback about the program’s implementation. DCH also allowed stakeholders to submit written comments through December 14th. 

GHF verbally commented during the forum, but because of time constraints, followed up with these written comments. 

Here is what you should know. 

Every year on November 1st, the ACA’s health insurance marketplace opens so that Americans who don’t have job-based health insurance or other coverage can shop for and enroll in health insurance. In 2023, 879,084 Georgians enrolled in coverage through the marketplace. This fall Georgians will preview changes to our marketplace shopping and enrollment experience that will go into full effect next year. Here’s what you need to know about those changes.  

Under the ACA, each state has the option to create its own health insurance marketplace, called a state-based marketplace (SBM), or use the federal marketplace at healthcare.gov. 

Since 2013, Georgians have used healthcare.gov to view plans, qualify for financial help to lower the cost of health insurance, and enroll in the health plan of their choosing. Earlier this year, Georgia lawmakers moved to change that. The state legislature and Governor Kemp passed a new law that allows Georgia to create its own state-based marketplace (SBM). Since then, the Georgia Department of Insurance has been working to create and launch Georgia Access.

What should you know about the change to Georgia Access? 

During this fall’s open enrollment period (Nov. 1, 2023-Jan. 15, 2024), Georgia will operate a hybrid model with the state and federal government working together to manage Georgia’s marketplace. During this hybrid status, you can still use healthcare.gov to shop for and enroll in coverage. 

You may see ads or other promotions about Georgia Access as well. You can visit GeorgiaAccess.gov and become familiar with it. When you click to shop for health coverage or apply for financial assistance, you will be taken to healthcare.gov to complete the process. 

In fall 2024, the state and federal government will transition the marketplace from this hybrid model to Georgia Access. That is when you will begin using GeorgiaAccess.gov to shop and enroll in coverage. (If you visit healthcare.gov after this transition takes place, you will be directed to GeorgiaAccess.gov instead.)

As this change approaches, GHF will share more information about what to expect and how to prepare. Our enrollment assisters are available if you have any questions about how to get covered and stay covered this year and next year: 

• Angelica Rivera, arivera@healthyfuturega.org, (470) 654-5484. Special focus on LGBTQ+ and Hispanic Georgians. 
• Deanna Williams, dwilliams@healthyfuturega.org, (470) 654-5509. Special focus on middle Georgia.  

So what is Georgia Access? 

Georgia Access is a state-based marketplace. SBMs are operated by the states, with oversight from federal health officials at the Centers for Medicare and Medicaid Services (CMS). An SBM carries out almost all aspects of operating the health insurance marketplace, including making sure insurance plans meet certain requirements, providing financial assistance, and supporting consumer outreach and assistance. 

SBMs must retain important protections that you have come to expect, like offering only comprehensive plans that follow the ACA’s protections and providing a “one-stop shop” where consumers can view plans, find out about financial assistance, and enroll in coverage. 

SBMs are not better or worse than healthcare.gov. It really depends on how well the state operates its marketplace. SBMs are time- and cost-intensive to set up and maintain with no guarantee of good results. States that effectively run their SBMs can innovate in ways that improve consumers’ shopping and enrollment experience or enhance the quality of insurance plans offered. 

Check out GHF’s SBM fact sheet if you want to learn more! 

The success of Georgia Access will be determined by the work that the Georgia Department of Insurance puts in ahead of its full launch next year. GHF will continue to work with the Department to ensure Georgia Access meets the coverage needs of Georgia individuals and families. 

Georgia is one of 10 states that has not yet expanded Medicaid. Our leaders’ in action leaves thousands of low-income Georgia adults without health insurance.

Instead of expanding Medicaid, Governor Kemp created a new program called Georgia Pathways to Coverage. This program will cover some low-income adults, but it has a lot of rules and requirements.

To qualify for Pathways, you must meet all of these four requirements:

• Be a U.S. citizen or a qualified permanent resident
• Be between the ages of 19 and 64
• Have an income below the poverty line. (If you don’t know if your income is below the poverty line, use the chart below.)
• Be working or doing other qualifying activities for at least 80 hours per month.

If you are uninsured and meet these requirements, you can apply for Pathways. You can apply online at gateway.ga.gov or by phone at 1-877-423-4746.

If you need assistance with your application, GHF’s enrollment assisters are here to help! Click here to ask for their assistance. 

What does this mean for Georgians?

Pathways is a complicated program with many rules and restrictions, so we expect only a fraction of eligible Georgians will get covered through the program. The Governor and his administration have estimated that between 31,000-100,000 Georgians will be able to enroll in Pathways. (Full Medicaid expansion would cover more than 400,000 Georgians.)  

Some people who are likely to be left out include:

• Stay-at-home parents
• Caregivers for aging family members or children with a disability
• People in mental health or addiction recovery programs
• Rural residents and people of color who live in areas where good jobs are hard to find
• People who do not have reliable internet access or a car

These folks may not meet the requirements for Pathways or won’t be able to keep up with the tedious monthly reporting. They will likely be left behind. 

Medicaid expansion: an easier, better solution

Pathways is a broken bridge that lets too many Georgians and too much money fall through the cracks. Because of its complications and restrictions, thousands of Georgians will remain uninsured, and our state’s tax dollars–which are meant to help families access health care and keep hospitals open–will sit unused in Washington, D.C. 

Georgians deserve better. We deserve access to affordable, quality health care regardless of how little money is in our wallets. We deserve healthy hospitals whose doors are open to care for their communities. We deserve to visit the doctor when we’re sick and fill a prescription without worrying about whether to pay our rent or the medical bill.

Luckily Georgia leaders can replace Pathways with a program that is simpler, covers more people, costs less per person, and meets our state’s needs: Medicaid expansion! 

How you can help

Here are some things you can do to get Georgians covered and keep up the calls for Medicaid expansion:

• Spread the word about Pathways. Tell the uninsured Georgians in your life about the program and encourage them to apply. Here is some helpful information to print and share:
  • Uninsured in Georgia? flier
  • Information about Pathways from the Georgia Department of Community Health
• If you apply for the Pathways program, tell us about it! We want to know if you got covered or were turned away. Record your story and enter a monthly $100 give away, sponsored by our partners at Vocal Video! GHF is committed to directly compensating select storytellers with electronic gift cards!
  • If you are helping people enroll in Pathways, we want to hear from you too! 
• Speak up for Medicaid expansion! Ask the Governor and our state legislators to expand Medicaid when they return to the state Capitol in January 2024.
  • Don’t know what to say? We’ve got you covered. Here are some fast facts about Medicaid expansion that you can use to write or call your state leaders. 

By working together, we can make sure that all Georgians–regardless of how much or little money they have–have health coverage and the access to care that comes with an insurance card.

2023 SESSION SINE DIE

The 2023 Georgia legislative session is over, but GHF is not finished!

We’ve made it to the end of the legislative session and through Sine Die (the last day of legislative session).

In this week’s update we review which notable health bills passed and which bills didn’t quite make it across the finish line. Among those bills is HB 520, this year’s mental health bill, which we cover below.

You can find a full list of this year’s health care-related legislation at GHF’s legislative tracker.

The GHF team loves bringing you these weekly legislative updates, and you have told us that you enjoy reading them! Our team works hard to deliver this service to you in a complete and accurate way every week of Georgia’s legislative session. If you rely on these updates to keep you connected to the health happenings under the Gold Dome, please consider supporting our work with a donation today. Thank you!  

Medicaid and PeachCare for Kids provide health insurance coverage to 2.4 million Georgians, most of whom are children. Though Medicaid and PeachCare typically involve a complex annual renewal process, members were relieved of it throughout the COVID-19 pandemic. Instead Georgia’s Medicaid agency (the Department of Community Health, DCH) has been required to keep Medicaid and PeachCare members continuously enrolled in exchange for additional federal funding.

Since March 2020, more than 610,000 Georgians¹ have newly enrolled in Medicaid/PeachCare and have benefited from the continuous coverage protections. However, today (April 1st, 2023) Georgia begins a renewal process to see which members are still eligible and to disenroll those children and adults who no longer qualify.

Legislative update: Week 11

In this week’s update:

• Action alert: Ask Senators to vote “YES” for HB 404 in support of safe, healthy housing!
• Mental health bill’s future is uncertain
• FY24 budget updates 
• Legislation on the move: vaping, state-based marketplace
• GHF’s got you covered this session!

ACTION ALERT: URGE YOUR SENATORS TO VOTE “YES” ON HB 404

Senate to vote on healthy housing bill!

Last week, the Senate Finance committee heard and approved HB 404. (GHF testified in support!) The Senate Rules committee followed suit and scheduled HB 404 for a Senate vote today or Wednesday. Please contact your Senator now and ask that they vote “Yes!”. 

HB 404, the Safe at Home Act, would help families stay safely and more stably housed. Decent, safe and stable housing is fundamental to keeping children and adults healthy, able to make ends meet, continue working, allow children to succeed at school, and so much more.

In it’s current form, HB 404: 

• Requires that rental properties are “fit for human habitation”
• Includes cooling as a utility that cannot be shut off prior to an eviction action
• Prohibits landlords from requiring a security deposit that is more than two months’ rent.
• Allows a tenant three business days (following a written notice) to pay owed monies prior to an eviction proceeding being filed. (This is called a “right to cure”)

Click here to find your state Senator. (Tip: they will be the second-to-last official listed on the page.) Call to ask them to support HB 404 when it comes up for a vote! 

If you don’t know what to say when you call, use this example: “My name is ________. I live and vote in your district. Please vote YES on House Bill 404 when it comes to the Senate for a vote. This bill would provide fair housing protections to families, including by making sure all rental units are safe and healthy. This is especially important to help keep Georgia kids in school, out of foster care, and healthy in their communities. Thank you!”

(Want to know more about how housing & health are connected? Take a look at GHF’s Healthy Housing page.)  

Legislative update: Week 10

In this week’s update:

• Action alert: Urge Senators to vote NO on SB 140!
• Action alert: Ask Senate committee to support safe, healthy housing (HB 404)!
• Action alert: Continue to urge Senators to support strong mental health reforms (HB 520)!
• Legislation on the move: vaping, biomarker testing, & more!
• GHF’s got you covered this session!

ACTION ALERT: URGE YOUR SENATORS TO VOTE NO TO SB 140!

Let’s keep doctors and families in charge of their own evidence-based health care!

SB 140 would ban certain surgical procedures and hormone replacement therapies for the treatment of gender dysphoria in youth in Georgia. The Senate may take a final vote on SB 140 as early as today! Act now and urge your Senator to vote “no”!

Last Tuesday, the House Public Health committee amended SB 140 to criminalize medical providers for administering gender-affirming care in line with established standards of care. The House approved the amended version of SB 140 on Thursday. Because the House made changes to the Senate bill, the Senate must vote on the bill one more time.

Research shows that gender-affirming care greatly improves the mental health and overall well-being of gender-diverse, transgender, and nonbinary children and adolescents. Every major U.S. medical and mental health organization–including the American Medical Association, American Academy of Pediatrics, Federation of Pediatric Organizations, and American Psychological Association–supports access to gender-affirming care for transgender young people and adults. 

This bill would be harmful to transgender youth, their families, and health care providers. Urge your state senator NOW to vote NO on SB 140!

Legislative update: Week 9

In this week’s update:

• Action alert: Urge Senators to support HB 520!
• Amended FY23 and FY24 budget updates 
• Biomarker bill gets Senate committee approval
• TANF for pregnant women 
• Advocacy events for your calendar
• GHF’s got you covered this session!

ACTION ALERT: URGE YOUR SENATORS TO SUPPORT HB 520!

New mental health bill will be heard in Senate committee today

A subcommittee of the Senate Health & Human Service committee will hear HB 520 this afternoon at 2 pm. Please call HHS committee members now to ask that they support the bill! 

HB 520 seeks to build on last year’s sweeping Georgia Mental Health Parity Act. HB 520 aims to address the statewide shortage of mental health providers, understand the capacity for in-patient mental health and substance use treatment, streamline the ways that state agencies involved in behavioral health can share data, and address the needs of so-called “familiar faces” (people that cycle between homelessness, jails, and hospitals due to serious mental illness). 

Similar to last year’s mental health bill, this bill has been the subject of misinformation and stigma. It is very important that state Senators hear from you with your support!

If you don’t know what to say when you call, use this example: “My name is ________ and I live in your district. Please vote YES on House Bill 520 when it comes to the Senate Health and Human Services committee for a vote this afternoon. It will help Georgians who need mental health and substance use services more easily access and afford those services. Thank you!”

LEGISLATIVE UPDATE: CROSSOVER DAY RECAP

In today’s update:

Monday was the 28th day of the Georgia legislative session, which is also called Crossover Day. Crossover Day is the final day for a bill to cross from its chamber of origin to the opposite chamber to remain viable for this legislative session.

In this special midweek legislative update, we run down which consumer health bills made it through and which did not. We have included only the bills that we covered in Monday’s week 8 legislative update.

Note: After the flurry of activity on Monday, we are still working to update our legislative tracker with the current status of each bill. While many are updated, it is best to find the bill you are interested in and click through to find the full information about the bill’s status on legis.ga.gov. 

CROSSOVER DAY ACTION

Legislative update: Week 8

In this week’s update:

• New mental health bill passes house!
• Modernizing the TANF program
• Better housing for Georgians!
• Crossover Day: legislation we are watching ahead of today’s deadline! 
• Advocacy events for your calendar
• GHF’s got you covered this session!

NEW MENTAL HEALTH BILL PASSES HOUSE!

Mental health bill moving onto the Senate! 

HB 520, this year’s mental health reform bill, received the approval of the Georgia House and will be considered by the Senate after Crossover Day.  

This bill was introduced by Representatives Mary Margaret Oliver and Todd Jones and seeks to build on last year’s sweeping Georgia Mental Health Parity Act. HB 520 aims to address the statewide shortage of mental health providers, understand the capacity for in-patient mental health and substance use treatment, streamline the ways that state agencies involved in behavioral health can share data, and address the needs of so-called “familiar faces” (people that cycle between homelessness, jails, and hospitals due to serious mental illness). The bill also expands the Behavioral Health Reform and Innovation Commission (BHRIC) to include two “peer support specialists.”

HB 520 also directs DBHDD and DCH to develop an 1115 waiver to use Medicaid funds to provide housing, employment, and nutrition supports, as well as case management, outreach, and education to Medicaid members. This type of waiver is intended to address the non-medical needs of Medicaid members that impact their health and reduce health disparities. These kinds of needs are sometimes called the social determinants of health (SDOH).