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GHF legislative update: February 3

LEGISLATIVE UPDATE: WEEK 3

New Medicaid Expansion Bill has Bipartisan Support

A new bill, Senate Bill 50, to expand health insurance to low-income Georgia adults was introduced in the Senate this week. For the first time since Medicaid expansion became available to states, four Republican senators joined Democrats in support of a legislative solution to close Georgia’s coverage gap! The bill would create a new program called “PeachCare Plus”. It is nearly identical to the PeachCare Plus bill introduced during last year’s legislative session, the first Medicaid expansion bill to receive a legislative hearing in Georgia. Rather than expanding the state-run Medicaid program, SB 50 would introduce a private insurance model, using federal dollars to purchase coverage for eligible individuals (adults with incomes below 138% of the federal poverty level) through Georgia’s health insurance marketplace.

Too many Georgians are forced to choose between medical care and paying their bills. Closing Georgia’s health insurance coverage gap would provide life-saving coverage to thousands of uninsured Georgians. We support this legislation and will keep you updated as it moves through the legislative process.

Read on for key takeaways from other bills on our radar, and opportunities to advocate with us and our partners at the Capitol. 

Pathways to Coverage Waiver Renewal: Public Comment Opportunity

The Georgia Department of Community Health (DCH) has submitted a waiver extension request for the Pathways to Coverage program. The proposed changes still leave thousands of Georgians uninsured and without an option for health coverage, including:

  • People with chronic or serious health conditions who are unable to work;
  • Parents of children aged 6-19, including those with disabilities; and
  • Caregivers of children or adults with disabilities, and the elderly

Pathways has struggled to meet its goals of meaningfully increasing access to care for low-income Georgians, enrolling only 6,500 participants in a year and a half. That is just 3% of those who would benefit from full Medicaid expansion.

How You Can Help: 

  • Attend a Public Hearing:
  • Submit a Public Comment: Make your voice heard by sharing your input via email to advocate for expanding Medicaid eligibility and removing barriers. Simply click the button below to write your comment, and we’ll ensure it reaches the Georgia Department of Community Health.

The deadline for public comments is Thursday, February 20, 2025. Let’s ensure every Georgian has access to the health care they need


Legislation on Our Radar

Senate Bills:

SB 5: Prior authorization gold card bill 

Streamlines prior authorization processes for providers meeting specific criteria or standards

  • GHF’s Position: Support
  • Status: Passed out of Senate Insurance and Labor – 1/29/25
  • Sponsors: Sen. Kirkpatrick
  • Summary:
    SB 5 requires health insurers to reduce certain prior authorization requirements for providers who meet specific criteria. Providers can avoid or reduce future prior authorization requests from insurers by adhering to evidence-based medicine and performance benchmarks set by insurers.This type of program is sometimes called “gold carding.”
    • Prior authorization is a process used by health insurance companies to decide whether they will cover a specific medical service, medication, or procedure before a patient receives it. Insurance companies use prior authorization to control costs and ensure that treatments are medically necessary. However, it can sometimes delay care and create extra work for doctors and patients.
  • Why It Matters:
    This bill would reduce administrative burdens for health care providers and allow more timely care for patients by eliminating some prior authorization processes for doctors providing evidence-based care or meeting specific standards.

SB 50: Peach Care Plus Act of 2025

  • Position: Support
  • Status: Referred to the Regulated Industries and Utilities Committee (01/29/2025)
  • Sponsor: Sen. David Lucas
  • Summary: SB 50 would create a new health coverage program in Georgia called PeachCare Plus. This program would cover low-income adults by enrolling them in fully subsidized private health insurance plans on Georgia’s state-based marketplace (Georgia Access).
    • Key details:
      • The bill would allow adults earning up to 138% of the federal poverty level (FPL) to enroll in private health insurance plans, with the state covering all costs (premiums and other direct costs).
      • The Georgia Department of Community Health (DCH) would oversee the program, with input from the Advisory Commission on the PeachCare Plus Program, a new bipartisan group that would monitor the waiver request and provide recommendations.
      • Any state savings from the program would go into the Indigent Care Trust Fund, which helps to pay hospitals for  health care delivered to uninsured, low-income Georgians.
  • Why it matters: SB 50 could help expand health coverage for hundreds of thousands of low-income Georgians, many of whom currently fall into the coverage gap—earning too much for Medicaid but not enough to afford private insurance. By using private health plans instead of traditional Medicaid, the bill aims to increase provider participation and ensure fairer reimbursement rates for hospitals and doctors. However, the program’s long-term viability depends on federal funding staying at current levels. If successful, PeachCare Plus could be Georgia’s version of Medicaid expansion, improving access to care across the state.

SB 60: Pharmacy Benefit Manager reform

  • Position: Support
  • Status: Referred to the Insurance and Labor Committee (01/30/2025)
  • Sponsor: Sen. Chuck Hufstetler
  • Summary: SB 60 would require pharmacy benefits managers (PBMs) to act in the best interests of patients, health plans, and health care providers. PBMs are companies that manage prescription drug benefits for health insurance plans, including deciding which medications are covered and negotiating prices with drug manufacturers. This bill would create legal responsibilities for PBMs to ensure fairness, transparency, and accountability in their business practices.
  • Why it matters: SB 60 aims to increase transparency and accountability for PBMs, which play a major role in prescription drug pricing. By requiring PBMs to prioritize patients’ interests, this bill could help prevent hidden fees, price manipulation, and inequitable reimbursement rates that contribute to rising drug costs. If passed, SB 60 could lead to lower prescription costs, better access to medications, and fairer treatment for independent pharmacies and health care providers in Georgia.

House Bills: 

HB 89: Allowing the Maternal Mortality Review Committee to access pharmaceutical and psychiatric records when investigating a peri- or post-natal death

  • Update: Passed out of the House Public and Community Health Committee – 1/29/25
    • The committee passed an updated (substitute) version of the original bill. Among the changes made in the committee were clarifications to exemptions to the requirement to share confidential patient information with the committee. 

HB 100: The Prescription Drug Consumer Financial Protection Act

  • Position: Support
  • Status: Referred to the Insurance Committee (01/28/2025)
  • Sponsor: Rep. Demetrius Douglas
  • Summary: HB 100 would require health insurers to pass at least 80% of all prescription drug rebates they receive to enrollees. This requirement means that when insurers negotiate discounts and rebates from drug manufacturers, a large portion of those savings must be used to lower out-of-pocket costs for patients at the pharmacy counter.
    • Key details:
      • Rebates are price concessions that drug manufacturers provide to insurers or pharmacy benefit managers (PBMs) in exchange for covering certain medications. Currently, insurers and PBMs do not always pass these savings to consumers.
      • Insurers must apply at least 80% of these rebates to reduce the cost-sharing amounts (copays, deductibles, and coinsurance) that patients pay for prescription drugs.
      • Insurers who fail to comply could face penalties, including fines or losing their license.
  • Why it matters: HB 100 aims to lower prescription drug costs for consumers by ensuring that drug rebates benefit patients rather than insurers. The bill could make medications more affordable by requiring insurers to pass along at least 80% of rebates, especially for people with chronic conditions who rely on costly prescriptions. However, some insurers may argue that this policy could lead to higher premiums if they cannot retain a portion of the rebates to offset other costs.

HB 102: Establishing the Georgia Quality Reporting Project (GQRP) within the Georgia Dept. of Community Health

  • Position: Support
  • Status: Referred to the Public and Community Health Committee (01/28/2025)
  • Sponsor: Rep. Sharon Cooper
  • Summary: HB 102 would create the Georgia Quality Reporting Project (GQRP), a statewide system to track and improve health care quality in Georgia by analyzing patient care data. The project would collect clinical and claims data from Medicaid care management organizations (CMOs) to evaluate health care quality, especially in treating opioid use disorder and other conditions.
    • Key details:
      • Data will be used to evaluate opioid care quality and other statewide health outcomes.
      • Patient identities will be protected, and all data collection must follow HIPAA (Health Insurance Portability and Accountability Act) privacy rules.
      • CMOs that fail to submit required data may face fines.
    • How is this different from the Georgia APCD?
      • While Georgia’s All-Payer Claims Database (APCD) already collects insurance claims data to track health care spending and utilization, the GQRP would also collect clinical data (like electronic health records) to measure the quality of care provided. This difference means that while the APCD tracks costs and usage, the GQRP will track health outcomes to assess how well treatments are working and improve patient care—especially for conditions like opioid use disorder.
  • Why it matters: HB 102 could help improve health care quality by tracking patient outcomes and identifying areas for improvement in Medicaid services. The focus on opioid care data could lead to stronger policies for substance use treatment and better health outcomes for Georgians. Additionally, increased transparency and accountability in health care reporting could help lower costs and improve patient care statewide.

HB 178: Medicaid coverage for low-income Georgians living with HIV

  • Position: Support
  • Status: Referred to the Public and Community Health Committee (01/30/2025)
  • Sponsor: Rep. Sharon Cooper
  • Summary: HB 178 would require Georgia’s Department of Community Health (DCH) to apply for federal approval to extend Medicaid coverage to low-income Georgians living with HIV.
    • Key details:
      • The program would aim to provide earlier and more effective coverage and treatment for people living with HIV.
      • Services covered would include a package of treatments, including antiretroviral medications (used to control HIV and improve health outcomes).
      • Eligibility requirements:
        • Must have a diagnosis of HIV
        • Must have an income below 138% of the federal poverty level (FPL)
        • Must not have any other form of health coverage
  • Why it matters: HB 178 could expand access to life-saving treatment for low-income Georgians with HIV who currently lack health coverage. By providing early treatment, this bill could help improve health outcomes, reduce transmission rates, and potentially lower long-term health care costs for the state by preventing complications. If approved, this program could fill coverage gaps for uninsured individuals who do not qualify for Medicaid under Georgia’s current eligibility standards.

Advocate with us at the Capitol!

Join These Advocacy Events During the Legislative Session

Each week during the legislative session, we’ll highlight legislative advocacy days hosted by partner organizations. These events are excellent opportunities to engage in the lawmaking process by meeting your legislators and advocating for critical health issues.

Here are the upcoming events:

Please contact Anthony Hill at ahill@healthyfuturega.org if you have an advocacy event you’d like included in GHF’s legislative update.

We hope to see you at one or more of these impactful events!


GHF has you covered!

Stay up-to-date with the legislative session
 

GHF will be monitoring legislative activity on a number of critical consumer health care topics. Along with our weekly legislative updates and timely analysis of bills, here are tools to help you stay in touch with health policy under the Gold Dome.


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