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Legislative Update: Week 11

Georgia State Capitol

WEEK 11: WHAT THE SENATE BUDGET MEANS FOR HEALTH CARE IN GEORGIA

Last week, the Georgia Senate passed its version of the Fiscal Year 2027 (FY27) state budget. The FY27 budget funds the state from July 1, 2026, to June 30, 2027. The Senate made significant changes to the House’s version of the budget, including dramatically expanding waiver capacity for Georgians with intellectual and developmental disabilities (IDD), redistributing Medicaid provider rate increases, and scaling back several House investments in public health, workforce, and rural health infrastructure.

Here is what the Senate version means for health care and the programs Georgians rely on:

THE BIG PICTURE

The largest health-related change in the Senate budget was a historic increase in funding for services for Georgians with intellectual and developmental disabilities (IDD). The Senate invested roughly $20.9 million in state funds for 1,217 new NOW and COMP waiver slots, a dramatic increase over the House’s 200 slots.

The Senate also reworked the House’s Medicaid provider rate package, increasing the funding overall, but concentrating it across fewer services. On the workforce side, the Senate reduced funding for new residency slots and cut the Mercer and Morehouse medical education investments in half, while adding a new family medicine residency program. The Senate also scaled back the House’s maternal home visiting expansion and removed the House’s new rural health infrastructure investments.

MEDICAID PROVIDER RATE INCREASES

Medicaid

The Senate made several changes to the House’s proposed Medicaid reimbursement rate increases, which would result in higher payments to providers serving Medicaid patients.

The Senate doubled the rate increases for primary care providers and autism services, and kept the House’s proposed increases for dental care, nursing homes, community health centers, air ambulances, heart and lung transplants, registered dietitians, facilities serving people with intellectual and developmental disabilities, and ventilator care.

However, the Senate removed the House’s proposed rate increases for:

  • Psychiatric residential treatment facilities (PRTFs), which provide around-the-clock mental health care for children and adults with serious behavioral health needs. Currently, the need for residential treatment across Georgia far outstrips the supply.
  • Parent training reimbursement for families of children with autism.
  • Enhanced case management for seniors and people with disabilities who rely on home and community-based waiver services.
  • Medical equipment and supplies used by Medicaid patients.

The Senate also cut roughly $2.2 million in existing state funds that support obstetric care in rural areas. This funding helps sustain labor and delivery services in parts of Georgia where access to maternity care is already limited.

NOW/COMP WAIVER EXPANSION

The Senate funded 1,217 new NOW and COMP waiver slots at approximately $20.9 million in state funds, compared to the House’s 200 slots at $4.6 million and the Governor’s 100 slots at $2.3 million. These Medicaid waivers allow Georgians with disabilities to receive care in their homes and communities rather than in institutional settings. More than 7,000 Georgians are currently on the waitlist for these services, so while this funding would not close the gap, the Senate’s proposed funding would be the state legislature’s biggest single-year investment in community-based disability services in recent memory. Our partners at the Georgia Council on Developmental Disabilities made this a priority for this legislative session.

GRADUATE MEDICAL EDUCATION AND HEALTH CARE WORKFORCE

Georgia faces a well-documented shortage of physicians, particularly in rural areas, in primary care, and in specialties like psychiatry. Both chambers invested in graduate medical education (GME) to train more doctors in Georgia, but they took different paths.

The Senate’s total GME investment was slightly higher than the House’s, but it shifted funding priorities. The Senate reduced funding for primary care residency slots, eliminated one-time funding for resident education spaces, and removed dedicated funding for rural surgery and child psychiatry slots. However, it restored Medicaid GME funding the House had cut due to a delayed State Plan Amendment, added a new family medicine residency program, and redirected resources from Healthcare Facility Regulation to support GME grants.

MATERNAL AND CHILD HEALTH

The Senate funded a smaller expansion of the maternal home visiting program, limiting it to 31 counties, compared to 62 counties in the House’s budget. Home visiting connects expectant and new mothers with trained nurses and social workers, and these programs are among the most rigorously studied maternal health interventions. Georgia’s maternal mortality rate remains one of the highest in the nation. This is a GHF priority!

INSURANCE AND THE MARKETPLACE

The Senate kept the House’s $25 million reduction to the state’s share of 1332 waiver reinsurance funding. The federal pass-through and State-Based Exchange fee revenue were unchanged.

The reinsurance program stabilizes premiums on Georgia’s individual insurance market, and this cut comes at a particularly precarious moment. The state is simultaneously shifting reinsurance funding away from general appropriations and toward fees paid by insurers participating in Georgia Access. This shift makes the reinsurance program’s funding more closely tied to marketplace enrollment levels. If Georgia Access enrollment drops due to the loss of enhanced premium tax credits (ePTCs), insurer fees will decline, and the revenue supporting reinsurance would shrink. A decrease in reinsurance funding could affect Georgia’s ability to stabilize and lower premiums for Georgia Access enrollees.

STATE HEALTH BENEFIT PLAN

Both chambers agreed on a per-member per-month rate of $1,935 for the State Health Benefit Plan, a $50 increase over the current rate and well below the Governor’s proposed $2,028. The lower rate means less pressure on school systems and state agencies that share the cost of employee health coverage.

HEALTH CARE ACCESS AND RURAL HEALTH

The Senate and House split most sharply on funding for rural health infrastructure. The House added funding for emergency preparedness for rural hospitals, rural hospital stabilization grants, and a hospital solvency evaluation process. The Senate eliminated all three, arguing that federal funding for the Rural Health Transformation Program (RHTP) and base appropriations already address these needs.

However, the Senate’s citing of the RHTP funds as a reason to cut separate state investments in rural hospital stability does not align with how the RHTP operates. The RHTP’s enabling legislation specifies that the funds cannot be used for emergency preparedness, hospital stabilization, offsetting Medicaid cuts, or for general hospital operations. The federal landscape makes the Senate’s reasoning even harder to sustain: the same legislation that created the RHTP also cut an estimated $155 billion from Medicaid nationally. Georgia is projected to see roughly $5.4 billion in Medicaid cuts over the next decade. Rural hospitals now face Medicaid funding cuts from one federal program while receiving limited, time-bound transformation grants from another.

WHAT COMES NEXT

The House disagreed with the Senate’s FY27 budget, so a conference committee is currently negotiating the final FY27 budget. The conference committee must finalize the budget in time for both chambers to pass it before Sine Die (the final day of the legislative session), this Thursday. If the two chambers do not come to a budget agreement by the time they gavel out on Thursday, the Georgia General Assembly will need to convene in a special session before the end of the current state fiscal year (June 30, 2026) to finish this constitutionally required task.

BILLS WE’RE TRACKING

Beyond the budget, here are the bills that our team is following:

House Bills:

HB 291: Community Health Worker Certification

Lead Sponsor: Rep. Darlene Taylor (173rd) | Status: Passed out of Senate HHS, but did not pass out of Senate Rules yesterday. HB 291 is unlikely to pass this session. | GHF Position: Support. This is a GHF priority!

What the bill does: HB 291 would establish a certification process for community health workers (CHWs) in Georgia. CHWs are frontline public health workers who help connect individuals to health care and essential services, particularly in underserved communities. They go by many titles, such as Patient Navigator, Community Health Advocate, and Promotora de Salud. By setting uniform standards and training for CHWs, creating a statewide certification system would support a skilled, stable CHW workforce.

HB 1192: State Agency Financial Accountability

Lead Sponsor: Rep. Taylor (R-173rd) | Status: Passed both the House and Senate; awaits the Governor’s signature | GHF Position: Monitor

What HB 1192 does: Requires the Department of Human Services and the Department of Community Health to keep funds designated for specific purposes in separate accounts and report annually to the legislature on cost savings and efficiency improvements.

Consumer impact: Greater transparency could help ensure that funds designated for specific health programs actually go toward those purposes.

HB 1238: Respite Care for Families of Youth with Behavioral Health Needs

Lead Sponsor: Rep. Dempsey (R-13th) | Status: Passed out of Senate HHS by substitute; passed out of Senate Rules. If passed by the Senate, the House must agree to the Senate’s changes to HB 1238. | GHF Position: Support

What HB 1238 does: Directs the state to seek federal approval for Medicaid to pay for respite care services for families caring for children under 21 with serious behavioral health conditions who are at risk of going into foster care.

Consumer impact: Families caring for children with significant behavioral health needs often reach a breaking point. Respite care gives families temporary relief while keeping kids in their homes and communities, rather than resorting to foster care or residential facilities. Respite care costs less than institutional placements and produces better outcomes for children.

HB 1262: Increasing Insurance Violation Penalties

Lead Sponsor: Rep. Lumsden (R-12th) | Status: Passed the House; Assigned to the Senate Insurance and Labor Committee. | Note: HB 1262 was not heard by the Senate Insurance Committee, but the bill language was presented to a Senate Insurance subcommittee, along with many other insurance reform measures. While several other insurance reform measures were added to HB 1344 before it passed out of the Senate Insurance Committee, HB 1262 was not included in the amendments. The insurance fines in HB 1262 are unlikely to pass this session. | GHF Position: Support

What HB 1262 does: Raises the maximum penalties the Commissioner of Insurance can impose on insurance companies for violations of mental health parity reporting requirements, general insurance law, and the Surprise Billing Consumer Protection Act. The bill increases the current per-violation standard from $2,000 to $10,000 and the knowing-violation standard from $5,000 to $25,000.

Consumer impact: Because all penalties remain discretionary, the bill’s real-world value depends entirely on whether Georgia’s Department of Insurance (DOI) chooses to use its expanded authority. DOI has expressed support for the bill, which suggests they want to hold insurers accountable when they violate the law.

HB 1344: Georgia Insurance Oversight

Lead Sponsor: Rep. Reeves (R-99th) | Status: Passed the House; Assigned to the Senate Insurance and Labor Committee | GHF Position: Monitoring

What HB 1344 does: A wide-ranging insurance bill that strengthens DOI enforcement authority, insurance fraud penalties, and other areas specific to property, casualty, and auto insurance.

HB 1393: Certificate of Need Repeal and Rural Hospital Antitrust Immunity Act

Lead Sponsor: Rep. Werkheiser (R-157th) | Status: Passed out of the House; amended and approved by Senate HHS | GHF Position: No position

What HB 1393 does: The Senate HHS Committee’s substitute combines two major changes to HB 1393. First, it repeals Georgia’s certificate of need (CON) program for all health care facilities except skilled nursing facilities, meaning hospitals, surgery centers, imaging centers, and other facilities would no longer need state approval to open, expand, or relocate. Second, it allows rural hospital authorities in counties with populations under 50,000 to jointly negotiate prices with insurers and collaborate on services while claiming limited immunity from federal antitrust law. Unlike the original House version, the substitute requires Attorney General review before immunity takes effect, caps collaborations at three rural hospital authorities, bans non-compete clauses against physicians, and requires narrow legal interpretation.

Consumer impact: The CON repeal would not improve access to care in Georgia since the bill does not require new facilities to serve underserved communities or accept Medicaid. The revised antitrust provisions are meaningfully improved over the original bill, but still authorize joint price negotiations between hospitals that would otherwise compete, which economic research consistently links to higher costs for commercially insured consumers. Annual oversight by DCH and the Attorney General is required but lacks funding, metrics, or clear enforcement tools.

Senate Bills:

SB 195: Over-the-Counter Access to Pre-Exposure Prophylaxis (PrEP)

Lead Sponsor: Sen. Hufstetler (52nd) | Status: Senate agreed to the House’s changes; awaits the Governor’s signature | GHF Position: Support

What SB 195 does: SB 195 would allow pharmacists in Georgia to dispense Pre-Exposure Prophylaxis (PrEP) for HIV prevention without a prescription from a doctor. PrEP is a highly effective medication that reduces the risk of HIV transmission by up to 99% when taken as prescribed. However, barriers to accessing PrEP such as requiring a doctor’s prescription, lack of insurance, or stigma can prevent people at risk from getting preventive treatment. Expanding access through pharmacies allows individuals to obtain PrEP more quickly and conveniently, particularly in areas with limited health care providers. The bill establishes guidelines for pharmacists to provide PrEP under a statewide protocol, thereby increasing access to the medication.

SB 427: Pathway for Internationally Trained Physicians

Lead Sponsor: Sen. Watson (R-1st) | Status: Amended version passed the House; the Senate agreed to the House’s changes; the bill awaits the Governor’s signature. | GHF Position: Support

What SB 427 does: Creates a pathway for qualified physicians trained outside the U.S. to practice in Georgia. Eligible physicians would receive provisional licenses, would work under a fully licensed provider for a specific time period, and must work in underserved areas for 2-4 years to qualify for full licensure.

Consumer impact: Georgia faces significant physician shortages, especially in rural areas. SB 427 would help address workforce gaps by allowing qualified international physicians to practice while meeting supervision and practice requirements.

SB 428: Medicaid Home and Community-Based Services for Mental Health

Lead Sponsor: Sen. Kirkpatrick (R-32nd) | Status: Passed the House by substitute; the Senate agreed to the House’s changes; the bill awaits the Governor’s signature. | GHF Position: Support

What SB 428 does: Directs the state to seek federal approval by December 31, 2026, for a Medicaid waiver that would pay for home and community-based mental health services for adults over 21 who need ongoing support but don’t need institutional care. Eligibility would be based on risk factors like hospitalization history, psychiatric crises, emergency visits, prior incarceration, or homelessness.

Consumer impact: SB 428 would allow Medicaid to cover ongoing community-based support that helps people remain stable and avoid costly crisis situations.

SB 462: Protecting Consumers from Surprise Ambulance Bills

Lead Sponsor: Sen. Still (R-48th) and others | Status: Passed out of House Health; added to the House’s first Supplemental Rules Calendar on 03/31. If passed by the House, the Senate must agree to the House’s changes before the bill would go to the Governor’s desk. | GHF Position: Support

What SB 462 does: Extends Georgia’s surprise billing protections to emergency ground ambulance transportation. SB 462 would cap what patients pay for out-of-network ambulance rides at the same amount they’d pay for in-network rides, and prohibit ambulance companies from billing patients for the rest. The bill sets a minimum payment rate for ambulance companies at the locally negotiated rate, or, if none exists, at the lesser of 325% of Medicare rates or the billed charges.

Note: The House also added language from HB 1274, which addresses excess auto insurance profits, to SB 462.

Consumer impact: Georgians currently face unexpected ambulance bills ranging from hundreds to thousands of dollars, even with insurance. SB 462 would close that gap in Georgia’s surprise billing law.

SB 500: Health Care Workforce Database Expansion

Lead Sponsor: Sen. Hodges (R-3rd) | Status: Passed the House by substitute; the Senate agreed to the House’s changes; the bill awaits the Governor’s signature. | GHF Position: Under Review

What SB 500 does: Expands the existing Behavioral Health Care Workforce Database to cover all licensed health care professionals in Georgia and renames it the Health Care Workforce Database. The bill broadens the set of licensing boards required to participate in data collection without appropriating new funds or setting implementation deadlines.

SB 535: Community Service Board Governance Restructuring

Lead Sponsor: Sen. Kirkpatrick (R-32nd) and others | Status: Passed out of the House; awaits the Governor’s signature | GHF Position: Monitoring

What SB 535 does: Restructures governance of Georgia’s community service boards (CSBs) by transferring executive director appointment authority from local governing boards to the DBHDD Commissioner. Executive directors would become DBHDD employees. The Commissioner could direct executive directors to override governing board decisions when a CSB fails to meet performance standards. CSB conversions to nonprofit or other structures require Commissioner approval, and cessation of operations requires Governor approval.

Consumer impact: CSBs are the primary delivery system for community-based behavioral health and developmental disability services in Georgia. Centralizing executive director appointments under DBHDD could improve statewide accountability and help address underperforming CSBs, but the change removes local community input from leadership decisions. The bill does not define the “performance standards” that would trigger a state override of local governing board authority, leaving significant discretion to DBHDD. Consumers and families who participate in CSB governance would see their influence reduced under the new structure.

SUPPORT OUR WORK BEYOND THE SESSION

GHF Staff 2026

The legislative session may be ending, but our work continues year-round.

When lawmakers leave the Gold Dome, GHF continues advocating for health care access across Georgia. During the off-session months, we:

  • Provide direct assistance to Georgians navigating health coverage through our free Medicaid and Georgia Access enrollment support
  • Publish in-depth research and analysis on critical health policy issues, like our new Marketplace Report tracking coverage trends and affordability in Georgia
  • Build coalitions like Cover Georgia and other collaborative efforts to expand access to affordable, quality health care
  • Prepare for the next session by monitoring federal policy changes, analyzing state agency actions, and developing legislative priorities
  • Educate communities about their health coverage options, rights, and resources

Your support makes all of this possible. Legislative sessions come and go, but Georgians need health care advocates every single day.

Please consider making a gift to GHF today to power our work in the months ahead.

GHF HAS YOU COVERED!

Stay connected with our work year-round.

Even when the legislature is out of session, GHF continues to monitor health policy developments and provide resources to help Georgians access the care they need. Here are ways to stay engaged:


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