ATLANTA – Advocates seeking health insurance for more low-income Georgians are encouraged that Medicaid expansion is starting to draw support among what for years has been unified Republican opposition. Although…
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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 170 would require insurance companies and other health benefit providers to share information with health care providers about payments made for a patient’s care. The bill aims to improve transparency so that treating health care providers know what payments or reimbursements an insurance company has made for their services.
SB 80 would revise the definition of a “rural hospital organization” in Georgia’s tax credit program, which provides state tax credits to individuals and businesses that donate to rural hospitals. The bill updates the eligibility criteria to allow more hospitals to qualify for these tax credits, potentially increasing funding for rural health care providers.
SB68 proposes major changes to Georgia’s civil justice system by limiting certain types of damages, changing rules for lawsuits, and adjusting legal procedures related to personal injury cases, insurance claims, and liability disputes. The bill includes major changes to Georgia’s medical malpractice laws and how lawsuits against health care providers and insurers are handled. The changes to medical malpractice aim to limit the costs of medical malpractice lawsuits, reduce liability for health care providers, and adjust how damages are awarded in personal injury and medical negligence cases.
SB 39 would prohibit the use of state funds to cover gender-affirming care, including hormone therapy and sex reassignment surgery, for individuals enrolled in state-funded health plans or receiving public assistance. The bill also bans state-owned health care facilities and state-employed providers from offering gender-affirming care.
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.
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 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.
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.
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.
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