LEGISLATIVE UPDATE: WEEK 5

Will New PBM Reforms Lower Drug Prices in Georgia?

Pharmacy Benefit Managers (PBMs) are companies that help insurance plans manage prescription drug benefits. They decide which medications are covered, negotiate prices with drug manufacturers, and set payment rates for pharmacies. While PBMs can lower drug costs by getting discounts from drug makers and pharmacies, they also have significant control over medication pricing, patient access, and pharmacy reimbursements. Critics argue that PBMs’ business practices can drive up costs for consumers and independent pharmacies, while supporters believe they help manage drug spending and ensure affordability. Additionally, PBMs are often owned by an insurer or pharmacy, meaning these PBMs are managed by the same stakeholders that set drug prices for consumers.

LEGISLATIVE UPDATE: WEEK 4

New Bill Aims to Create Georgia’s First Community Health Worker Certification Program

This week, lawmakers introduced House Bill 291, a bill that would create a state certification process for Community Health Workers (CHWs) in Georgia. CHWs are trusted public health professionals who connect Georgians, especially those in underserved communities, to health care and essential services. People know them by titles such as Patient Navigator, Community Health Advocate, and Promotora de Salud. CHWs play a vital role in improving health outcomes, delivering culturally-relevant information and care, and addressing social determinants of health like housing, transportation, and food insecurity.

HB 291 would help build a skilled and stable CHW workforce by establishing a certification process. The bill expands CHW’s ability to serve in various health care and community settings. HB 291 could also pave the way for Georgia Medicaid to reimburse CHWs in more settings and roles. Currently, Medicaid only covers CHW services provided through the Resource Mothers program, which supports certain pregnant and postpartum individuals. Certification could allow Medicaid to fund CHW services in more health care teams, public health programs, and care coordination efforts statewide.

If passed, HB 291 would recognize CHWs as essential members of Georgia’s health care system. It would ensure they have the training, support, and financial sustainability needed to continue their work.

This is one of GHF’s 2025-2026 legislative priorities, and we support this bill. We’ll keep tracking HB 291 and advocating for strong policies that support CHWs and expand access to care. Keep reading for more updates!

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. 

LEGISLATIVE UPDATE: WEEK 2

Severe Weather Closed the State Capitol for Most of the Week 

Severe weather disrupted last week’s legislative schedule, postponing budget hearings and other activities. As a result, some state agencies will now present their budget requests this week. Since there wasn’t much action at the Capitol last week, we’ve covered a few more health-related bills from the first week of session below. 

Update on State Agency Budget Presentations:

State agency budget presentations now begin this week. For the latest schedule, check out the legislative session schedule here. Two upcoming meetings on our radar are: 

• Appropriations Subcommittee on Human Resources (House)–where legislators will hear presentations about the human resource needs of the Departments of Human Services and Behavioral Health & Developmental Disabilities, as well as the Georgia Council on Developmental Disabilities
• Appropriations Subcommittee on Health (House)–where legislators will hear budget presentations from the Departments of Community Health and Public Health

What Does Georgia’s Health Care Future Look Like?

Imagine a Georgia where every family has access to affordable health care, where mental health services are readily available, and where no one falls through the cracks of a complex system. Achieving this vision requires bold ideas, collaborative solutions, and voices from every corner of the state. That’s exactly what happened on January 14, 2025, at Georgians for a Healthy Future’s 15th Annual Health Care Unscrambled.

With over 200 advocates, policymakers, and public health experts gathered at the Georgia Freight Depot, the event served as a catalyst for action, offering actionable insights and solutions to the challenges shaping Georgia’s health care landscape.

LEGISLATIVE UPDATE: WEEK 1

Georgia’s 2025 Legislative Session Has Officially Begun

On Monday, January 13th, the Georgia General Assembly convened to kick off the first year of the state’s two-year legislative cycle. During this period, lawmakers will introduce and consider bills that have two years (this session and next) to become law. The legislative session gives state lawmakers a chance to address key issues affecting Georgians, including health and health care.

The following day GHF hosted Health Care Unscrambled 2025 (our 15th annual HCU!), where we unveiled our 2025-2026 policy priorities. A heartfelt thank you to everyone who attended! If you missed the event or would like to revisit the discussions, you can find a full recap on our event page here, including a recording and presentation slides. 

On Thursday, Governor Kemp delivered his State of the State address and unveiled his budget proposals for the remainder of the current fiscal year and the next state fiscal year. Below, we’ve highlighted key health-related components of the Governor’s budget for your review.

This Week: Budget Week
House and Senate Appropriations Committee members are holding joint hearings to review state agency budget requests and spending this week. These hearings provide important insights into agency priorities and funding needs for the year ahead.

For more information, you can access the legislative session schedule here.

​​Every person who calls Georgia home deserves to live healthy and thrive. While Georgia has made recent strides to improve the health of our residents, we haven’t yet reached that goal according to Georgians themselves and our state’s health data.

To help state and community leaders make effective and informed decisions about the health and well-being of Georgians, Georgians for a Healthy Future created the illustrated What the health, Georgia guide. This publication is intended to be a reference that decision makers can go back to again and again as they consider new health laws and policies and determine how to invest public funds in health care and public health.

Download a copy of What the Health, Georgia here! 

 Georgians for a Healthy Future (GHF), the Georgia Council on Substance Abuse (GCSA), and the Center for Pan-Asian Community Services (CPACS) are nonprofits focused on building healthier communities. We partner together to promote policies and systems that increase access to substance use and mental health prevention, identification, and recovery services for Georgia youth. 

The pandemic has dramatically shifted the lives of Georgia’s children and families. Children have faced inconsistent and uneven access to school, social isolation, and family stressors (from job loss, illness, or other changes). The potential impacts of these challenges are compounded for vulnerable youth, such as those in low-income families, in communities of color, or LGBTQ+ youth. The changes and challenges over the last year could result in or exacerbate mental illness or substance use disorders among Georgia students. 

According to the Centers for Medicare and Medicaid Services (CMS), COVID-19 has drastically reduced the utilization of mental health services among Medicaid & Children’s Health Insurance Program (CHIP) beneficiaries. In 2020, there was a 34% decline in the number of mental health services used by children under 19. Nationally, this decline means that 14 million fewer mental health services were provided to CHIP enrollees.1 The decline in services means that many fewer young people are receiving needed substance use and mental health services, leaving them ill-prepared to return or continue their educations successfully. Additionally, many students lost a critical lifeline for receiving mental health and substance use services during school closures.2 Prior to the pandemic, over one in three young people relied on schools as their primary source of mental health care. 

School-based substance use and mental health services are critical to ensuring that Georgia’s children have access to the services they need. Such school-based care is essential for ensuring young people are healthy and ready to learn, especially as we build back from the downstream effects of the COVID-19 pandemic. 

Georgians for a Healthy Future, the Georgia Council on Substance Abuse, and the Center for Pan-Asian Community Services offer the following comments with respect to the Georgia Department of Education’s utilization of ESSER funds to address the behavioral health needs of Georgia’s children, with a special focus on substance use prevention and treatment. 

Training School Staff on Substance Use and Mental Health 

School districts should train school health personnel and staff (i.e. school counselors, social workers, and nurses) to identify substance use and mental health needs as students return to the classroom and properly refer them to appropriate services, including community mental health and substance use providers. Identifying substance use and mental health issues early, allows students to get the treatment they need before the situation turns into an emergency. 

One evidence-based technique is SBIRT, which stands for Screening, Brief Intervention, and Referral to Treatment. SBIRT is low-cost, effective, and supported by the American Academy of Pediatrics. SBIRT helps trusted adults (like teachers, school nurses, or counselors) to have structured conversations that identify students’ drug or alcohol use and connects them to follow-up counseling or treatment if needed. Georgia policymakers have also demonstrated their support for SBIRT by adopting Senate Resolution 1135 during the 2018 legislative session, which endorses SBIRT as a “best practice to facilitate academic success and positive school climate.”3 SBIRT can also be combined with other screening tools that may only address depression, anxiety, or other mental health needs so that a student’s full spectrum of needs is addressed. 

Some related training for teachers and other school staff is beginning through the Opioid Affected Youth Initiative grant program from the Criminal Justice Coordinating Council (CJCC). With their OAYI grant, GCSA is already working with the Department of Education to identify high schools in each of the sixteen (16) RESAs that are most in need of training to have compassionate and constructive with their students who either experience overdose and come back to school, or with students who have friends or loved ones who do not survive overdose. This curriculum will serve as a foundation to build the strengths of each participating school, boost their confidence in having these difficult conversations with students about substance use, and lay the groundwork for similar trainings that focus on prevention and early intervention. The program is currently operating in 16 high schools throughout the state. With additional funds from ESSER, the program could be expanded to more schools, additional school staff could be trained, and participants could be trained for conversations that range from prevention to early intervention to support after overdose. 

Implementing SBIRT Pilot Projects 

Pilot projects to address students’ substance use and mental health needs are an innovative and effective use of the time-bound funding appropriated to the state through ESSER. Specifically, we encourage DOE to use the funding to implement SBIRT pilot projects in all Georgia high schools. 

GCSA has successfully implemented two SBIRT pilot projects, one at Marietta High School and one at Decatur High School, that demonstrated the effectiveness of providing SBIRT in high school settings. In both projects, local community members in recovery from substance use were embedded in the schools to lead the substance use screenings and conversations with students. 

SBIRT pilot projects would allow schools to screen students at risk for substance use; provide opportunities for school staff to learn strategies and interventions for addressing substance use; tailor the screening and brief intervention model to the specific needs of a school; capture data and lessons learned for implementing the program successfully throughout the state; and allow schools to adopt sustainable funding mechanisms to support the programs long-term.4 

Sustainable Investments in School-Based Health Services to Address Substance Use 

In 2018, Georgia submitted a State Plan Amendment (SPA) to CMS to remove the Individualized Education Program (IEP) requirement for school nursing services and allow school districts to bill for school nursing services provided to all Medicaid-enrolled students. Implementing this SPA would bring in additional revenue from the federal government and increase resources for schools to address student substance use.5 For example, if the SPA were implemented and the SBIRT pilot projects were successful, school Medicaid reimbursements could cover the cost of sustaining the program. The SPA is currently on hold, but if the state revived it, ESSER funds could be used to cover the costs of setting-up the program, thus making the funding more sustainable. We encourage DOE to collaborate with the Department of Community Health to revisit the SPA and leverage ESSER funds to implement the change. 

Population-based approach

We commend the Department of Community Health for taking a population-based approach to improving the health of Georgia’s Medicaid members. We are especially encouraged by the Department’s commitment to engaging with the care management organizations (CMOs) to monitor and improve racial health disparities among Medicaid members. This commitment is a strong first step, and we believe DCH could go even farther to address and improve health disparities in these three ways:

Planning for Healthy Babies

Planning for Healthy Babies (P4HB) is an important program to improve maternal and infant outcomes and address health disparities, but it serves only a small population of women in Georgia. One of the reasons P4HB is so successful is the targeted outreach efforts to women in areas with poor infant health outcomes. DCH should take a similar approach for all Medicaid eligible populations. By focusing CMO and DCH outreach efforts on areas of the state with poor health outcomes and high Medicaid-eligible populations, they may be able to make a similar impact on health disparities for a larger population.

Meaningful engagement with Medicaid members

To successfully reduce health disparities, we advise DCH and the CMOs to work closely and meaningfully with Medicaid members and community members from the populations experiencing the greatest health burdens to craft impactful strategies tailored to a specific group. There are great opportunities to close racial health gaps among Georgia’s Black & Hispanic communities especially. Georgia has the 2nd largest Black/African American population in the U.S.(The Office of Minority Health, 2021), and 15% of Black Georgians are uninsured (KFF, 2020). Georgia also has the 9th largest Hispanic/Latino population in the U.S., and 47% of Georgia Hispanics are uninsured (The Office of Minority Health, 2021). Black and Hispanic Georgians suffer from chronic and infectious diseases, including COVID-19, at rates higher than those of white Georgians CDC, 2021) and have shorter life expectancies ( The Office of Minority Health, 2021).

Unique barriers (including language, systemic inequities to build wealth, available pathways to coverage, immigration status, social discrimination, and more) block these groups from equitable health status and outcomes. These complex and long-standing barriers to health can only be overcome with meaningful, sustained engagement with members of these and similar groups. Based on GHF’s observations, the infrastructure that DCH and CMOs have for engaging members falls short of what is needed. (GHF humbly offers its assistance to all interested parties re-thinking engagement strategies and programs.)

Beyond language and cultural competency

The Quality Strategy points to translation and language services and cultural competency as strategies to reduce health disparities. These are important components, but they are not sufficient on their own. We encourage DCH to explore additional interventions that better address the root causes of disparities. These interventions could include maximizing the roles of the state’s community health workers (CHWs) and peer support coaches; and incentivizing CMOs to operate robust wrap-around service programs to address housing, food, transportation, and economic needs of members. Numerous studies have shown that CHWs and peer support coaches can play meaningful roles in improving health outcomes, lowering health spending, and reducing health disparities (Chan, 2021).

Another solution to reducing health disparities is to ensure every Georgian has a pathway to health coverage. Medicaid expansion would go farther than the proposed Pathways 1115 waiver towards accomplishing this. Several studies have shown that full expansion of

Medicaid (up to 138% FPL) narrowed disparities in health outcomes for Black and Hispanic individuals, particularly related to infant and maternal health (KFF, 2020). While this decision does not lay with the Department of Community Health, your leaders and staff are trusted and important messengers to state lawmakers about how such a move could improve the health of Georgians.

Behavioral health

We were encouraged to see the Quality Strategy call out behavioral health as an area of focus. Data before and during the pandemic supports that behavioral health needs are growing across the population, and there is no doubt that this holds true for Medicaid members.

However, the measures for Goal 1.5 predominantly address mental health (increase screening for depression among adults and adolescents), while largely ignoring substance use. We know that youth substance use is a risk factor for other issues, including school absenteeism, depression, and committing acts of violence. Data show that Georgia youth are experimenting with drugs and alcohol at younger ages (SAMSA, 2019). Therefore, DCH could significantly impact the behavioral health outcomes of young members by adding measures related to substance use screenings and referral to treatment services. To increase screening for substance-use disorders among youth, DCH could leverage CHIP funds for Health Service Initiatives. Utilizing these funds would provide sustainable funding for school-based or population-based services to address substance use.

Access to care via telemedicine

The increased utilization of telemedicine during COVID-19 has proven it is an important method of care for Georgia consumers, including Medicaid members. For that reason, we are pleased to see it identified in the Quality Strategy. However, telemedicine cannot overcome all access challenges because many Medicaid members live in areas with limited internet connectivity, especially those who live in communities of color and rural communities. We encourage DCH to look for additional methods to increase access to care, including addressing transportation gaps.

Notably, the Quality Strategy does not mention the Non-Emergency Medical Transportation benefit for Medicaid enrollees. In our experience, many enrollees do not know about the NEMT benefit and therefore do not make use of it. Additionally, at times NEMT is unreliable and unprepared to meet members’ transportation needs (i.e., sending a regular van to pick up a member who needs a wheelchair-ready van or sending transportation that cannot accommodate a child’s sibling). DCH could increase access to care by promoting the benefit to more beneficiaries and investing in improvements to the program.

Measurement, evaluation, and enforcement

GHF applauds the strong evaluation and enforcement measures included in the Quality Strategy. The inclusion of the value-based purchasing program in the GF 360º program and the intermediate sanctions policy offer strong accountability measures for Georgia’s CMOs.

We were further pleased to see multiple measures of network adequacy, including appointment availability, incorporated into the Quality Strategy. GHF views appointment availability and travel time/distance as perhaps the most accurate measures of network adequacy in terms of increasing access to care. We encourage DCH to hold these measures above other measures like provider member ratios. To meaningfully ensure network adequacy for Medicaid members, we encourage DCH to adopt more robust enforcement measures for these requirements. Specifically, DCH could leverage intermediate sanctions against CMOs with provider directories that are out-of-date or otherwise inaccurate. Requiring CMOs to maintain up-to-date and accurate provider directories will help ensure Medicaid enrollees can receive timely care and avoid costs associated with unknowingly utilizing out-of-network providers.

Legislative update: Week 8

The GHF team prides itself on delivering timely and accurate updates to you on health care happenings at the Capitol. We hope that you enjoy reading our weekly legislative updates and that they help you stay informed and connected. If you enjoy them, please consider supporting our work with a donation today. Thank you for your continued support!

In this week’s update:

• Action alerts: Ask the House Rules Committee to prioritize mental health & substance use recovery today!
• Bills likely to receive a House or Senate vote today
• Approved last week: Emergency services, prior authorization, & the FY22 big budget
• Advocacy events this week: HIV decriminalization & Medicaid expansion advocacy day!
• U.S. Senate approves COVID-19 relief including extra Medicaid expansion funding for Georgia
• GHF’s got you covered this session!