Every year on November 1st, healthcare.gov and state-specific health insurance marketplaces open so that Americans who don’t have job-based health insurance or other coverage can shop for and enroll in health insurance. In 2024, 1.3 million Georgians enrolled in coverage in this way, and this year their marketplace will look a little different. Here’s what Georgians need to know about the changes. 

Since 2013, Georgians have used healthcare.gov to view health insurance plans, qualify for financial help to lower their costs and enroll in the health plan of their choosing. In 2023, Georgia lawmakers moved to change that. The state legislature and Governor Kemp passed a new law that allows Georgia to create its state-based marketplace (SBM). Since then, the Georgia Department of Insurance has been working to create and launch Georgia Access (GeorgiaAccess.gov). Georgia Access launches November 1st. 

As Georgians prepare to cast their votes in this year’s elections, the importance of health care policy has never been clearer. From the future of affordable coverage to the persistent gaps in access for communities around our state, the stakes are high. Georgia’s on-going health challenges highlight the need for candidates who prioritize health and wellness. Georgians need elected leaders who will make decisions that ensure access to affordable, high-quality health care, especially for communities who have historically had more difficult barriers to accessing and affording care.

With this in mind, we’ve developed a set of questions for voters to ask state and local candidates on key health care issues affecting communities around our state. These questions can help guide your conversations with candidates at town halls, forums, or on social media.

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.

Legislative update: Week 11

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:

• Changes to prior authorization bill
• Bills that still need final action
• Updates to Georgia’s FY22 budget
• Vaccine eligibility opens to all Georgians, ages 16+
• GHF’s got you covered this session!

2021 legislative session ends this week

Georgia’s 2021 legislative session is set to wrap up this week. The final two days of the session take place on today, March 29th and Wednesday, March 31st, also called “Sine Die”. Sine Die marks the 40th and final legislative day for the year and means “no future date set”.

Our next legislative update will include a summary of the more notable bills taken up this session. You can find a full list of health care related legislation at GHF’s legislative tracker.

Legislative update: Week 9

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: Tell your legislators to support Medicaid expansion & prior authorization!
• Our priorities: Express lane Medicaid & expanding telehealth services
• Crossover day recap
• Advocacy events this week: LGBT advocacy & League of Women Voters virtual legislative day
• President Biden signs COVID-19 relief including extra Medicaid expansion funding for Georgia
• GHF’s got you covered this session!

This year, no Georgian has been left untouched by the health or economic impacts of COVID-19. America’s failure to control the pandemic has spotlighted the importance of public policy decisions that prioritize health and wellness. The consequences of underfunding essential public health infrastructure and Medicaid, and the disparate impact that public policies have no Black Americans and other people of color is clear. National, state, and local leaders, many elected by the public, are responsible for the policy decisions made ahead of and in response to COVID-19, its economic fallout, and the movement for racial justice.

This election season (October 12 to November 3, 2020), Georgians have the opportunity to learn more about these elected positions, the decision-making power each has, and how those positions impact their health and the well-being of Georgians. This year, Georgians will cast their votes for the U.S. President, members of U.S. Congress, state legislators, state supreme court judges, and other positions.

In this blog, we cover the U.S. President’s impact on the health and well-being of Georgians and their families. 

This year, no Georgian has been left untouched by the health or economic impacts of COVID-19. America’s singular failure to control the pandemic has spotlighted the importance of public policy decisions that prioritize health and wellness. The consequences of underfunding essential public health infrastructure and Medicaid, and the disparate impact that public policies have no Black Americans and other people of color is clear. National, state, and local leaders, many elected by the public, are responsible for the policy decisions made ahead of and in response to COVID-19, its economic fallout, and the movement for racial justice.

Ahead of the 2020 election season (October to November 3, 2020), Georgians have the opportunity to learn more about these elected positions, the decision-making power each has, and how those positions impact their health and the well-being of Georgians. This year, Georgians will cast their votes for the U.S. President, members of U.S. Congress, state legislators, state supreme court judges, and other positions.

As Georgia candidates on this fall’s ballot crisscross the state or their districts asking for support, voters will consider their positions on a number of important issues including health care. To help voters make their decisions, we put together this list of questions for voters to ask of candidates about five timely and pressing consumer health care issues. These questions can be used at town halls and candidate forums or posed to candidates via social media or in one-on-one conversations.

As Georgia faces the public health emergency of COVID-19, it can be hard to be optimistic about our health and our futures. However, Georgians for a Healthy Future believes that our state can successfully overcome this tremendous challenge if Georgians adhere to the advice of public health experts and our state’s leaders swiftly adopt evidence-based policies that protect the health and safety of all Georgians. At the same time, Georgia leaders must look ahead to ways they can promote the health and well-being of all Georgians in the economically challenging months to come. Georgians for a Healthy Future has identified policy priorities that we believe are necessary for success in addressing the immediate public health emergency and the emerging economic consequences. These are the policies that we will fight for as we continue our fight for the health and wellness of all Georgians.

Our recommendations are shaped by feedback from GHF’s board of directors, partner advocacy organizations, local groups helping Georgians in their communities, and stories from Georgians just like you. You can share your COVID-19 experiences with GHF here. Thank you for your generous input.

As the status of this crisis changes and we gather more information, you can find updates to these policy recommendations and actionable information here.

Health system capacity and public safety

GHF supports:

• Statewide and local shelter-in-place orders and other aggressive social distancing practices to slow the spread of the COVID-19 virus
• Funding to quickly expand the capacity of Georgia’s Department of Public Health to test and monitor the spread of COVID-19
• Funding to purchase personal protective equipment for health care workers
• Funding to purchase equipment for patient care like ventilators and respirators
• Maximizing the scope of practice for all qualified and licensed health care providers (e.g. physicians assistants, advanced practice registered nurses, registered nurses)
• Expanding options and health coverage of telehealth and virtual visits in all medically appropriate circumstances

Access to quality, affordable health care for all Georgians

GHF supports:

• Maximizing Medicaid flexibility and funding to increase access to care by:
  • Expanding Medicaid to all poor and near-poor Georgians (those making less than 138 percent of the federal poverty line)
  • Taking advantage of emergency 1135 waivers to increase the number of providers who can see Georgians with Medicaid coverage
  • Adopting administrative changes to preserve coverage for current Medicaid members and to enroll Georgians who are already eligible but unenrolled, including the expansion of presumptive and retroactive eligibility and a halt on the annual renewal process
  • Expanding coverage of home- and community-based services and long-term services and supports
• Expanding access and protections in comprehensive private health coverage
  • Promoting enrollment for people who qualify for private insurance, especially among those who are eligible for financial assistance through the Affordable Care Act (ACA) by:
    • Establishing a new Special Enrollment Period for people who wish to purchase health insurance now
    • Easing the enrollment and paperwork requirements for people enrolling in coverage due to job loss or income changes
    • Prohibiting health insurers from canceling a consumer’s coverage, even if they fall behind on premium payments
  • Eliminating cost-sharing for COVID-19 testing (and related tests) and treatment
  • Limiting the sale of plans that do not offer comprehensive benefits or follow the standards set by the ACA
  • Establishing comprehensive surprise billing protections
• Promoting access to mental health services and substance use recovery supports for all Georgians
• Easing limits on prescription drugs so that consumers can more easily access 90-day supplies of medications

Equity at the center of the response

This pandemic will hit some Georgia communities harder than others. All federal and state policy remedies should endure to offer the most help to those who are disadvantaged due to income, race or ethnicity, disability or health status, age, geography, and other factors. Georgia’s response must proactively address health equity concerns. Among other strategies, this should include disseminating public health messages that include information about affected groups and communities in languages and contexts they understand and directing additional funding to community health centers and other providers that serve disproportionately impacted communities.

Meeting the basic needs of Georgians and their families

As evidenced by yesterday’s job loss statistics, it is imperative that the public health response to the COVID-19 crisis be followed by an ambitious economic response. GHF supports policies that provide equitable opportunities for stability, dignity, and well-being for all Georgia families. While not an exhaustive list, these policies include:

• Expanded access to Georgia’s unemployment insurance system, including 26 weeks of benefits and the easing of eligibility requirements and activities.
• A moratorium on foreclosures and evictions, the provision of rental assistance and mortgage forbearance, and other supports that keep Georgians in their homes
• Improved access to nutritious foods through SNAP, WIC, school system food programs, and other public programs
• Universal paid family leave that allows workers regardless of income to take time off to care for themselves and their loved ones in times of sickness and crisis
• A moratorium on utility shut offs, including internet access so that families can keep the lights on and children can continue to learn remotely

GHF will support partner organizations in their efforts to advocate for these policies and supports for Georgia families and individuals.

Some of these policies have been adopted or partially adopted by federal officials, Governor Kemp, and state agency officials. GHF thanks Georgia leaders for the actions they have already taken. In the coming weeks, GHF will track which policies are fully implemented, partially adopted, or not taken up at all, and will provide updates accordingly.

Thank you for your support and advocacy. We wish you health and safety!

Updated: December 18, 2020

The Georgians for a Healthy Future team is continuing to monitor the COVID-19 (coronavirus) outbreak closely. As always, GHF strives to be a resource for Georgia consumers. While things continue to change quickly during this health care pandemic, we will share practical advice and actionable information to help you navigate a confusing time and find the answers you need. Here we present information about how to access health care services and what to expect from your health insurance coverage when you do. We will keep the corresponding blog post updated as things change and with links to helpful resources as they become available.

Georgia’s statewide shelter in place ended on April 30, 2020 for most Georgians. Vulnerable populations including those who are medically fragile and elderly should continue to shelter in place until June 12, 2020.

Governor Kemp also extended Georgia’s public health state of emergency through January 08, 2020. He also issued executive orders requiring businesses to operate by strict social distancing and sanitation rules through May 13, 2020. As of June 1, 2020 restaurants are still required to abide by 39 restrictions to open their dining rooms.

We encourage all of you to continue to help prevent the spread of the virus by taking the necessary steps to “flatten the curve” including staying home, avoiding group gatherings, washing your hands, practicing good hygiene, and following the guidance of public health experts.

If you are experiencing symptoms of COVID-19 or may need a test

If you believe that you are experiencing symptoms of COVID-19 or have been exposed to the novel coronavirus, call your primary care doctor or an urgent care clinic. Let them know you think you may have COVID-19, so they can take the proper precautions and direct you to available testing sites. You may also call the Georgia Department of Public Health on their COVID-19 hotline at 844-442-2681. Public health officials are urging people not show up unannounced at a doctor’s office, emergency room or other health care facility.

The Centers for Disease Control and Prevention have a Coronavirus Self-Checker which may be a helpful tool if you think you are experiencing symptoms of the virus.

You can find out more about COVID-19, its symptoms, what to do if you think you are sick, and other COVID-19 information at dph.georgia.gov/novelcoronavirus.

COVID-19 testing is available for all Georgians, regardless of whether you have coronavirus symptoms. Anyone can call their local health department to get scheduled for testing. They can also download the Augusta University ExpressCare app, visit augustahealth.org, or call (706) 721-1852.

Effective May 7, 2020, COVID-19 testing is available to all Georgians who request it, whether they have symptoms or not. Call your local health department to schedule an appointment at a location near you and to inquire if testing is free.

What to expect from your health insurance

If you have insurance, make sure to use it for any testing and medical exams related to COVID-19 and any other medical services you may need during this time.

The COVID-19 crisis has caused many Georgians to lose their jobs and also lose their employer-sponsored health care coverage. If you have lost your coverage or have had a drop in your income, you may be eligible for Medicaid or financial assistance to buy health insurance through the Affordable Care Act. Please read the If You Lose Your Job section below.

If you have Medicaid or PeachCare for Kids

If you and your family have lost your source of income in this crisis, or are in lower-income work with no health coverage, enrolling in Medicaid may be an option for you.

Medicaid provides all “medically-necessary” services to its members. During the national public health emergency period, your Medicaid coverage will cover the cost of a COVID-19 test.  If you are diagnosed with COVID-19 and need medical treatment, Medicaid should also cover those costs. 

Check with your Medicaid insurance company for more information and guidance. Click the name of your Medicaid company to find out more: Amerigroup, CareSource, PeachState Health Plan, and WellCare.

If you need other health care services during this time, check with your Medicaid insurance company and doctor to see if you can have a “virtual appointment” using the internet, video call, or telephone call, instead of going in-person.

Georgia’s Department of Community Health (DCH) has announced that Medicaid & PeachCare members will not owe any co-payments for any health service from May 1, 2020 until the end of the national public health emergency.

No one can willingly lose their Medicaid coverage during the public health emergency. If you lose your Medicaid coverage during this time, contact your Medicaid insurance company.

If you have private insurance

If you have insurance through your job, the State Health Benefit Plan, or the Affordable Care Act marketplace (also called healthcare.gov), use it for any testing or medical exams related to COVID-19. The Families First Act requires that health plans and insurers cover testing for COVID-19 so your test should be free. If someone wants to charge you for a test, call the DPH’s COVID-19 hotline.

If you are diagnosed with COVID-19 and require medical treatment, you should expect to pay some out-of-pocket costs like your deductible.

As of March 21, 2020 Cigna, Humana, Aetna, and UnitedHealthcare have waived cost-sharing for COVID-19 treatment. Aetna and Cigna have pledged to waive COVID-19 treatment costs for qualified medical bills until June 1, 2020. Humana has not announced an end date to their COVID-19 cost-sharing policy.

If you purchased coverage outside of the ACA marketplace or you have a short-term plan or health-sharing ministry, call your insurance company to find out how they are covering COVID-19 testing and treatment. The cost-sharing requirement under the Families First Act does not apply to people who are enrolled in non-ACA compliant plans (ex: short-term plans).

If you need other health care services during this time, check with your insurance company and doctor to see if you can have a “virtual appointment” using the internet, a video call, or a telephone call instead of going in-person.

In order to ensure people affected by COVID-19 have access to health care Georgia’s Insurance Commissioner issued a directive on March 20, 2020, that instructed health insurers to refrain from canceling health policies due to non-payment. That directive expires on May 31st. If you are behind on your premium payments or expect to be, call your insurance company right away to see if they can offer a payment plan, financial assistance, or other help to keep you enrolled.

If you have Medicare

Medicare covers the lab tests for COVID-19. You pay no out-of-pocket costs. All necessary hospitalizations are also covered by Medicare, including hospitalizations for quarantine. More information about Medicare’s coverage and services is available here.

If you are uninsured
If you need a COVID-19 test, contact your local public health department to find a testing site and to ask whether the test will be free. Request that they waive any testing costs.

If you need other health care services during this time, find a local community clinic, or apply for financial assistance through a hospital charity care program. Georgians should not let their insurance status get in the way of getting needed testing or treatment.

If you lose your job

Many Georgians across the economy have lost their jobs and may be at risk of losing their coverage. If this is your situation, you can keep yourself and your family covered during this health crisis. You may be eligible for a Special Enrollment Period up to 60 days after losing your job-based health insurance. When you begin the enrollment process, healthcare.gov will ask you about your estimated income for 2020 and will let you know if you qualify for financial help to lower your premiums and other cost-sharing. 

For free help with the enrollment process, contact these organizations:

• Insure Georgia, insurega.org, 866-988-8246
• The Health Initiative, thehealthinitiative.org, 404-688-2524 (leave a voicemail in the general mailbox)

Coverage through the ACA marketplace (healthcare.gov) covers testing for COVID-19. It will also cover part or all of the costs related to COVID-19 treatment. Call your insurance company for more information.

If you are unable to enroll in a health insurance plan, you may have other options through services such as a community clinic, which can connect you with the care you need.

Resources for you and your loved ones

During this uncertain time, many of our partner organizations are doing the hard work of finding and centralizing the information that you and your loved ones may need. Here are a few that we think are most helpful. We will continue to update this list with actionable resources and information so you can stay healthy, safe, and well. 

• COVID-19 guidance and information
  • Information from public health experts: Visit the Georgia Department of Public Health’s website for the latest guidance and updates about COVID-19 in Georgia.
  • Coronavirus resources for people who are not strong readers: Georgia State University has published a library coronavirus materials for people who may not have strong reading or literacy skills. They have included materials up to a 9th-grade reading level.
• COVID-19 guidance and information for people who do not speak English as a first language: 
  • Google Drive folder with resources in 20 languages, collected and maintained by the Center for Pan Asian Community Services
  • The GSU School of Public Health’s Prevention Research Center has compiled COVID-19 information sheets (from CDC & the International Rescue Committee) in 25 languages
• Make sure your basic needs and finances are taken care of:
  • If you need help finding food:
  • Food Bank of Northeast Georgia: Visit www.foodbanknega.org, click “Need Help”. Call the office at (706) 354 8191
  • Atlanta Community Food Bank: Text the word FINDFOOD to 888-976-2232 with your ZIP code and street address and you will be sent a list of the three closest distribution centers.
    Text service also available in Spanish, using the word COMIDA
  • Georgia Mountain Food Bank: uses the same system as Atlanta Community Food Bank
  • Golden Harvest Food Bank Visit www.goldenharvest.org, click on ‘Find Help’ at the top of the page, you will be taken to a map where you can enter your zip code to find the nearest food distributor
  • Middle Georgia Community Food Bank–Call 211 and you will be connected with an associate who will be able to tell you where you can find food
  • Feeding the Valley Food Bank: Visit feedingthevalley.org, on the front page, enter your zip code into the ‘Need Food’ box and you will be shown the closest food pantries to your location
  • America’s Second Harvest of Coastal Georgia: Visit helpendhunger.org, select ‘Find Food’ on the homepage, you will be taken to a map where you can enter your zip code or county to be shown the nearest food distribution centers
  • Second Harvest of South Georgia: Visit feedingsga.org, select ‘Find Help’ in the ‘Learn’ section at the top of the page, you will be taken to a map where you can find the closest distributors to you

• Housing:
  • Georgia Covid-19 Resource List, Atlanta Legal Aid Society, Inc.
  • GLSP’S Eviction Prevent Project, Georgia Legal Services Program
• Finances:
  • COVID-19 stimulus payments: The IRS has published a way for people to receive their recovery refund (also called COVID-19 stimulus payments) even if you were not required to file taxes in 2019. Details are available here.
  • Avoid scams: What Consumers Need to Know About COVID-19 Scams, Georgia Watch
  • Direct financial assistance: Patient Advocates Fund’s COVID Care Recovery Fund delivers $500 in direct financial aid to eligible patients who need non-medical, cost-of-living help as a result of their diagnosis of COVID-19.
  • Financial health during COVID-19: Financial Resilience Center, National Disability Institute
• Health Care:
  • Find a clinic – Georgia Primary Care Association
  • Find a clinic – Georgia Charitable Care Network
• Resources for people with developmental disabilities:
  •  COVID-19 Resources for Georgians with Developmental Disabilities, Georgia Council on Developmental Disabilities
• Staying mentally healthy and keeping your recovery: Behavioral Health in the time of COVID-19 by Georgians for a Healthy Future
• Keeping children healthy and well: 
  • COVID-19 latest information and resources, Voices for Georgia’s Children and Georgia Statewide Afterschool Network
  • Teach Kids Coping Skills, Children’s Healthcare of Atlanta Strong4Life
  • Transitioning Into Your Family’s New “Normal”, Children’s Healthcare of Atlanta
  • Five-Minute Coronavirus Stress Resets, The New York Times
• Resources for pregnant families during COVID-19: Healthy Mothers, Healthy Babies Coalition of Georgia has put together a toolkit for families navigating pregnancy, labor, and the postpartum period in Georgia during COVID-19
• Community Health Workers
  • Information and Resources for Community Health Workers: This information kit was created for CHWs serving in Georgia to supplement the robust list of information provided by the National Association of Community Health Workers.