On December 23, 2019, the Georgia Department of Community Health (DCH) submitted Governor Kemp’s Medicaid waiver proposal to federal health officials.

The Governor’s proposed 1115 Medicaid waiver, called Georgia Pathways plan, would allow Georgians with incomes below the poverty line to enroll in Medicaid coverage but only if they can meet monthly work requirements (at least 80 hours per month of work, school, training, or volunteering per month). The plan would cover only a fraction of those who could be covered by a full Medicaid expansion.

DCH’s submission of the proposal to the Centers for Medicare & Medicaid Services (CMS) comes after a 30-day public comment period, during nearly 1000 Georgians weighed in with their opinions on the plan. Despite the overwhelming opposition to the plan, Governor Kemp and DCH sent their proposal to federal officials with no meaningful changes.

On January 8, 2020, officials at CMS determined Georgia’s application was complete, which kicked off a second 30-day public comment period. The public comment period allows Georgians impacted by this plan, health advocates, and any other interested party to weigh in.

Along with more than 1700 others, GHF submitted comments to communicating our deep concerns about the plan’s shortcomings. You can read GHF’s full comments here.

Legislative Update: Week 1

The 2020 legislative session has begun

Last week, the Georgia General Assembly convened for the first time in 2020. The first four days of the 2020 legislative session were mostly taken up with committee appointments, Governor Kemp’s second State of the State address, and other annual traditions including GHF’s own Health Care Unscrambled. 

This week will be dedicated primarily to budget hearings for the current (FY 2020 Amended) and next year’s (FY 2021) state budgets. The General Assembly will reconvene next Monday, January 27th for the fifth day of legislative session. 

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Efforts to address surprise billing gain early momentum

The issue of surprise out-of-network medical billing (sometimes called “surprise billing” or “balance billing”) is already getting a lot of attention early in the 2020 session. At Health Care Unscrambled, Senate Health & Human Services Chairman Ben Watson said, “If we do not pass balanced billing or surprised billing this year, I don’t think it will be a successful session.” Governor Kemp added his support during his State of the State address, saying “Working with patients, providers, and the private sector, we’ll craft a legislative remedy to reduce surprise medical billing. We will demand transparency, embrace empathy, and insist on fairness.” 

GHF and our partners at Georgia Watch have long advocated for a legislative solution that protects Georgia consumers from payment battles between insurers and providers. We are grateful for the support of Governor Kemp, Lieutenant Governor Duncan, and legislative leaders on this important issue. We look forward to working with all parties to ensure that Georgia consumers are no longer stuck with surprise bills when they go to the doctor.

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Governor outlines priorities in annual address

Governor Kemp submits his budget recommendations

On Thursday, Governor Kemp addressed the General Assembly in his second annual State of the State address and, per tradition, used the opportunity to introduce his proposed budget. Governor Kemp also laid out his priorities for his second year in office, including education, foster care, and public safety.

The amended budget (an update to the current state budget) includes a 4% cut to cut state spending through the end of the state fiscal year (June 30, 2020).

The Governor’s recommended FY 2021 budget, which will begin on July 1, 2020, includes a 6% cut to state spending. Despite the cut, a $89.6 million increase in the Medicaid budget is proposed to address growing enrollment. The House will now take up and consider the two budgets before passing them to the Senate later in the session.

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Action Alert!

Act now, submit your comment today!

Before the legislative session began, Gov. Kemp filed paperwork with health officials in the federal government to move forward with their plans to change Medicaid and private insurance in Georgia. Now those health officials must ask for your input, beginning with the Medicaid plan! 
 

Gov. Kemp’s Medicaid plan will leave thousands of low-income Georgians with no meaningful pathway to coverage. We need you to step up AGAIN and become a health care hero by telling health officials what you think of the Medicaid plan! The deadline for comment is Friday, February 7th. Visit CoverGA.org to comment today! 

Did you submit a comment in November? Please submit a comment again so federal officials can hear directly from you.

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Early legislation introduced

Legislation to restrict vaping

SB 298 would raise the minimum age to purchase vaping products from the current age of 18 to 21. It would also set tougher penalties for selling tobacco, nicotine and vaping products to minors and would require schools to include information about the harms of vaping and smoking in their health education curricula. The legislation is sponsored by Senator Renee Unterman. Similar legislation is expected to be introduced in the House in the coming weeks. The bill has been referred to the Senate Regulated Industries and Utilities Committee.

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The legislative calendar begins to take shape

The General Assembly set its calendar for the first fourteen days of the 2020 legislative session in HR 879. After this week’s budget hearings, the session will pick up again according to the following schedule:

January 27: Day 5

January 28: Day 6

January 29: Day 7

February 30: Day 8

February 31: Day 9

February 3: Day 10

February 4: Day 11

February 5: Day 12

February 6: Day 13

February 10: Day 14

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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, we have the tools you need to stay in touch with health policy under the Gold Dome.

• Sign up for the Georgia Health ActionNetwork (GHAN) to receive action alerts that let you know when there are opportunities for advocacy and action
• Track health-related legislation
• GHF’s 2019-2020 legislative priorities

Atlanta, Georgia – Statement by Laura Colbert, Executive Director of Georgians for a Healthy Future, regarding today’s ruling by the 5th Circuit Court of Appeals in the Texas v. U.S lawsuit.

The lawsuit seeks to invalidate the Patient Protection and Affordable Care Act; Georgia is a plaintiff in the case.

“Today’s ruling by the 5th U.S. Circuit Court declaring the Affordable Care Act’s individual mandate unconstitutional and remanding the law back to District Court only serves to prolong Georgians’ uncertainty about their access to quality, affordable health care.

“More than 480,000 Georgians enrolled in health coverage through the ACA’s marketplace in 2019 and nine in 10 benefit from financial help to reduce their costs. Many, many more Georgians benefit from the standards and protections put in place by the ACA.

“As long as the court continues to entertain this legally dubious case, thousands of Georgians are at risk of losing their health coverage, protections for people with pre-existing conditions, and access to basic health services like mental health care and prescription drugs. Revoking the ACA’s protections and disentangling the law from Georgia’s health care system would only serve to sow chaos and confusion, to the detriment of Georgia families. These losses would disproportionately affect Georgians of color who already face inequitable barriers to care.

“The support of this lawsuit by Georgia Governor Kemp and Attorney General Carr is incongruent with their respective statements about increasing access to care and improving affordability for Georgia families and individuals. We urge Georgia leaders to re-consider their support of this case.

“It is important for Georgia consumers to know that this does not change the coverage they have today or their 2020 insurance plans. Georgians should maintain their health coverage and seek help at healthcare.gov if a life change results in a loss of their current coverage.”

For more information about Georgia consumers and Georgia’s ACA marketplace: Getting Georgia Covered: What we can learn from the 6th open enrollment period

About GHF:

With a mission to build and mobilize a unified voice, vision, and leadership to achieve a healthy future for all Georgians, Georgians for a Healthy Future provides a strong voice for Georgia consumers and communities on the health care issues and decisions that impact their lives. Georgians for a Healthy Future has a three-pronged approach which includes: 1) outreach, education, and engagement with consumers and communities; 2) coalition building and mobilization; and 3) public policy advocacy. For more information, visit www.healthyfuturega.org.

In March, Georgia’s Governor and state legislature approved SB 106, legislation that allows the state to pursue an 1115 “waiver” to make changes to Georgia’s Medicaid program and a 1332 state innovation waiver to make changes to private insurance in the state. (Waivers allow a state to set aside or “waive” certain requirements imposed by the federal government and try new models of providing health coverage and care.)

In June, the Governor hired Deloitte Consulting to develop the proposals for Georgia’s Medicaid program and the private insurance market. Five months later, on October 31^st and Nov. 4^th respectively, Governor Kemp announced the details of his proposed plans.

The Governor’s proposed 1115 Medicaid waiver, called Georgia Pathways plan, would allow Georgians with incomes below the poverty line to enroll in Medicaid coverage but only if they can meet monthly work requirements (at least 80 hours per month of work, school, training, or volunteering per month). The plan would cover only a fraction of those who could be covered by a full Medicaid expansion.

The Governor’s proposal to re-shape the state’s private health insurance market consists of two parts:

1. A reinsurance program to lower premiums; and
2. A dramatic erosion of the Affordable Care Act’s rules and structures, including provisions that privatize insurance enrollment; cap the financial assistance available to low- and middle-income consumers; and erode consumer protections (like the requirement that health plans cover essential health services).

This plan would result in many Georgians who currently have health insurance becoming uninsured or underinsured.

The announcement of the Governor’s plans kicked off a 30-day public comment period during which Georgians impacted by these proposals, health advocates, health care industry stakeholders, and others could weigh in on the plans. 

The Governor’s Medicaid proposal does not go far enough towards closing Georgia’s coverage gap and his plan to dramatically scale back the ACA in Georgia would turn back the clock on Georgians with pre-existing conditions and consumers who need financial help to afford private coverage, among many others. GHF submitted comments to state officials communicating our deep concerns about both plans. You can read GHF’s full comments here:

• GHF’s comments on Georgia’s 1115 Medicaid demonstration waiver application
• GHF’s comments on Georgia’s Section 1332 waiver application

On November 4, 2019, Governor Brian Kemp released a draft plan that, if approved, would drastically undermine comprehensive coverage for the 417,000 consumers who now have comprehensive coverage through the marketplace. Federal law allows states to make changes to the Affordable Care Act (ACA) so long as a comparable number of Georgians have coverage that is at least as comprehensive and affordable as they would have under the ACA, and the changes do not increase the federal deficit. Even under the most forgiving interpretation of these guardrails, Governor Kemp’s proposal fails to meet the test.

Fortunately, there’s still time to fight back! The state is required to seek public comments on this plan and will be accepting comments until December 3, 2019. Comments can be submitted online at CoverGA.org, at in-person comment hearings. This is an opportunity for Georgians to tell state leaders how this plan will impact their health and finances, and the health and finances of their loved ones.

Instead of undermining the coverage that so many Georgians rely on, state leaders should focus on preserving critical consumer protections, strengthening comprehensive coverage, investing in outreach and enrollment to Georgia communities, and working to address the rising health care costs for low-and middle-income Georgians. 

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Disrupts coverage for more than 400,000 Georgians with a privatized marketplace 

Governor Kemp’s proposal seeks to expand coverage to approximately 30,000 out of more than one million uninsured Georgians at the peril of those consumers currently enrolled in comprehensive coverage using a risky new program. 

At the center of his plan, Governor Kemp aims to decentralize how consumers currently enroll in individual market coverage in favor of private web brokers and insurers. This means that consumers would no longer have an unbiased place to compare plan options and instead would be forced to rely on private entities who would have the incentive to enroll consumers in plans that offered the highest commission and not necessarily the plan that best fits their health needs.

Likely result: Georgia consumers will struggle to navigate numerous websites, translate the sales lingo of insurers, and disentangle conflicting information. For many, it may be harder to find in a plan that they feel good about.

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Limits financial assistance, increasing out-of-pocket costs

Along with dismantling healthcare.gov, Governor Kemp plans to restructure financial assistance in a way that would raise premium costs for comprehensive coverage and likely cause many Georgians to lose coverage altogether. Under his plan, consumers could use financial assistance to purchase skimpier coverage, like short-term plans, that don’t have to meet the ACA’s minimum standards. Additionally, his plan doesn’t address whether or not cost-sharing reductions would be required, which currently help to lower deductibles and other out-of-pocket costs for certain low-income consumers. As a result, Georgia consumers should expect to pay more out-of-pocket to get the care they need.

To make matters worse, because financial help is based on premiums for comprehensive coverage that will likely become more expensive under this plan, providing financial help to all eligible Georgians will cost more than what is currently budgeted. This means that some consumers who currently receive (or are eligible for) financial help would lose this valuable benefit.

Likely result: Premiums for comprehensive coverage will rise. At the same time, fewer Georgians will receive financial help to purchase coverage. Georgians will pay more out-of-pocket when they need health care.

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Weakens consumer protections

In order to allow private companies to run enrollment, the Governor’s plan seeks to eliminate crucial consumer protections. The protections that may be suspended include the requirement that insurance plans include enough doctors and hospitals so people can get care (called “network adequacy”); requirements about what information insurers must provide to consumers and how that information is presented; and mental health parity, which requires insurers to cover mental health services in a similar way as other health care. The Governor’s plan assumes these new skimpy plans will provide 90% of the benefits that comprehensive coverage under the ACA provides. There is no explanation or evidence to support this assumption.

Removing the requirement to cover the ten essential health benefits and mental health parity threatens access to critical services for many consumers with pre-existing conditions. For example, treatment and recovery services for people with substance use disorders would be threatened at a time when the state continues to struggle with opioid-related deaths and substance use disorders in general. These consumer protections enable people with mental illness and substance use disorders to obtain insurance that covers their conditions without bankrupting them. Without them, consumers will have to pay out-of-pocket for life-saving care, opening them up to thousands of dollars of medical debt.

Likely impact: Skimpy plans that do not offer basic health services like prescription drugs, maternity care, or mental health services will become commonplace. As a result, Georgians will have a harder time accessing needed care and will pay more out-of-pocket.

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The bottom line is Governor Kemp’s plan is terrible for Georgians. Any rational analysis will find it doesn’t meet even the laxest requirements of federal law. Georgians should weigh in today to reject this plan!   

Philip is a 57 year old part-time roofer who resides in Fort Gaines, Georgia, a rural community in the southwest region of the state.

Philip suffered a knee injury along with a herniated disc in his back while repairing a roof. Because he is uninsured he has been repeatedly refused medical care because of his inability to pay. Despite making financial sacrifices to see several doctors and specialists, he has been unable to receive adequate help and get the treatment he needs. Philip says that if he had health coverage he would find the right specialist, get an MRI, and have his back fixed so he would no longer be in severe pain every day.

For the time being, Philip is able to see Dr. Karen Kinsell, the last practicing physician in Clay County. Dr. Kinsell is a volunteer physician who provides medical care to approximately 3,000 patients in a small office building that once served as a Tastee Freeze stand. Dr. Kinsell has advised Philip to stop roofing in order to ease the pain in his back but roofing is currently his family’s only income and Philip says there are no other viable job options for him in the area.

Philip believes access to health care is important and that significant changes need to be made so more people can access care. “Fix the issue, fix the problem, health insurance isn’t affordable for low-income people trying to work. Help us.”

Like Philip, 360,000 low-income Georgians, many of whom are uninsured, live in small towns and rural areas across the state. These areas have the most at stake in the debate over whether or not to close Georgia’s health insurance coverage gap. For rural Georgia residents like Philip, health coverage would open doors to the physicians and other health services that they need to stay employed or get back to work. For rural communities like Fort Gaines, more residents with health coverage could attract another primary care physician to the area.

Right now, Georgia’s policy makers are drafting two health care “waivers”. One of the waivers could be used to extend coverage to all low-income adults, including Philip and his southwest Georgia neighbors. Or state leaders could continue to ignore the needs of low-income, rural Georgians with a more limited plan.

The details of these waivers will be announced in the coming weeks and state leaders must offer online and in-person opportunities to hear public feedback. GHF will keep you up-to-date about what the waivers will mean for Georgians like you and Philip, and help you weigh in during the public comment periods!

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Your story is powerful! Stories help to put a human face to health care issues in Georgia. When you share your story, you help others understand the issue, its impact on Georgia, and why it’s important.

Your health care story is valuable because the reader may be your neighbor, friend, someone in your congregation, or your legislator. It may inspire others to share their stories or to become advocates. It is an opportunity for individuals who receive Medicaid or fall into the coverage gap, their family members, their physicians and concerned Georgia citizens to show that there are real people with real needs who will be impacted by the health policy decisions made by Congress and Georgia’s state leaders.

Share your story here!

Since launching our Georgians in the Driver’s Seat initiative with The Arc Georgia, GHF staff have spoken with consumers around the state about their transportation needs as they relate to health. During one of those opportunities, GHF met Tannyetta and her four-month-old daughter Ayla at Atlanta’s CAPN Clinic.

Tanyetta enrolled in Medicaid while she was pregnant and both she and Ayla have Medicaid coverage now. In order to get back and forth from health appointments Tanyetta uses a free transportation service through Medicaid. This benefit, available to Medicaid-covered Georgians who do not have their own transportation, is called non-emergency medical transportation (NEMT). Transportation is provided in the form of pre-loaded public transit cards, van transport, rides with ride-share companies, and in other ways depending on the needs of the individual. Tanyetta does not have her own transportation but is able to get to medical appointments safely because of NEMT.

Much like Tanyetta, Georgians around the state are able to see health providers because they can use NEMT if they do not have another way to travel. For almost 400,000 Georgians each year, the service works well. However, there are times when it falls short of its promise. Patients and families are picked up late going to or from an appointment. In the worst cases, they are never picked up at all. People who use wheelchairs are picked up by vans that cannot accommodate their chairs. Parents who need to take one child to see the doctor are blocked from bringing their sibling, forcing them to find alternative and expensive childcare.

The people for whom NEMT is breaking down are often those who need it the most: patients with complex care needs. These riders are children and adults with physical and intellectual disabilities, seniors who would otherwise have to live in nursing homes, and people with multiple chronic conditions. Almost four million NEMT rides are provided to Medicaid-covered Georgians each year. Riders use an average of nine trips per year, demonstrating that those who use the service visit the doctor frequently and rely heavily on NEMT to get them there. When NEMT falls short for these riders, the consequences can be serious, so it is imperative the system works well all of the time.  

In order to improve Georgia’s NEMT services (so that they work all of the time, every time!), we need to hear from the people who use it. You can help! Fill out this rider survey, if you use transportation services to get to health appointments. If you are a caregiver or otherwise help people arrange for NEMT rides, we want to hear from you too.

If you do not fit into one of those categories, share the survey with someone who does! Ask your patients, your social media network, and others to fill out the survey if they have used Medicaid’s transportation services. The survey is available at this link and is open through December 09, 2019: https://www.surveymonkey.com/r/MedicaidTransport.

Have a story about transportation and health that you want to share? Tell us about it! We’ll get in touch with you soon to learn more.

Sherry is 77 years old and lives independently in Murray County in north Georgia. She gets up five days a week at 5 am and prepares for her day, which begins with a bus ride to the RossWoods Adult Day Center. Medicaid and Medicare make it possible to spend her weekdays at RossWoods where she engages in arts and crafts and social activities designed to keep her brain and body healthy. She also receives information about her medications and doctor’s appointments. Sherry is one of over half a million seniors and people with disabilities in Georgia who depend on Medicaid and Medicare to live and function in their communities.

Sherry has several health conditions including high blood pressure, a blood clot in her heart, chronic obstructive pulmonary disorder, a pacemaker, and arthritis in one of her legs. On top of all that, she recently fell and broke her wrist, causing nerve damage. Thanks to Medicaid, Sherry is able to afford the medications she needs to live a functional and healthy life. She would not have the financial means to pay the standard $30–$50 copay for each of her seven medications but Medicaid means she pays just $1.20 per medication instead.

To get to the pharmacy for her medications, doctors’ appointments and RossWoods, a type of Medicaid called the Community Care Services Program (CCSP) waiver provides Sherry with transportation. CCSP waivers provide “community-based social, health and support services to eligible consumers as an alternative to placement in a nursing home.” When asked about her Medicaid coverage, Sherry said: “I couldn’t make it if I didn’t have [Medicaid]. There would be no way.”

For 168,000 seniors like Sherry who typically live on low, fixed incomes, Medicaid makes the difference and helps to pay the costs of their Medicare coverage. For some, it provides additional health benefits not covered through Medicare. For others, Medicaid allows them to age with dignity in their communities by covering needed home and living adaptations like chair lifts, wheelchair ramps, or engaging day programs with trained staff.

In March 2019, Georgia lawmakers approved SB 106, the Patients First Act. The new law allows Georgia to use two kinds of health care waivers to make changes to health coverage in the state. These waiver plans could affect you, your friends, family, neighbors, and Georgians all across the state and the way you access and pay for health care.

(Waivers allow a state to set aside or “waive” certain requirements imposed by the federal government and try new models of providing health coverage and care.)

The state has hired Deloitte as a consultant to work with state leaders to develop the waiver plans. Georgia’s decision-makers have proposed an aggressive timeline and aim to finalize the waiver plans by the end of 2019.

Two types of waiver plans

Two types of plans are being developed by state leaders: an 1115 waiver and a 1332 waiver. An 1115 waiver allows Georgia to make changes to the state’s Medicaid program. Medicaid is the state’s health insurance program that covers kids, some low-income parents, seniors, and people with disabilities, and pregnant women. SB 106 limits the 1115 waiver to cover people making up to the poverty line (about $12,000 a year for an individual or $26,000 for a family of four). Medicaid expansion, which GHF has advocated for, would extend public coverage to people with incomes just above the poverty line (138% of the federal poverty line.) A successful way to use an 1115 waiver would be to cover everyone under the poverty line and exclude barriers to coverage such as burdensome paperwork requirements, confusing cost-sharing, or counterproductive lock-out periods.

A 1332 waiver allows the state to make changes to private insurance and the health insurance marketplace. About 450,000 Georgians buy their health coverage through the marketplace. Most of these Georgians receive federal tax credits to cover some or all of their premium costs. (Another 827,600 of Georgians are eligible for private coverage and financial help to buy it but have not yet enrolled.) A successful way to use a 1332 waiver is to establish a “reinsurance program” to reduce premium costs. This waiver should also ensure all plans continue to cover the essential health benefits (like prescription drugs) and maintain protections for people with preexisting conditions.

You can weigh in!

Now is the time to ensure that Georgia gets a plan that will provide comprehensive coverage to as many people as possible. Thousands of Georgians across the state could gain health care coverage through the Patients First proposals. While positive intentions have been expressed by Georgia’s elected officials about the forthcoming waivers, none has yet committed to ensuring all Georgians have a pathway to comprehensive, affordable coverage.

For every 1115 and 1332 waiver that the state wants to pursue, Georgia’s policymakers must seek input from the public. Because there are required state and federal public comment periods for each waiver proposal, there will be at least four public comment periods (a state and federal period for an 1115 waiver and a state and federal period for a 1332 waiver). These are your chances to help shape and influence health care in Georgia!

GHF and our Cover Georgia partners will let you know when the public comment periods begin and end and we will provide an easy way for you to have your say. Make a plan to submit comments during every public comment period so that state leaders know how their ideas will impact you and your family! Your story can help make a difference for thousands of Georgians and can support positive changes in health care coverage.

To learn more, visit coverga.org and download our new Happening Now fact sheet! Follow #CoverGA on FaceBook and Twitter for the most current updates!

In late 2018, Georgians for a Healthy Future was awarded a General Operating Support grant from the Community Foundation for Greater Atlanta. The Foundation works to connect the passions of philanthropists with the purposes of nonprofits. Awards were given through a highly competitive process and we are excited about this partnership as we continue to work to ensure quality, affordable health care for all Georgians.

GHF was one of twenty-nine nonprofits to have received this highly competitive General Operating support grant from the Community Foundation for Greater Atlanta. Seven nonprofits, including GHF, were awarded grants to support well-being and “ensure a healthy region where all residents have access to quality health care and nutritious food.”

With the support of the Community Foundation for Greater Atlanta, GHF continues to offer Georgians the tools and information they need to become effective health advocates for themselves and their communities, inject the consumer perspective into health care stories in the media, and convene partner groups in coalition to strengthen our collective ability to advocate for the needs of Georgians across the state. We are ecstatic to have been among the select organizations who share our vision and drive to improve the lives of the people of Georgia. We look forward to continuing our work as the voice for Georgia health care consumers with the support of the Community Foundation for Greater Atlanta.

Read the Foundation’s December 2018 press release.