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.

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.

By: Knetta Adkins

On August 2nd, I had the opportunity to meet with Secretary Xavier Becerra, the 25th Secretary of the Department of Health and Human Services. During his August trip to Georgia, Secretary Becerra hosted a roundtable with community leaders to hear about the health care concerns and challenges most affecting Georgians. Congresswomen Carolyn Bordeaux, Lucy McBath, and Nikema Williams, state Representative Matthew Wilson, and Mayor Keisha Lance Bottoms participated in the roundtable, as well as representatives from Community Catalyst, Protect Our Care Georgia, and others. It was an exciting moment to represent Georgians for a Healthy Future and share on behalf of the marginalized Georgians for whom we advocate.