Federal Court Decision Clears Way for Medicaid Waiver for Georgia

by T.A. DeFeo


Georgia could soon implement a program that proponents say will lead to more coverage for Georgians who are otherwise ineligible for Medicaid.

The Centers for Medicare and Medicaid Services made an “arbitrary and capricious” decision when it rescinded a Medicaid waiver for Georgia Pathways to Coverage program, U.S. District Judge Lisa Godbey Wood ruled last week.

In 2019, Georgia lawmakers gave Gov. Brian Kemp the green light to pursue the waiver. The Kemp administration filed a Section 1115 application for the Medicaid waiver, saying it could offer coverage to tens of thousands of Georgians through Georgia Pathways.

In October 2020, under President Donald Trump, CMS approved the application. However, in early 2021, under President Joe Biden, CMS told Georgia officials the agency was reconsidering its approval, and in December 2021, CMS rescinded its approval, leading the state to sue CMS the following month.

“This waiver was a well-considered effort to offer a path to health coverage for low-income Georgians in a better way than traditional Medicaid — exactly the kind of demonstration project that Section 1115 of the Social Security Act is meant to encourage,” Kyle Wingfield, president and CEO of the Georgia Public Policy Foundation, said in a statement.

According to the state, Georgia Pathways expands Medicaid to roughly 50,000 ineligible Georgians. Under the program, which includes a work requirement for recipients, the state covers premiums for recipients with access to employer-sponsored insurance.

“This kind of coverage offers them better access to more healthcare providers, which in turn should lead to better health outcomes,” Wingfield added. “It also minimizes the disruption of changing plans should they earn more money and lose Medicaid eligibility, because they will already be on their employer’s plan. That eliminates a key disincentive for Medicaid recipients to seek higher wages and improve their finances.”

A Georgia Department of Community Health spokesperson did not respond to a request for comment.

“We are pleased to see the court protect access to affordable health insurance access for all Georgians,” Erik Randolph, director of research for the Georgia Center for Opportunity, said in a statement.

“By setting back the timeframe, this unprecedented move continues to harm poor Georgians who need help accessing health insurance,” Randolph added. “We believe Georgia Pathways is a step in the right direction in avoiding the pitfalls of traditional Medicaid expansion while offering more healthcare options for Georgians.”

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T.A. DeFeo is a contributor to The Center Square. 
Photo ” Lisa Godbey Wood” by news.uga.edu. 





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