Georgia to explore Medicaid changes after GOP health plan's implosion

Gov. Nathan Deal. Bob Andres/AJC
Gov. Nathan Deal. Bob Andres/AJC

Credit: Greg Bluestein

Credit: Greg Bluestein

Gov. Nathan Deal said Monday his administration is exploring changes to Georgia's Medicaid program after a sweeping Republican overhaul of the Affordable Care Act was scuttled in a stunning rebuke to Donald Trump and Congressional leaders.

The Republican governor said there are limits to what the state can request “as long as mandates under the basic Obamacare legislation stand in place.” But he said the state would review healthcare options that could include changes to “mandated minimum coverage” provisions that require the state Medicaid program to cover a range of health services to recipients.

“Those are areas that some would like for us to explore, and I think we have the possibility of doing that within the context of our Medicaid program,” he said.

“We will be looking at those possibilities,” Deal added. “We have not formulated any proposal at this time, but the waivers will be primarily restricted to our Medicaid program.”

No significant change is expected this year. The governor’s office said later Monday that he would seek legislative approval for major changes to the state’s Medicaid program, and there are no plans for lawmakers to tackle that debate in the final days of the session that wraps up this week.

Georgia lawmakers in 2014 passed legislation that gives the Legislature the final say over any expansion to the Medicaid program. Provisions were slipped into the last three budget plans allowing the state to pursue a specialized Medicaid waiver, but no such authorization was put in this year’s spending law.

“We are exploring a variety of solutions that bring Georgians greater flexibility and access to care,” said Deal spokeswoman Jen Talaber Ryan. “No specific proposals have been decided upon, but he will continue working with members of the General Assembly to evaluate all options.”

Georgia flirted with a wide-ranging waiver in 2015 under President Barack Obama's administration that would have sought more Medicaid money to help the state's struggling rural hospitals and its big "safety net" hospitals like Grady Memorial in Atlanta. But the state later quietly abandoned those discussions.

The demise of the GOP healthcare proposal, which collapsed last week among opposition from Republican moderates and conservatives, has revived statehouse talks that Georgia could pursue a new waiver program.

This time, though, state officials would be appealing to a familiar figure: Former Georgia Rep. Tom Price, now Trump's health secretary.

Although Price doesn't have the power to transform Medicaid funding into the lump-sum block grants that state leaders have long sought, he has broad discretion to make other changes to healthcare funding that could be more politically acceptable for conservatives.

One of the most common methods is known as a Section 1115 waiver, and several conservative states have already used it to expand the Medicaid program on their own terms. A waiver from Arkansas, for one, let the state use Medicaid funding to allow uninsured residents to buy their own insurance plans.

"We’re exploring all of those possibilities," Deal said on Monday, without mentioning any specific type of waiver.

Deal and other state leaders did not lament the failure of the GOP plan last week. The governor had repeatedly urged Congress not to "punish" Georgia and other states that refused to expand Medicaid, as the proposal would have rewarded states with more generous Medicaid funding.

Then to placate a growing conservative revolt, the proposal would have restricted Georgia and the 18 other states that haven't expanded from growing their Medicaid rolls. And Georgia leaders said those changes would have made a dilemma - reopening a debate about expanding Medicaid - even worse.

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