Judge says Georgia Medicaid plan can be implemented

A federal judge in Brunswick has ruled that the Biden administration must allow Georgia to implement its plan to narrowly expand Medicaid, imposing work or engagement requirements on new enrollees.

Georgia is one of about 12 states that have not expanded Medicaid to all poor adults in the form envisioned under the Affordable Care Act. That leaves hundreds of thousands of the poorest Georgia adults without coverage. Gov. Brian Kemp proposed a plan that would instead result in Medicaid insurance for a more limited number of enrollees. The Biden administration opposes those limitations.

Kemp celebrated the ruling on Twitter Friday. His plan, he tweeted, “would better serve Georgians than a one-size-fits-all Medicaid expansion.”

Under Kemp aides’ original calculations, the Georgia plan would end up covering about 50,000 of Georgia’s poor adults, whereas a full Medicaid expansion would cover all without insurance, or about 400,000. The other 350,000 would be left uninsured, their analysis found, either unwilling or unable to meet the work and engagement requirements.

In Georgia, Medicaid covers most children. It covers adults in a few situations, such as some in nursing homes, or those who have been federally declared to be disabled. It does not cover most non-elderly adults.

Advocates for the poor say that many of the disabled poor are never officially declared disabled, and so never qualify for Medicaid coverage. They say many either don’t fit the stringent requirements — for example, being disabled by a condition that could be fixed by a surgery, but unable to get the surgery — or they are too disabled to go through the process of obtaining the declaration, for example if they are mentally ill.

Kemp’s engagement requirements for new Medicaid enrollees would offer a choice among specified activities. That could include working a regular job for 80 hours a month, or working 80 hours a month for a registered nonprofit. Working informally, for example as a live-in aide to a relative with dementia, would not qualify.

Work requirements for access to Medicaid have repeatedly been struck down by the courts. Courts have said eliminating someone from coverage because of a work requirement does not meet the objective of Medicaid, which is to provide health coverage.

Georgia has argued that its waiver was more flexible and wasn’t the same as a work requirement. Georgia argued that imposing the requirements would improve the lives of those in the program.

Critics say it does the opposite.

“Gov. Kemp is right in his claim that health and employment are related, except he puts the cart and the horse in the wrong order,” Laura Colbert, director of Georgians for a Healthy Future, said in a statement. The group endorses full Medicaid expansion.

“It is access to health care and a person’s improved health that enable people to go to work, be successful, and contribute to their communities,” Colbert said. “The Governor’s insistence on requiring work for health coverage completely ignores full-time parents and caregivers, students, and people going through mental health or addiction recovery.”

The Trump administration approved Georgia’s plan, called a “waiver,” in its waning days. The Biden administration never looked favorably on its limitations.

In blocking the work and engagement requirement, the Biden administration argued that the pandemic had changed the original calculations for the waiver plan, bringing its foundation into question. The U.S. Centers for Medicare and Medicaid Services under Biden argued that the landscape of who is and isn’t uninsured, and who can and can’t meet the engagement requirements, had changed in the pandemic.

During the pandemic the economy has seen everything from mass layoffs and job losses of historic proportions, to high employment. In addition, studies estimate that well over 1 million Americans may be unable to work due to the effects of long COVID.

On Friday, Judge Lisa Godbey Wood of the U.S. District Court for the Southern District of Georgia said it was unlawful for the Biden administration to revoke that approval.

CMS’ decision “was not reasoned —it was arbitrary and capricious on numerous, independent grounds,” Godbey Wood wrote.

The CMS, part of the Biden administration, is virtually certain to appeal. The state of Georgia chose to file in a south Georgia court, not in Atlanta. Godbey Wood was appointed to the bench by president George W. Bush.

CMS said previously that it does not comment on pending litigation.