FIVE THINGS TO KNOW: A Georgia Medicaid waiver

For seven years, Georgia GOP leaders have rebuffed the notion of expanding Medicaid to cover the state’s poorest, citing concerns about future costs. That may be about to change, as newly installed leaders consider doing an expansion but with a “waiver” to allow Georgia to shape the program more conservatively. Here’s the lowdown:

• What’s Medicaid? Medicaid is the government health insurance program that pays for care for the poor, as well as some children, elderly people and disabled people.

• Expand it to whom? Right now there’s a coverage gap in Georgia for thousands of very poor adults. Programs help pay health coverage for other people: the elderly, children, mothers of minor children, people the government declared disabled, and people who make at least, say, $16,000 a year for a single person. But for people who make less money than that and don’t fit into those categories, it’s up to the state to decide whether Medicaid should cover them. Up to now Georgia has decided not to, citing the cost.

• What’s a waiver? Who waives what? Medicaid has federal rules. Georgia might like to opt out of some of those rules. Specifically, there’s a lot of talk about expanding Medicaid but obtaining a “waiver” from the federal government saying that Georgia can impose a work requirement for Medicaid recipients if it wants. There are different kinds of federal health care waivers, and this one is known as a 1115 Waiver, after a section of federal law.

• Why the controversy? It’s financial and political. Medicaid costs money. Opponents point out that outright expansion could cost Georgia $200 million or more per year. Advocates counter that the federal government would likely match that at a 9-to-1 ratio, sending billions of dollars into the state’s health system. Politically, Medicaid expansion is tied to President Barack Obama’s Affordable Care Act, a deeply unpopular concept to the GOP base.

• What’s the point? Advocates say covering those poor would result in better health with good ripple effects for the economy. They also point to the cost of caring for those people when they show up at hospitals without insurance. Hospitals care for them anyway and eat that cost, putting a strain especially on rural hospitals.