Georgia gets bad news on Medicaid waiver funding

The Trump administration rejected a conservative proposal for Utah with limits similar to Georgia’s.

Georgia leaders’ hopes to get the federal government to pay almost all the costs of providing Medicaid coverage to more people appear to be dashed.

And if the state budget is forced to shoulder more of the financial burden of its new Medicaid plan, that raises the question whether the plan will be forced to do less and cover fewer people.

Gov. Brian Kemp is putting together the plan, a "waiver" request to the federal government that might include a limited expansion of Georgia's Medicaid coverage. A component of that plan had been to request that the federal government fund almost all the cost, 90% of it, as if it were a full Medicaid expansion to all of Georgia's poor. That's a big bump from the standard federal funding match of 67% that Georgia normally receives for providing Medicaid coverage.

Georgia had support for the idea at high levels. As late as May, Seema Verma, the administrator of the U.S. Centers for Medicare and Medicaid Services, or CMS, told The Atlanta Journal-Constitution that the 90% match for Georgia could be on the table.

“That’s still under consideration,” she said. “We haven’t ruled it out.” Kemp has met personally with Verma to discuss the waiver.

But the big federal funding bump looks unlikely, emerging accounts suggest.

The Trump administration this past weekend rejected a conservative proposal for Utah with limits similar to Georgia’s.

“Late Friday the State of Utah received a call from the White House informing state leaders that its most recent Medicaid waiver request, which had yet to be formally submitted, would not be approved,” Utah Gov. Gary Herbert and legislative leaders said in a joint statement. The Utah leaders said they were “deeply disappointed.”

National reports cited anonymous White House sources saying no state, including Georgia, would receive the 90% match for limited Medicaid expansion.

The news exploded through health care policy communities, and Utah officials said they may just have to expand Medicaid fully, to all people earning less than 138% of the poverty level. Georgia GOP leaders have steadfastly refused to fully expand Medicaid, citing the cost.

The CMS, which rests under the authority of the White House, did not comment to the AJC. National reports over the past two years have outlined a disagreement between the CMS and the White House. Senior White House leaders favor denying any expansion in their power, even more conservative ones, in favor of concentrating on repealing or striking down the entire Affordable Care Act.

Kemp’s plan for Georgia is still unknown at this point. His consultant, Deloitte, has only just delivered its report laying out the basic data and facts to start from. (They include that 27% of Georgians ages 19 to 34 are uninsured, one of the worst rates in the nation.)

Kemp’s office has been in close contact with the CMS. His aides declined to comment on the developments.

Critics of Kemp's proposal responded swiftly to the news by renewing calls for a larger effort.

“Full expansion remains the clear option,” tweeted the Georgia Budget and Policy Institute, a liberal-leaning research organization. Democrat Stacey Abrams, who based her campaign on Medicaid expansion, echoed the sentiment.

While the proposal, Senate Bill 106, was moving through the Legislature, Democrats and liberal health advocates said the plan would spend more state dollars to cover fewer people.

“We estimate this type of waiver would cost about three times as much to cover each patient compared to if we did the full increase,” Laura Harker, a health policy analyst at the Georgia Budget and Policy Institute, said at a Senate hearing in February. The full increase envisioned under the ACA would cover people up to 138% of the poverty level. Georgia’s law only allows the waiver plan to cover people up to 100% of the poverty level with Medicaid.

The bill’s backers said the goal was not just to expand coverage but to tranform the system and encourage people to move off Medicaid.

State Sen. Blake Tillery, who sponsored the bill on behalf of Kemp, said the intent was to go after a 90% federal match.

He testified with Blake Fulenwider, the Georgia Department of Community Health’s chief health policy officer. Fulenwider said they weren’t alone in pursuing this approach. He pointed to Utah as an example.

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