Feds reject work requirement in Kemp’s Medicaid overhaul

The Biden administration has redjected Georgia Gov. Brian Kemp's plan to provide Medicaid coverage to thousands of low-income and uninsured adults in the state who meet a work requirement, the coronavirus pandemic will “significantly compromise” the program’s effectiveness. (Elijah Nouvelage/Getty Images/TNS)

Credit: TNS

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The Biden administration has redjected Georgia Gov. Brian Kemp's plan to provide Medicaid coverage to thousands of low-income and uninsured adults in the state who meet a work requirement, the coronavirus pandemic will “significantly compromise” the program’s effectiveness. (Elijah Nouvelage/Getty Images/TNS)

Credit: TNS

President Joe Biden’s administration rejected Gov. Brian Kemp’s plan to provide Medicaid coverage to thousands of low-income and uninsured adults in Georgia who meet a work requirement, gutting the centerpiece of the Republican’s health care policy on the cusp of an election year.

Federal health officials said Thursday that the state cannot impose work requirements on Georgians receiving Medicaid benefits because the coronavirus pandemic will “significantly compromise” the program’s effectiveness.

The rest of Kemp’s waiver proposal, which allows more low-income adults to be eligible for Medicaid, can move forward.

The plan had been in limbo after the White House pulled back approval in February. Georgia Democrats have criticized the requirement as a half-measure that would leave hundreds of thousands without coverage, and Democrat Stacey Abrams has put Medicaid expansion at the center of her 2022 rematch attempt against Kemp.

Kemp’s office blasted the decision to nix the work requirement, which was greenlit by President Donald Trump’s top health official in 2020, and vowed to fight it in court. It’s not immediately clear if Kemp will move forward with the rest of the waiver policy.

“We are disappointed the Biden administration chose to turn its back on a bipartisan group in the Georgia General Assembly that came together to help create a fair and balanced health care framework that increases options and lowers costs,” Kemp spokeswoman Katie Byrd said.

“Though they attempted to hide behind the holiday in announcing two days before Christmas, we plan to challenge their misguided — likely political — decision in a court of law,” she said.

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Gov. Brian Kemp and Seema Verma, then the administrator for the Centers for Medicare and Medicaid Services, celebrate after they signed a health care measure at the Georgia Capitol in October 2020. The federal government approved Kemp’s plan to reshape Medicaid and individual insurance in Georgia under the Affordable Care Act. Kemp's plan would have allowed perhaps as many as 50,000 poor and uninsured adults to be added to the Medicaid rolls within two years. Still, his office estimated that more than 400,000 people would not meet the Medicaid requirements and would be left uninsured. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

Gov. Brian Kemp and Seema Verma, then the administrator for the Centers for Medicare and Medicaid Services, celebrate after they signed a health care measure at the Georgia Capitol in October 2020. The federal government approved Kemp’s plan to reshape Medicaid and individual insurance in Georgia under the Affordable Care Act. Kemp's plan would have allowed perhaps as many as 50,000 poor and uninsured adults to be added to the Medicaid rolls within two years. Still, his office estimated that more than 400,000 people would not meet the Medicaid requirements and would be left uninsured. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

Combined ShapeCaption
Gov. Brian Kemp and Seema Verma, then the administrator for the Centers for Medicare and Medicaid Services, celebrate after they signed a health care measure at the Georgia Capitol in October 2020. The federal government approved Kemp’s plan to reshape Medicaid and individual insurance in Georgia under the Affordable Care Act. Kemp's plan would have allowed perhaps as many as 50,000 poor and uninsured adults to be added to the Medicaid rolls within two years. Still, his office estimated that more than 400,000 people would not meet the Medicaid requirements and would be left uninsured. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

Credit: HYOSUB SHIN / AJC

Kemp made the plan his answer to Democratic calls to expand Medicaid, casting it as a “fiscally conservative” way to add more needy recipients to Georgia’s rolls.

At a press conference last year, the governor declared the “status quo is simply unacceptable” as he cited the state’s lofty premium costs and high level of uninsured people — second-worst in the nation.

Laura Colbert of Georgians for a Healthy Future, a healthcare advocacy group, said Kemp is now left with three options: appealing the decision and “callously” leaving thousands of Georgians with no pathway to insurance; move forward with the rest of the waiver plan; or fully expand Medicaid.

“We urge Governor Kemp and the Georgia General Assembly to take a clear-eyed look at these choices and examine the costs of our state’s on-going refusal to offer a hand-up to uninsured Georgians simply because they don’t have enough money in their wallets,” Colbert said.

‘The Grinch’

It would have allowed perhaps as many as 50,000 poor and uninsured adults to be added to the Medicaid rolls within two years. Still, Kemp’s office estimated that more than 400,000 people would not meet the Medicaid requirements and would be left uninsured.

Health care advocacy groups and Democrats have long painted the governor’s proposal as an incremental step and called for a full Medicaid expansion for the state’s very poor, as envisioned in the Affordable Care Act.

More than three dozen states have expanded their Medicaid programs, a step the governor has labeled as too costly and too inflexible. Some Republicans privately hoped that Kemp would embrace a full expansion in 2022, though that idea always seemed infeasible in a polarizing election year.

House Speaker David Ralston was among the Republicans who cast blame on the White House for both the decision and the timing of its announcement.

“It is shameful that President Biden has denied thousands of Georgians healthcare coverage,” he said. “Like the Grinch, he has stolen hope away from so many families who need it -- right at Christmas.”

Democrats, in turn, criticized Kemp and other leading Republicans for long opposing the expansion.

“We’ve known this was coming, and we know how to fix it,” said state Rep. Matthew Wilson, a Democratic candidate for insurance commissioner. “The Georgia General Assembly must fully expand Medicaid when we go back into session next month.”

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02/09/2021 —Atlanta, Georgia — Rep. Matthew Wilson (D-Brookhaven) speaks against HB 112 in the House Chambers on day 14 of the Georgia Legislative session at the Georgia State Capitol in Atlanta, Tuesday, February 9, 2021. (Alyssa Pointer / Alyssa.Pointer@ajc.com)

Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com

02/09/2021 —Atlanta, Georgia — Rep. Matthew Wilson (D-Brookhaven) speaks against HB 112 in the House Chambers on day 14 of the Georgia Legislative session at the Georgia State Capitol in Atlanta, Tuesday, February 9, 2021. (Alyssa Pointer / Alyssa.Pointer@ajc.com)

Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com

Combined ShapeCaption
02/09/2021 —Atlanta, Georgia — Rep. Matthew Wilson (D-Brookhaven) speaks against HB 112 in the House Chambers on day 14 of the Georgia Legislative session at the Georgia State Capitol in Atlanta, Tuesday, February 9, 2021. (Alyssa Pointer / Alyssa.Pointer@ajc.com)

Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com

Credit: Alyssa Pointer / Alyssa.Pointer@ajc.com

That might not be the only option for advocates of expansion in 2022. Biden’s signature policy proposal, the Build Back Better Act, would provide a work-around for the federal government to expand Medicaid to all poor adults without the state’s approval. That bill is stalled in the Senate, and it’s not yet known whether the provision will remain intact.

A separate Kemp waiver program was also approved last year by the Trump administration.

That proposal amounts to a “reinsurance” plan to lower premium prices for those who buy individual insurance. Kemp plans to pour public money into the private insurance market with a goal to reduce premium prices for some Georgians.

The Biden administration has pushed to scale back that proposal, and it has requested new public comment from Georgians, who can submit comments until Jan. 9.