Feds temporarily halt approval of Kemp’s Medicaid overhaul

October 15, 2020 Atlanta - Governor Brian Kemp and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma celebrate with fist bump after they signed on healthcare reform at the Georgia State Capitol on Thursday, October 15, 2020. The federal government approved Gov. Brian Kemp’s plan to reshape Medicaid and individual insurance in Georgia under the Affordable Care Act, the governor and a top Trump administration health official announced on Thursday. (Hyosub Shin / Hyosub.Shin@ajc.com)
October 15, 2020 Atlanta - Governor Brian Kemp and Centers for Medicare and Medicaid Services (CMS) Administrator Seema Verma celebrate with fist bump after they signed on healthcare reform at the Georgia State Capitol on Thursday, October 15, 2020. The federal government approved Gov. Brian Kemp’s plan to reshape Medicaid and individual insurance in Georgia under the Affordable Care Act, the governor and a top Trump administration health official announced on Thursday. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

Credit: HYOSUB SHIN / AJC

The Georgia plan was switched to ‘pending’

The Biden administration pulled back approval of Gov. Brian Kemp’s plan to provide Medicaid coverage to thousands of low-income and uninsured adults in Georgia who meet a work or activity requirement because the still-raging coronavirus pandemic makes meeting some of the key guidelines “unfeasible.”

Federal health officials said Friday the state’s Medicaid overhaul proposal was switched from “approved” to “pending” over concerns that it’s “unreasonably difficult or impossible for many individuals to meet the community engagement requirement” in the plan in the midst of a global coronavirus outbreak.

“Taking into account the totality of circumstances, CMS has preliminarily determined that allowing work and other community engagement requirements to take effect in Georgia would not promote the objectives of the Medicaid program,” according to a letter sent to state officials by Elizabeth Richter, the acting administrator for the Centers for Medicare and Medicaid Services.

The decision could undermine the centerpiece of Kemp’s plan to reshape Medicaid in the state, which was greenlit by President Donald Trump’s top health official in October. At the celebratory press conference, Kemp 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.

Kemp’s office said Saturday it was reviewing the decision by President Joe Biden’s administration, which throws into doubt the fate of his plan to allow perhaps as many as 50,000 poor and uninsured adults be added to the Medicaid rolls within two years. Kemp’s health deputies have 30 days to respond.

Advocacy groups and Democrats applauded the move and amplified calls for a full Medicaid expansion to all the state’s very poor, as envisioned by the Affordable Care Act and already carried out by 39 states. State Republican leaders say a full expansion is too costly in the long run, although some GOP elected officials have embraced the idea.

State Sen. Michelle Au, a physician and newly elected Johns Creek Democrat, said she was happy to see the “misguided work requirements” were under new federal scrutiny. And state Sen. Jen Jordan said she hoped the decision scuttled Kemp’s “half-measure” and put full expansion of the program within reach.

“This is really positive news,” said Jordan, D-Sandy Springs. “Because if we can be fiscally responsible, cover more people and make sure everyone has access to expanded health care, it would be a big step forward.”

Georgia Medicaid now mostly covers children, and some adults, such as those who’ve been declared disabled by the government. Under Kemp’s plan, other working-aged Georgians could apply but would have to meet requirements the state would impose. That might include working at a registered employer for 80 hours a month or attending college full time.

A separate Kemp waiver program also approved last year by Trump’s administration appears to remain intact. That plan amounts to a “reinsurance” plan to lower premium prices for those who buy individual insurance. If that proposal moves forward, Kemp plans to pour public money into the private insurance market with a goal to reduce premium prices for some Georgians.

Staff writer Ariel Hart contributed to this report.

WHAT IT MEANS

The decision throws into doubt the fate of the governor’s plan to allow perhaps as many as 50,000 poor and uninsured adults be added to the Medicaid rolls within two years.

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