Georgia Senate Bill 106 would authorize the governor to expand Medicaid and apply for reinsurance for the ACA exchanges.
Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to medical assistance generally, is amended by adding a new Code section to read as follows:
The department shall be authorized to submit a waiver request, on or before June 30, 2020, to the United States Department of Health and Human Services Centers for Medicare and Medicaid Services pursuant to Section 1115 of the federal Social Security Act, which may include an increase in the income threshold up to a maximum of 100 percent of the federal poverty level.
Georgia, like Utah, wants a partial expansion of Medicaid to 100% FPL. Right now, the Center for Medicare and Medicaid Services (CMS) will approve that waiver at standard federal financing rate. Utah and Georgia presumably want CMS to pay the ACA enhanced rate of 90% of costs.
The folks who earn between 100-138% FPL are dual qualified. They earn enough to qualify for Exchange subsidies on premiums and out of pocket costs. They earn little enough to also qualify for full Medicaid expansion. If a partial expansion went through in Georgia, they will be no worse off as this cohort would still be eligible for premium assistance and cost sharing reduction (CSR) silver plans.
The critical question is the counterfactual when we think about this problem.
Is the correct counterfactual full Medicaid expansion?
Or is the correct counterfactual current policy of no Medicaid expansion at all.
Choosing that counterfactual fundamentally predetermines the answer.
But either way, Georgia is thinking about expanding some of its Medicaid program. This makes whatever waiver Utah submits critical for both the Arches State and as an indicator of the future for the Peach State.
What I have been telling people for going on six years now is that expanding Medicaid up to 100% FPL should be ineligible for ACA level federal sharing because the qualification for expansion funding is baked into the statute. More than one state that has already expanded would have liked to do it this way — probably most of them, really, but they were either told not to ask or if they asked they were rejected.
Damn you for the earworm.
Medicaid expansion in many of these states doesn’t mean what most people think. In Missouri, Medicaid is available for 100-138% FPL. In my case, it cost 400 dollars per month. ACA silver plan, 36 dollars per month.