Since its establishment in 1965, the government-funded healthcare assistance Medicaid, has been the subject of much praise and criticism. Though it has changed significantly since the 1960s, Medicaid continues to be a valuable resource for low-income citizens obtaining health services. In its current form, Medicaid is funded jointly by both the state and federal governments and provides coverage to a variety of groups, including low-income families, pregnant women, people with disabilities, and people who need long-term care .
In 2010, President Obama signed the Affordable Care Act (ACA), colloquially known as Obamacare, into law. Among other changes, the ACA required states to expand Medicaid to people who make below 133% of the federal poverty level. Additionally, it mandated that every citizen acquire health insurance either privately, through healthcare.gov (subsidized healthcare for people making up to 400% of the federal poverty level), or through Medicaid . In 2012, however, the Supreme Court ruled in National Federation of Independent Businesses v. Sebelius that the federal government could neither force states to expand Medicaid, nor implement the individual mandate . While many states did decide to expand Medicaid and receive funds from the federal government, other states, including Georgia, chose other paths to reform their Medicaid systems.
Medicaid Waivers in Georgia
One path that states chose to explore are Section 1115 and Section 1332 waivers. These waivers allow states to suspend and/or change their Medicaid requirements to try and develop a more innovative method of Medicaid allocation, but federal funding for such programs is not guaranteed. The first waiver, the Georgia Pathways to Coverage program, develops an avenue for those under the federal poverty level to receive Medicaid coverage. The main, and most controversial, difference between this program and regular Medicaid expansion is that the Georgia Pathways program requires that people who make under 100% of the federal poverty level work, volunteer, or go to school at least 80 hours a month to be eligible for Medicaid coverage .
The second waiver, a reinsurance program called the Georgia Access Model, consists of two phases. The first phase subsidizes insurance companies for insuring people in places where insurance is very expensive. One example of such a location is rural Georgia. The second phase creates an exchange similar to healthcare.gov but eases some of the restrictions for the types of plans that can appear on the exchange . These less restrictive conditions mean that cheaper but less comprehensive health insurance plans could appear on the Georgia exchange that could not appear on the federal exchange. An important difference to note between Georgia’s Medicaid waiver programs and standard Medicaid expansion is that standard expansion would result in the state gaining more funds from the federal government while the waiver programs do not guarantee federal funding.
There are a variety of controversies attached to the proposed Medicaid waiver programs. First, the waiver program is estimated to expand coverage to only about 50,000 of the 408,000 Georgians who make below 100% of the federal poverty level but are not covered by Medicaid. Second, there have been a variety of federal court cases challenging other states’ work requirements with their Medicaid waiver programs. If one or more of these cases reaches the Supreme Court, it is possible that work requirements in such programs may be ruled unconstitutional. Related to this, many citizens feel that the work requirements are too strict and criticize the fact that taking care of sick relatives will not count towards a citizen’s 80 hours. Additionally, critics argue that people need healthcare to become healthy before they can even consider working, volunteering, or going to school . A third major criticism is that the waivers will waste money by not getting the complete matching federal funds the state would receive under standard Medicaid expansion .
While the public comment period for the proposed Georgia Pathways program ended on February 7, 2020, the public comment period for the reinsurance program has not yet opened. Additionally, the federal government has not yet approved either program. As the debate surrounding Medicaid expansion continues, thousands of Georgians continue to have limited access to healthcare.
Written by Julianna Isbitts