Georgia’s Medicaid “Experiment” a Tepid Response to Coverage Gap

Tim SweeneyState leaders at the Department of Community Health are reportedly working with a few Georgia hospitals to take advantage of language in the recently signed 2016 Georgia budget that allows the agency to seek a federal Medicaid waiver. The language included in the 2016 budget that authorizes the department to pursue a waiver appeared in both 2014 and 2015 state budgets as well, but the fact Georgia is considering crafting one is a new and positive development. Unfortunately, the recent reports say the department probably won’t pursue a waiver to extend coverage to 300,000 Georgians who fall in Georgia’s coverage gap. If the waiver process aims only to allow small-scale pilot projects in a few Georgia communities, it will be a substantial missed opportunity.

Medicaid waivers come in several forms. As the name suggests, waivers allow states to bypass certain federal Medicaid requirements. Called a Section 1115 waiver, the one referred to in the budget is the broadest available to states. It is designed to allow states to propose experiments or pilot projects that further the goals of Medicaid and programs like Georgia’s PeachCare. Those experiments could include extending coverage to otherwise ineligible people or including services typically left out. The experiment should demonstrate a new or innovative approach to qualify for a waiver.

These Medicaid waivers have been around for decades, but they are attracting more attention lately as states use them to implement a customized approach to the Affordable Care Act’s expansion of Medicaid. In 2013 Arkansas became the first use a 1115 waiver as a way to implement its so-called private option. Arkansas uses federal Medicaid money to purchase private health insurance through the new health insurance marketplace rather than expand the state’s existing Medicaid program. Iowa, Indiana, Michigan and other states followed Arkansas’ lead and used the waiver to close their state’s coverage gap.

The specific waivers in each of these states differ greatly, but the one thing they share in common is they use the authority to think creatively to forge a path that fully closes the coverage gap in their state.

The result? These states are enjoying much more federal support than is available to ones that take a piecemeal approach to coverage and access. This new support is already delivering significant positive results to state residents who have gained health insurance and also for hospital finances in these states. One recent study shows Arkansas and Michigan are realizing more than $600 million in state savings in 2014 and 2015 alone.

Georgia would be better served if state leaders follow examples being set by states around the country and close the coverage gap in Georgia.  The opportunity is sitting right in front of us to extend health coverage to hundreds of thousands of Georgians who will otherwise remain uninsured. Medicaid expansion promises to benefit Georgians and communities across the state with improved access to health care services and increased overall investment in the state’s financially struggling health care delivery system.

The fact health care stakeholders and Georgia’s health officials are working on a way forward is a positive sign. Maybe we can find a solution to change Georgia’s ranking from the second highest adult uninsured rate in the country. Section 1115 waivers are an important tool for states to gain flexibility to improve treatment access for Medicaid patients. Georgia leaders can maximize these tools if they focus on statewide solutions that extend health coverage to people across the state instead of limiting these benefits to a handful of communities.

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