Everything you need to know about the Georgia Pathways and Georgia Access waivers

Health

GEORGIA (WRBL) – Governor Brian Kemp and members of the Georgia General Assembly revealed two waivers that the state government intends to use to give 408,000 Georgians access to health insurance where so far, they haven’t.

Now that the waiver submission process has started, here’s what you need to know:

Background

Following the March 27, 2019 passage of the Patients First Act, Kemp initiated the process of applying for a waiver from the Department of Health and Human Services to give Georgia more flexibility expanding Medicaid in conservative legislative directions.

Kemp said that the new legislation “…paves the way for state leaders to craft innovative flexibility options within Medicaid and the Affordable Care Act to lower healthcare premiums, enhance accessibility, and ensure quality outcomes” across Georgia.

Tools to pave the way, two waivers planned by the Patients First Act

The 1115 Demonstration Waiver refers to Section 1115 of the Social Security Act and allows the Secretary of Health and Human services to approve experimental, pilot, or demonstration projects that are expected to promote objectives laid out in the Medicaid program.

According to Medicaid.gov, “The purpose of these demonstrations, which give states additional flexibility to design and improve their programs, is to demonstrate and evaluate state-specific policy approaches to better serving Medicaid populations.”

The Georgia Pathways Health Waiver (1115 SSA Waiver)

For Georgia, this means that the so-called Georgia Pathways Health Waiver is expected to create opportunities for individuals working or volunteering for at least 80 hours per month to earn access to Medicaid, as well as Employer-sponsored health plans.

“Right now in our state, there are thousands of people working, training, volunteering, or getting an education who cannot afford employer-sponsored insurance or a plan on the open market,” said Governor Kemp. “These Georgians need coverage, but they have run out of realistic options. The Georgia Pathways Waiver addresses this challenge by providing 408,000 Georgians with access to obtain affordable health insurance.”

The choice will depend on which option is more cost-effective for Georgia’s state government as they continue to explore solutions for the costs of healthcare.

The Georgia Access Waiver (1332 ACA Waiver)

The second waiver, a 1332 State Innovation Waiver, what Kemp is calling the Georgia Access Waiver, is part of the policies created by the Affordable Care Act.

Section 1332 of the Affordable Care Act (ACA) permits a state to apply for a State Innovation Waiver (now also referred to as a State Relief and Empowerment Waiver) to pursue innovative strategies for providing their residents with access to high quality, affordable health insurance while retaining the basic protections of the ACA,” according to the Center for Medicare and Medicaid Services.

For Georgia, this means that Governor Kemp and other state lawmakers can create and implement new options for accessing health care for Georgia residents, as long as the costs remain comparable and as affordable as the care currently provided by the ACA.

Additionally, Georgia Access Waiver open for a 30-day public comment period to end on Dec. 3.

The Public Notice and Waiver application is also open now.

What happens now

The use of the two waivers by the state government is intended to provide Georgians with a customer-focused experience for families that are able to afford health insurance subsidies, that the state will be able to open to multiple enrollment portals.

Functionally, the change in portal options to purchase and browse private insurance plans will provide coverage plans with reduced premiums for residents and expand help small business employers to offer full coverage and provide more options for those with pre-existing conditions, according to the Governor’s office.

“By crafting two unique waivers that work in tandem to create a pathway to affordable healthcare for Georgians and reduce private-sector insurance premiums for families, Governor Brian Kemp is shaking up the status quo and putting patients first with a Georgia-centric approach that meets the healthcare needs of those who proudly call the Peach State home. The submission of Georgia Pathways and Georgia Access is a huge step in the right direction and will lead to a safe, prosperous, and healthy future for Georgia,” the Governor’s office said in a press release.

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