HB97: HB97 Community Health, Department of; expansion of Medicaid; provide

Georgia has not expanded Medicaid under the federal Affordable Care Act, leaving many low-income adults without coverage. This bill would add a new section to Georgia's Medicaid law directing the Department of Community Health to pursue that expansion, but through qualified health plans sold on the state's insurance marketplace rather than traditional Medicaid enrollment. The bill defines who would qualify: adults ages 19 to 65 with income at or below 138 percent of the federal poverty level who are citizens or documented qualified immigrants, unless the department decides someone with major medical needs would be better served by standard Medicaid. By October 31, 2025, the department must apply to the federal government for a waiver to run the program, and the state would pay premiums and cost-sharing subsidies for enrollees directly to insurers. The Commissioner of Insurance would certify which health plans qualify. The department must report enrollment and costs to the General Assembly annually, and the bill itself counts as the legislature's required notification and approval for pursuing the change.

• Adds a new Code section requiring the Department of Community Health to apply for a federal waiver to expand Medicaid coverage to certain low-income adults.
• Defines eligible individuals as adults 19 to 65 with income at or below 138 percent of the federal poverty level who are citizens or documented qualified immigrants.
• Directs the state to pay premiums and cost-sharing subsidies directly to private insurers offering qualified health plans, rather than enrolling people in traditional Medicaid.
• Authorizes the Commissioner of Insurance to certify which health plans meet minimum coverage requirements for the program.
• Requires annual reports to the General Assembly on enrollment numbers, program costs, and cost-control recommendations.
• Declares the bill itself to serve as the legislature's required notification and approval needed to move forward under existing Medicaid expansion law.

Low-income Georgia adults between 19 and 65 who currently lack health coverage, the Department of Community Health, the office of the Commissioner of Insurance, and private insurers that could be certified to offer qualified health plans under the program.

If implemented, hundreds of thousands of low-income Georgians could gain access to subsidized private health coverage instead of remaining uninsured. The approach relies on federal approval and private insurance plans rather than direct Medicaid enrollment, which would shape who administers care and how costs are tracked.

• New Code Section 49-4-142.6 defines 'eligible individual,' 'healthcare coverage,' 'Medicaid expansion program,' and 'qualified health plan' for purposes of the expansion.
• Subsection (b) requires the department to submit a Section 1115 waiver request to federal Medicare and Medicaid officials by October 31, 2025, seeking to enroll eligible individuals in marketplace health plans.
• Subsection (c) authorizes the department to pay premiums and cost-sharing subsidies directly to qualified health plans on behalf of enrollees.
• Subsection (d) gives the Commissioner of Insurance authority to certify which health plans meet minimum coverage standards for the program.
• Subsection (e) requires the department to notify the General Assembly once expansion is operational and to report annually on enrollment, costs, and cost projections.
• Section 2 states the Act itself fulfills legislative notification and approval requirements under existing Code Sections 49-4-142.1 and 49-4-142.2.

1. 2025-01-28House Second Readers (House)
2. 2025-01-27House First Readers (House)
3. 2025-01-17House Hopper (House)

• Samuel Park (D, HD-107)Primary sponsor
• Floyd Griffin (D, HD-149)
• Mack Jackson (D, HD-128)
• Tangie Herring (D, HD-145)

• Medicaid expansion
• health insurance
• low-income healthcare
• state budget
• health policy