HB258: HB258 PeachCare for Adults Act; enact

Georgia currently has no health coverage program specifically for low-income adults ages 18 to 64 who earn too much for Medicaid but still struggle to afford insurance. This bill would create the PeachCare for Adults Program to fill that gap. It directs the Board of Community Health to request a federal waiver (a special permission from the federal government under Section 1115 of the Social Security Act) by January 1, 2026, and requires the Department of Community Health to launch the program by January 1, 2027. The program would match Medicaid's benefits, cover vaccines and mental health and substance use treatment, and charge premiums on a sliding scale tied to income, with no premium for those at or below the poverty level. Enrollment could not be tied to work requirements. Medicaid providers would automatically qualify as program providers, and the department could contract out administrative tasks like enrollment and eligibility checks.

• Establishes the PeachCare for Adults Program to provide health coverage to adults ages 18-64 with income at or below 133 percent of the federal poverty level who are not on Medicaid.
• Requires the Board of Community Health to submit federal waiver requests by January 1, 2026 to secure enhanced federal funding for the program.
• Sets a launch deadline of January 1, 2027 for the Department of Community Health to implement the program.
• Requires coverage matching Medicaid benefits, essential health benefits, vaccines, and mental health and substance use treatment on par with physical illness treatment.
• Creates an income-based premium scale, charging no premium below the poverty level and capping premiums at 2 percent of income or the cost of a benchmark marketplace plan above it.
• Automatically makes any Medicaid-enrolled healthcare provider a provider in the new program, with reimbursement based on the Medicaid fee schedule.

Low-income adults ages 18 to 64 who earn too much for Medicaid but qualify under the new income limit, the Department of Community Health and Board of Community Health, Medicaid healthcare providers, the Department of Revenue, and the Department of Administrative Services, which may help administer parts of the program.

If enacted, thousands of low-income Georgia adults who currently fall into a coverage gap between Medicaid eligibility and marketplace affordability could gain access to health insurance with capped premiums, vaccine coverage, and mental health treatment, without having to meet work requirements to enroll.

• Section 49-4-201 defines an 'eligible person' as someone 18 to 64 years old with income at or below 133 percent of the federal poverty level who is not on Medicaid.
• Section 49-4-202 requires the Board of Community Health to submit federal Section 1115 waiver requests by January 1, 2026 and pursue enhanced federal matching funds under the Affordable Care Act.
• Section 49-4-203 requires the program to launch by January 1, 2027 and sets minimum coverage standards, including essential health benefits, vaccines, and mental health and substance use treatment.
• Section 49-4-203(d) creates a premium scale: no charge at or below the poverty level, and above it the lesser of 2 percent of income or the cost of a benchmark silver-level marketplace plan.
• Section 49-4-203(e) bars the state from making enrollment contingent on work requirements.
• Section 49-4-203(f) requires an annual public report to the Governor on enrollment, services, and provider payments.
• Section 49-4-204 makes Medicaid providers automatic program providers, ties reimbursement to the Medicaid fee schedule, and allows contracting for administrative functions like eligibility verification.
• Section 49-4-204(e) allows the department to share applicant income information with the Department of Revenue under a cooperative agreement, subject to confidentiality penalties under O.C.G.A. § 48-7-60 and § 48-7-61.

1. 2025-02-06House Second Readers (House)
2. 2025-02-05House First Readers (House)
3. 2025-02-04House Hopper (House)

• Debbie Buckner (D, HD-137)Primary sponsor
• Scott Holcomb (D, HD-101)
• Carolyn Hugley (D, HD-141)
• Billy Mitchell (D, HD-088)
• Karen Bennett (D, HD-094)
• Stacey Evans (D, HD-057)

• health coverage
• Medicaid expansion
• PeachCare
• public assistance
• mental health treatment