HB 178: Social services; treatment services under Medicaid to persons with HIV; provisions

Georgia's Medicaid program does not currently have a specific pathway for treating people living with HIV who lack health insurance. This bill would add a new section to Georgia law directing the Department of Community Health to ask the federal government for permission to set one up. Specifically, the department would have to submit a Section 1115 waiver request to the federal Centers for Medicare and Medicaid Services by December 31, 2025. The waiver would ask to run a demonstration project offering Medicaid treatment services, including antiretroviral drugs, to Georgians diagnosed with HIV who earn less than 138 percent of the federal poverty level and have no health insurance. If the federal government approves the waiver, the department would then have to take the steps needed to put it into effect.

• Requires the Department of Community Health to submit a Section 1115 Medicaid waiver request to the federal Centers for Medicare and Medicaid Services by December 31, 2025.
• Directs that the waiver seek a demonstration project providing HIV treatment services, including antiretroviral drugs, through Medicaid.
• Sets eligibility criteria for the program: an HIV diagnosis, income below 138 percent of the federal poverty level, and no health insurance.
• Requires the department to implement the waiver's terms once the federal government approves it.
• Adds this requirement as a new Code section (O.C.G.A. § 49-4-142.6) within Georgia's Medicaid law.

Georgians living with HIV who have low incomes and no health insurance would become eligible for the new Medicaid treatment program. The Department of Community Health would be responsible for submitting the waiver request and running the program if approved, and federal Medicaid officials would decide whether to approve it.

If the federal government approves the waiver, uninsured, low-income Georgians with HIV could gain access to Medicaid-funded treatment, including antiretroviral drugs, that they currently cannot get through the state's existing Medicaid rules. Whether this happens depends on federal approval, which is not guaranteed by the bill.

• Section 1 adds new Code section 49-4-142.6, requiring the waiver request be submitted by December 31, 2025.
• The demonstration project must be designed for early, effective HIV treatment through a package of services including antiretrovirals.
• Eligibility is limited to people with an HIV diagnosis, income under 138 percent of the federal poverty level, and no health insurance.
• Once the waiver is approved, the department must take all necessary steps to implement its terms and conditions.
• Section 2 repeals any conflicting state laws.

1. 2025-02-03House Second Readers (House)
2. 2025-01-30House First Readers (House)
3. 2025-01-29House Hopper (House)

• Sharon Cooper (R, HD-045)Primary sponsor
• Lee Hawkins (R, HD-027)
• Ron Stephens (R, HD-164)
• Darlene Taylor (R, HD-173)
• Karla Drenner (D, HD-085)

• Medicaid
• HIV treatment
• health insurance
• public health funding