House Bill 258
By: Representatives Buckner of the 137th, Holcomb of the 101st, Hugley of the 141st, Mitchell
of the 88th, Bennett of the 94th, and others
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to public
assistance, so as to establish the PeachCare for Adults Program; to provide for a short title;
to provide for definitions; to provide for submission of federal waiver requests; to provide
for requirements; to provide for providers; to provide for administration of the program; to
provide for rules and regulations; to provide for related matters; to repeal conflicting laws;
and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to public assistance,
is amended by adding a new article to read as follows:
<ins>"ARTICLE 10
49-4-200.
This article shall be known and may be cited as the 'PeachCare for Adults Act.'
</ins>
<ins>49-4-201.
As used in this article, the term:
(1) 'Board' means the Board of Community Health.
(2) 'Department' means the Department of Community Health.
(3) 'Eligible person' means an individual between and including the ages of 18 and 64
years who has income less than or equal to 133 percent of the federal poverty level and
who is not enrolled in Medicaid.
(4) 'Enrolled person' means an eligible person who is enrolled in the PeachCare for
Adults Program.
(5) 'Medicaid' means the program of medical assistance conducted pursuant to Article 7
of this chapter, the 'Georgia Medical Assistance Act of 1977.'
(6) 'PeachCare for Adults Program' or 'program' means the program for health coverage
established pursuant to this article.
49-4-202.
(a) In order to implement the PeachCare for Adults Program pursuant to this article, the
board shall submit any waiver request to the Centers for Medicare and Medicaid Services
of the United States Department of Health and Human Services pursuant to Section 1115
of the federal Social Security Act necessary to add coverage for adults between and
including the ages of 18 and 64 years with incomes less than or equal to 133 percent of the
federal poverty level.
(b) The board shall take all necessary steps to secure the enhanced federal match available
under the applicable provisions of Section 2001 of the federal Patient Protection and
Affordable Care Act (P.L. 111-148).
(c) The board shall submit all necessary waiver requests pursuant to this Code section no
later than January 1, 2026.
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<ins>49-4-203.
(a) The department shall establish the PeachCare for Adults Program. Such program shall
be implemented no later than January 1, 2027.
(b) The program shall include, at a minimum:
(1) The same coverage provided to recipients of Medicaid, including, but not limited to,
the essential health benefits as provided in 42 U.S.C. Section 18022;
(2) Any healthcare benefits specified in the federal Patient Protection and Affordable
Care Act (P.L. 111-148) with respect to health insurance coverage or health insurance
products;
(3) Coverage for all vaccinations recommended for children and for adults by the
Advisory Committee on Immunization Practices of the federal Centers for Disease
Control and Prevention; and
(4) Coverage for the treatment of mental health and substance use disorders at least as
extensive as that provided for the treatment of physical illnesses.
(c) Only eligible persons may enroll in the program.
(d) The program shall include an affordability scale for premium based on income:
(1) For an enrolled person with an income greater than 100 percent of the federal poverty
level, the premium shall be the amount of premium for an enrolled person with an
equivalent income to enroll in the second-lowest cost silver-level plan offered in the
state's health insurance marketplace or 2 percent of an enrolled person's gross income,
whichever is lesser; and
(2) An enrolled person with an income less than or equal to 100 percent of the federal
poverty level shall not be charged a premium.
(e) Enrollment in the program shall not be contingent on work requirements.
(f) The department shall publish in print or electronically an annual report, a copy of which
shall be provided to the Governor, setting forth the number of enrolled persons in the
program, the health services provided, the amount of money paid to providers, and other
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<ins>pertinent information with respect to the administration of the program. The department
shall not be required to distribute copies of the annual report to the members of the General
Assembly but shall notify such members of the availability of the report in the manner
which it deems to be most effective and efficient.
49-4-204.
(a) Any healthcare provider that is a Medicaid provider shall be deemed to be a provider
in the program.
(b) Healthcare provider reimbursement rates shall be based on the Medicaid fee schedule.
Contingent upon available funds, the department may increase reimbursement rates for
healthcare providers.
(c) The department, through the Department of Administrative Services or any other
appropriate entity, may contract for any or all of the following: the collection of premiums,
processing of applications, verification of eligibility, outreach, data services, and
evaluation, provided that such contracting achieves administrative or service cost
efficiency. The department, and other state agencies, as appropriate, shall provide
necessary information to any entity which has contracted with the department for services
related to the administration of the program upon request.
(d) All state agencies shall cooperate with the department and its designated agents by
providing requested information to assist in the administration of the program.
(e) As necessary to enforce the provisions of this article, the department or its duly
authorized agents may submit to the state revenue commissioner the names of applicants
for healthcare benefits or payments provided under this article, as well as the relevant
income threshold specified therein. If the department elects to contract with the state
revenue commissioner for such purposes, the state revenue commissioner or his or her
agents or employees shall notify the department of whether or not each submitted
applicant's income exceeds the relevant income threshold provided. The department shall
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<ins>pay the state revenue commissioner for all costs incurred by the Department of Revenue
pursuant to this subsection. No information shall be provided by the Department of
Revenue to the department without an executed cooperative agreement between such
departments. Any tax information secured from the federal government by the Department
of Revenue pursuant to express provisions of Section 6103 of the Internal Revenue Code
shall not be disclosed by the Department of Revenue pursuant to this subsection. Any
person receiving any tax information under the authority of this subsection is subject to the
provisions of Code Section 48-7-60 and to all penalties provided under Code Section
48-7-61 for unlawful divulging of confidential tax information.
49-4-205.
The department shall be authorized to promulgate rules and regulations consistent with and
necessary to carry out the provisions of this article."
</ins> SECTION 2.
All laws and parts of laws in conflict with this Act are repealed.