HB 97: Community Health, Department of; expansion of Medicaid; provide

Georgia has not adopted the full Medicaid expansion allowed under the federal Affordable Care Act. This bill would add a new section to Georgia law directing the Department of Community Health, working with the Commissioner of Insurance, to submit a federal waiver request by October 31, 2025 seeking approval to expand Medicaid coverage. Instead of enrolling people directly in traditional Medicaid, the bill would move eligible adults ages 19 to 65 earning at or below 138 percent of the federal poverty level into qualified private health plans sold on the state insurance marketplace, with the state paying their premiums and cost-sharing subsidies. People who are medically frail or have complex needs would stay in standard Medicaid instead. The Commissioner of Insurance would certify which private plans qualify. If the federal government approves the waiver, the department would report annually to the General Assembly on enrollment, costs, and cost-control recommendations. The bill also counts itself as the legislature's required notification and approval for this kind of Medicaid change.

• Requires the Department of Community Health to submit a federal Medicaid expansion waiver request to the federal government by October 31, 2025.
• Directs eligible low-income adults (19 to 65, earning up to 138 percent of the federal poverty level) into private qualified health plans on the state marketplace rather than traditional Medicaid.
• Authorizes the state to pay full premiums and cost-sharing subsidies directly to the qualified health plans for enrolled individuals.
• Requires the Commissioner of Insurance to certify which private health plans qualify for the program based on minimum coverage rules.
• Requires annual reports to the General Assembly on enrollment numbers, program costs, and cost-control recommendations once the expansion is operational.
• Declares that passing this bill itself satisfies existing legal requirements for legislative notification and approval of Medicaid changes.

Low-income Georgia adults ages 19 to 65 who currently earn too much for standard Medicaid but too little for other coverage, the Department of Community Health, the office of the Commissioner of Insurance, private insurers offering marketplace plans, and the General Assembly, which would receive annual reports.

If approved by federal regulators, this would extend health coverage to Georgians currently in a coverage gap, paying their private insurance premiums with state funds instead of enrolling them in traditional Medicaid. The bill's effect depends entirely on federal waiver approval and future state funding decisions.

• New Code Section 49-4-142.6(a) defines 'eligible individual' as adults 19-65 earning up to 138% of the federal poverty level who are citizens or qualified aliens and not better served by standard Medicaid.
• Subsection (b) requires DCH to submit a Section 1115 federal waiver request by October 31, 2025 to enroll eligible individuals in qualified health plans on the state marketplace.
• Subsection (c) authorizes the department to pay premiums and cost-sharing subsidies directly to qualified health plans on behalf of enrollees.
• Subsection (d) requires the Commissioner of Insurance to certify which health plans qualify by setting minimum coverage requirements.
• Subsection (e) requires immediate notification to the General Assembly once expansion is operational, plus annual reports by November 1 on enrollment, costs, and cost-control recommendations.
• Section 2 states the Act itself serves as the legislature's required notification and approval 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
• Georgia health policy
• low-income coverage
• state marketplace plans