---
title: HB 97. Community Health, Department of; expansion of Medicaid; provide
collection: bills
id: 2025-2026/hb97
cite_as: HB 97, 2025-2026 Regular Session (Ga.)
canonical_url: https://georgiacommons.org/bills/2025-2026/hb97
md_url: https://georgiacommons.org/bills/2025-2026/hb97.md
text_url: https://georgiacommons.org/bills/2025-2026/hb97/text
source_url: https://www.legis.ga.gov/legislation/69450
date: 2025-01-28
status: introduced
corpus_version: bills-2026-09-13
license: Public record of the Georgia General Assembly, via LegiScan; see about.md
publisher: Georgia Commons, an independent project of Georgia Civic Data. Not the State of Georgia. Not legal advice.
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omitted: votes and history
omitted_chars: 129
omitted_url: https://georgiacommons.org/bills/2025-2026/hb97.md?full=1
bill_number: HB 97
session: 2025-2026 Regular Session
session_slug: 2025-2026
chamber: House
bill_type: bill
status_date: 2025-01-17
last_action: House Second Readers
sponsors:
  - Samuel Park
  - Floyd Griffin
  - Mack Jackson
  - Tangie Herring
text_version: Introduced
has_text: true
legiscan_url: https://legiscan.com/GA/bill/HB97/2025
upstream_id: 1929207
summaries_model: claude-sonnet-5
topic_tags:
  - Medicaid expansion
  - health insurance
  - Georgia health policy
  - low-income coverage
  - state marketplace plans
---

# HB 97. Community Health, Department of; expansion of Medicaid; provide

## Text

House Bill 97
By: Representatives Park of the 107th, Griffin of the 149th, Jackson of the 128th, and Herring
of the 145th
A BILL TO BE ENTITLED
AN ACT
To amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated,
relating to medical assistance generally, so as to provide for the expansion of Medicaid; to
provide for definitions; to authorize the Department of Community Health to utilize
appropriations for the purposes of funding Medicaid expansion; to provide for the submission
of requests for waivers, amendments to waivers, and state plan amendments; to authorize the
office of the Commissioner of Insurance to certify qualified health plans; to provide for
reporting; to provide for rules and regulations ; to provide for related matters; to provide for
legislative notification and approval; to repeal conflicting laws; and for other purposes.
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
SECTION 1.
Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to
medical assistance generally, is amended by adding a new Code section to read as follows:
<ins>"49-4-142.6.
(a) As used in this Code section, the term:
(1) 'Eligible individual' means an individual who:
</ins>
<ins>(A) Is an adult between 19 and 65 years of age with an annual income that is equal to
or less than 138 percent of the federal poverty level;
(B) Has been authenticated to be a United States citizen or a documented qualified
alien as defined in Section 431 of the Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, (P.L. 104-193), as amended; and
(C) Is not determined to be more effectively covered through the standard Medicaid
program, such as an individual who is medically frail or other individual with
exceptional medical needs for whom coverage as provided under this Code section is
determined by the department to be impractical, overly complex, or would undermine
continuity or effectiveness of care.
(2) 'Healthcare coverage' means healthcare benefits as defined by rules promulgated by
the Commissioner of Insurance for the certification of qualified health plans.
(3) 'Medicaid expansion program' or 'program' means an expansion of the Medicaid
program in accordance with this Code section.
(4) 'Qualified health plan' means a health insurance plan certified by the office of the
Commissioner of Insurance for the Medicaid expansion program.
(b) On or before October 31, 2025, in consultation with the office of the Commissioner of
Insurance, the department shall submit to the United States Department of Health and
Human Services Centers for Medicare and Medicaid services pursuant to Section 1115 of
the federal Social Security Act a waiver request along with other necessary amendments
for the Medicaid expansion program under the federal Patient Protection and Affordable
Care Act (P.L. 111-148), as amended by the federal Health Care and Education
Reconciliation Act of 2010 (P.L. 111-152) and the American Rescue Plan of 2021
(P.L. 117-2), and any regulations or guidelines issued under such acts in accordance with
this Code section. The waiver request shall provide for:
(1) The enrollment of certain low-income individuals making less than 138 percent of
the federal poverty level in the eligibility category created by
</ins>
<ins>Section 1902(a)(10)(A)(i)(VIII) of the federal Social Security Act, 42 U.S.C. Section
1396a, into qualified healthcare plans offered on the state marketplace established under
Section 1332 of the federal Patient Protection and Affordable Care Act (P.L. 111-148);
and
(2) The full payment of any premiums or other direct costs associated with enrolling in
qualified healthcare plans for eligible individuals making less than 138 percent of the
federal poverty level who are enrolled in the program.
(c) The department is specifically authorized to pay premiums and supplemental
cost-sharing subsidies directly to the qualified health plans for eligible individuals enrolled
in the program.
(d) The office of the Commissioner of Insurance shall certify qualified health plans
providing minimum requirements for healthcare coverage.
(e) If the Medicaid expansion program provided for in this Code section is approved, the
department shall immediately report to the General Assembly that such expansion is
operational and annually on or before November 1 of each year shall report to the General
Assembly:
(1) The number of individuals enrolled in the Medicaid expansion program;
(2) Costs incurred by the state for the Medicaid expansion program;
(3) Estimated costs for the implementation of the Medicaid expansion program for the
current and following state fiscal year; and
(4) Recommendations to control costs of the Medicaid expansion program.
(f) The department and the office of the Commissioner of Insurance shall be authorized
to promulgate rules and regulations consistent with and necessary to carry out the
provisions of this Code section."
</ins>
SECTION 2.
This Act shall be considered legislative notification for purposes of Code Section 49-4-142.1
and legislative approval for purposes of Code Section 49-4-142.2.
SECTION 3.
All laws and parts of laws in conflict with this Act are repealed.

## Summaries written by Georgia Commons

The following was written by claude-sonnet-5 from the text above and is not part of the bill. Quote the text, not the summary.

House Bill 97 would direct Georgia's Department of Community Health to seek federal approval to expand Medicaid, covering low-income adults through private health plans on the state insurance marketplace.

### Plain-language summary

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.

### What it does

- 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.

### Who it affects

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.

### Why it matters

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.

### Key provisions

- 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.

## Status

- Status: Introduced (2025-01-17)
- Last action: House Second Readers (2025-01-28)
- Sponsors: Samuel Park, Floyd Griffin, Mack Jackson, Tangie Herring
- Official page: https://www.legis.ga.gov/legislation/69450

> The history, votes, and amendments (129 characters) are at https://georgiacommons.org/bills/2025-2026/hb97.md?full=1