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

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:

"49-4-142.6.

(a) As used in this Code section, the term:

(1) 'Eligible individual' means an individual who:

(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 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."

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.