SB 360: Public Assistance; public option buy-in program to provide healthcare coverage to individuals not eligible for Medicaid coverage; provide

Currently, Georgians who earn too much for Medicaid but can't get affordable coverage through the health insurance exchange can fall into a coverage gap. This bill would direct the Department of Community Health to create a new 'Public Option Buy-In Program' for those people, requiring it to match Medicaid's coverage standards and benefit levels. Eligible people would include those who don't qualify for Medicaid or exchange coverage, as well as those who would lose eligibility if federal subsidies or tax credits under the Affordable Care Act are cut by Congress. Participants would pay the same per-person cost the state pays care management organizations for Medicaid. The department would require any company bidding for Medicaid contracts to also bid on running this new program, and would need to request federal approval (state plan amendments or waivers) before implementing it.

• Creates a new Public Option Buy-In Program inside the Department of Community Health to cover people ineligible for Medicaid or exchange coverage.
• Requires the program to match Medicaid's care management organization standards and benefit levels.
• Sets the cost to participants at the same per-person amount the state pays for Medicaid coverage through care management organizations.
• Requires companies bidding on Medicaid contracts to also submit bids to run the new buy-in program.
• Directs the department to prioritize care organizations whose provider networks overlap with Medicaid's when picking who runs the program.
• Requires the department to seek any necessary federal approval, such as Medicaid state plan amendments or waivers, before rolling out the program.

Georgians who don't qualify for Medicaid and lack affordable coverage through the health insurance exchange, including people who could lose coverage if federal Affordable Care Act subsidies are cut. The bill also affects the Department of Community Health and the care management organizations that contract with the state for Medicaid.

People who currently fall between Medicaid eligibility and exchange affordability could gain a new coverage option priced at the state's Medicaid rate. The program's creation depends on federal approval, so its availability and timeline would hinge on decisions by the U.S. Department of Health and Human Services.

• Section 1 adds a new Article 10 to Chapter 4 of Title 49 of the Georgia Code, defining terms like 'eligible person,' 'exchange,' and 'Medicaid' for the new program (O.C.G.A. § 49-4-200).
• O.C.G.A. § 49-4-201 requires the Department of Community Health to establish the program with benefits and standards at least equal to Medicaid's care management organizations, priced at the state's per-person Medicaid cost.
• O.C.G.A. § 49-4-202 requires bidders on Medicaid contracts to also bid on running the buy-in program, and directs the department to favor bidders whose provider networks overlap with Medicaid's.
• O.C.G.A. § 49-4-203 requires the department to seek any Medicaid state plan amendments or federal waivers needed to implement the program.
• O.C.G.A. § 49-4-204 authorizes the department to write rules and regulations to carry out the program.
• Section 2 repeals any conflicting state laws.

1. 2025-03-27Senate Read and Referred (Senate)
2. 2025-03-25Senate Hopper (Senate)

• Sally Harrell (D, SD-40)Primary sponsor
• Jason Esteves (D, SD-35)
• Josh McLaurin (D, SD-14)
• Kim Jackson (D, SD-41)
• Elena Parent (D, SD-44)
• Sonya Halpern (D, SD-39)

• healthcare coverage
• Medicaid
• public option
• health insurance exchange
• Department of Community Health