SB 428: Medical Assistance; Department of Community Health to submit a waiver request to the federal Centers for Medicare and Medicaid Services; direct

Currently, Georgia's Medicaid program largely reimburses mental health treatment provided in institutional settings. This bill adds a new section to Georgia's Medicaid law directing the Department of Community Health to submit a waiver request to the federal Centers for Medicare and Medicaid Services (the federal agency that oversees Medicaid) by December 31, 2026. The waiver would seek permission for Medicaid to pay for home and community based services for adults over 21 who need mental health treatment but do not need an institutional level of care. Eligibility would be based on risk factors such as past hospital stays, psychiatric crises, emergency room visits, incarceration, or homelessness. If the federal government approves the waiver, the department must then take the steps needed to actually pay for that care using Medicaid funds.

• Adds a new Code section (O.C.G.A. § 49-4-142.6) directing the Department of Community Health to submit a Medicaid waiver request by December 31, 2026.
• Targets Medicaid recipients over age 21 who need mental health services but do not require institutional level care.
• Defines qualifying risk factors including hospitalization history, psychiatric crises, ER visits, prior incarceration, and homelessness.
• Requires the department, once the waiver is approved, to take necessary steps to pay for these home and community based services with Medicaid funds.
• Repeals any conflicting Georgia laws.

Adults over 21 on Medicaid who need mental health treatment but not institutional care, the Department of Community Health, which must apply for the waiver, and providers of home and community based mental health services who could become newly eligible for Medicaid reimbursement.

If the federal waiver is approved, more Georgians with mental health needs could receive treatment at home or in their communities instead of institutions, potentially reaching people with histories of hospitalization, crisis episodes, incarceration, or homelessness who currently fall outside Medicaid's coverage of community-based mental health care.

• Section 1 creates new Code section 49-4-142.6, giving the department authority (not a strict mandate, using 'may') to submit the waiver by December 31, 2026.
• The waiver targets adults over 21 needing mental health services who do not require institutional level care.
• Eligibility is tied to risk factors such as hospitalization stays, psychiatric crises, emergency department visits, prior incarceration, or homelessness.
• Once the federal waiver is approved, the department must take all necessary steps to arrange Medicaid payment for the covered services.
• Section 2 repeals any conflicting existing laws.

1. 2026-05-11Effective Date 2026-07-01
2. 2026-05-11Act 492
3. 2026-05-11Senate Date Signed by Governor (Senate)
4. 2026-04-10Senate Sent to Governor (Senate)
5. 2026-03-23House Passed/Adopted (House)
6. 2026-03-23House Third Readers (House)
7. 2026-03-10House Committee Favorably Reported (House)
8. 2026-02-26House Second Readers (House)

• Kay Kirkpatrick (R, SD-032)Primary sponsor
• Bo Hatchett (R, SD-050)
• Ben Watson (R, SD-001)
• Drew Echols (R, SD-049)
• Kim Jackson (D, SD-041)
• Chuck Efstration (R, HD-104)

1. PassedSenate voteFebruary 24, 2026

   46 yea, 0 nay (6 not voting, 3 absent)

   Passage By Substitute: Senate Vote #577

2. PassedHouse voteMarch 23, 2026

   166 yea, 2 nay (1 not voting, 7 absent)

   Passage: House Vote #745

• Medicaid
• mental health services
• healthcare policy
• home and community based care