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

In plain language

What the bill does

Who it affects

Why it matters

Key provisions

From the bill

Discussed in meetings (13)

The House and Senate meetings that took this bill up, from their machine transcripts. Each account was written by Georgia Commons with AI and is not part of the record; the video is what was said.

1. Senate Health and Human Services Committee, February 18, 2026

   From 0:17:22 · Watch on the General Assembly's Vimeo channel

   Summary by Georgia Commons: The sponsor said SB 428 would authorize a federal waiver for adults 21 and older, currently ineligible for Medicaid, with severe mental health or substance use disorders and repeated crises. The sponsor described case management, housing support, treatment, employment assistance and transportation intended to reduce hospital and jail use. Asked about oversight, the sponsor said DCH would oversee providers. A DCH representative said developing the application would cost $500,000, with no ongoing state budget requirement. DCH's Medicaid director said federal rules require cost neutrality, with individual cost estimates developed for the application and program costs monitored afterward. The director cited a Texas model showing savings and a 20% to 25% reduction in repeat incarceration. Members questioned whether homelessness was required, how costs could be estimated for uninsured people and whether services could cover jail care. DCH representatives said eligibility details would be developed through the waiver, enrollment could be capped, and services would occur in community settings, not jails, with coordination upon release. They also said income and asset limits would apply. The committee unanimously adopted an amendment removing “and” before homelessness and adding language allowing any combination of listed factors. The amended bill then passed unanimously and advanced to Rules.

2. Senate Rules Committee, February 20, 2026

   From 0:09:55 · Watch on the General Assembly's Vimeo channel

   Summary by Georgia Commons: The sponsor described SB 428 as a Department of Community Health agency bill enabling a new type of waiver for people who are homeless and have serious mental illness. No substantive questions followed. The bill was later selected for the floor calendar, and the committee unanimously approved it as part of a five-bill motion.

3. Senate floor session, February 24, 2026 (legislative day 23)

   From 3:22:41 · Watch on the General Assembly's Vimeo channel · Confirmed by the bill's status history (Senate Third Read)

   Summary by Georgia Commons: The sponsor described SB 428 as a Department of Community Health proposal for people with complex needs who frequently use emergency rooms and jails and are often homeless. The sponsor said it would authorize the department to seek federal Medicaid permission for intensive case management and other community supports. No questions were asked of the sponsor. During voting, another senator criticized the majority's gradual approach to Medicaid expansion and urged broader expansion. The Senate adopted the committee substitute without objection and passed the bill, 46-0.

4. House Health Committee, March 9, 2026

   From 0:46:14 · Watch on the General Assembly's Vimeo channel

   Summary by Georgia Commons: The sponsor said SB 428 would authorize the Department of Community Health to seek a Medicaid waiver using new federal flexibility. The sponsor said the waiver would provide intensive case management and supports for people not currently eligible who repeatedly use emergency rooms and jails, including some experiencing homelessness. The sponsor said no appropriations request accompanied the bill. One member asked why the language permitted rather than required an application. The sponsor said federal uncertainty prompted that choice, but the department intended to apply. Another member asked whether participants would need an institutional level of care. The sponsor said some probably would, but the proposal focused on people not receiving services and would use nurse case managers to connect them with available resources. The sponsor argued this could reduce costs for the state and hospitals and help sheriffs managing mental health needs in jails. The committee recommended passage by voice vote.

5. House Rules Committee, March 11, 2026

   From 0:21:23 · Watch on the General Assembly's Vimeo channel

   Summary by Georgia Commons: The sponsor said SB 428 would authorize the Department of Community Health to apply for a waiver to provide medical benefits, including intensive nurse case management, to people who frequently use jails, emergency departments and other expensive care settings. The sponsor said many of these people fall through gaps in services and end up living on the street, and described the proposal as a way to help change that. No questions were asked, and no vote was shown.

6. House Rules Committee, March 23, 2026

   From 0:37:50 · Watch on the General Assembly's Vimeo channel

   Summary by Georgia Commons: The committee placed SB 428 on the day's calendar after a motion and second, with no stated opposition. No explanation of its provisions or substantive debate occurred.

7. House floor session, March 23, 2026 (legislative day 36, PM)

   From 0:52:47 · Watch on the General Assembly's Vimeo channel · Confirmed by the 2026 House Journal, p. 2986

   Summary by Georgia Commons: The sponsor said SB 428 would direct the Department of Community Health to request federal permission to provide home and community-based mental health services for eligible adults. The sponsor described people with serious mental health needs who do not need institutional care but cycle through hospitals, homelessness or incarceration without consistent support. The sponsor argued that earlier care could stabilize lives, reduce repeat hospitalizations and emergency room use, and save taxpayers money. A member asked whether Medicaid waivers allow states to test approaches outside ordinary program rules. The sponsor agreed. The House passed the bill 166 to 2.

• Read aloud: Senate floor session, January 28, 2026 (legislative day 8), 0:26:04
• Read aloud: Senate floor session, February 19, 2026 (legislative day 21), 0:34:49
• Read aloud: Senate floor session, February 20, 2026 (legislative day 22), 0:41:27
• Read aloud: House floor session, February 25, 2026 (legislative day 24), 0:33:12
• Read aloud: House floor session, February 26, 2026 (legislative day 25, AM), 1:04:10
• Read aloud: House floor session, March 10, 2026 (legislative day 30), 0:50:01

Status timeline

Sponsors

Votes

Topics