SB428: SB428 Medical Assistance; Department of Community Health to submit a waiver request to the federal Centers for Medicare and Medicaid Services; direct

Georgia's Medicaid program currently reimburses certain home and community based services under specific waivers, but there is no waiver covering adults over 21 who need mental health services but do not require an institutional level of care. This bill adds a new section to Georgia law (O.C.G.A. § 49-4-142.6) that allows the Department of Community Health to submit a waiver request to the federal Centers for Medicare and Medicaid Services (CMS) by December 31, 2026. The waiver would let Medicaid reimburse home and community based mental health services for adults assessed as not needing institutional care, 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 take the steps necessary to start paying for that care with Medicaid funds. The bill also repeals any conflicting laws.

• Adds a new Georgia law (O.C.G.A. § 49-4-142.6) allowing the Department of Community Health to request a Medicaid waiver from the federal government.
• Sets a deadline of December 31, 2026 for the department to submit the waiver request to the federal Centers for Medicare and Medicaid Services.
• Targets adults over age 21 who need mental health services but do not require an institutional level of care.
• Lists specific risk factors, such as hospitalization history, psychiatric crises, emergency room visits, incarceration, or homelessness, that can be used to determine eligibility.
• Requires the department to begin paying for these home and community based services with Medicaid funds once the federal waiver is approved.
• Repeals any existing Georgia laws that conflict with this new provision.

Adults over 21 in Georgia who need mental health treatment but not institutional care, especially those with histories of hospitalization, psychiatric crises, emergency room visits, incarceration, or homelessness. It also affects the Department of Community Health and Georgia's Medicaid program.

If the federal government approves the waiver, more Georgians with serious mental health needs could receive treatment in their homes or communities instead of institutions, with Medicaid covering the cost. Until federal approval happens, no new services or funding take effect.

• Section 1 adds new Code section 49-4-142.6 to Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated.
• Subsection (a) allows (does not require) the department to submit the federal waiver request no later than December 31, 2026.
• Subsection (a) defines the target population as Medicaid recipients over 21 needing mental health services who do not require an institutional level of care, based on listed risk factors.
• Subsection (b) requires the department to take all necessary steps to begin Medicaid payment for these services only after the federal waiver is approved.
• Section 2 repeals any conflicting Georgia 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
• home and community based care
• health policy
• Department of Community Health