Senate · Introduced · 2025-2026 Regular Session

SB481: SB481 Medical Assistance; Medicaid coverage for heart and lung transplants when medically necessary; require

Last action February 10, 2026 · Senate Read and Referred

A Georgia Senate bill would require the state's Medicaid program to cover heart and lung transplants, along with related care and anti-rejection drugs, whenever a licensed physician says the procedure is medically necessary.

In plain language

Currently, Georgia law does not specifically guarantee Medicaid coverage for heart and lung transplants. This bill adds a new section to the Official Code of Georgia Annotated (O.C.G.A. § 49-4-159.5) requiring the Georgia Department of Community Health, referred to as 'the department,' to cover these transplants for Medicaid patients whenever a physician licensed in Georgia determines the procedure is medically necessary. The coverage would extend beyond the surgery itself to include related healthcare services provided before and after the transplant, as well as immunosuppressant drugs, which patients take to prevent their bodies from rejecting the new organ. Because Medicaid programs are jointly run with the federal government, the bill also directs the department to submit any needed state plan amendments or waiver requests to the U.S. Department of Health and Human Services so the new coverage can actually take effect under federal Medicaid rules.

What the bill does

Adds a new Georgia law (O.C.G.A. § 49-4-159.5) requiring Medicaid to cover heart and lung transplants determined medically necessary by a Georgia-licensed physician.
Requires Medicaid coverage to include healthcare services related to the transplant both before and after the procedure.
Requires Medicaid coverage of immunosuppressant drugs, the medications transplant patients take to prevent organ rejection.
Directs the state department to file any Medicaid state plan amendments or federal waiver requests needed to put this coverage into effect.
Repeals any existing state laws that conflict with the new requirement.

Who it affects

Georgia Medicaid enrollees who need or have received heart or lung transplants, the physicians who treat them, transplant centers and hospitals, and the Georgia Department of Community Health, which administers Medicaid and must seek federal approval for the change.

Why it matters

Patients on Medicaid needing a heart or lung transplant could gain guaranteed coverage for the surgery, follow-up care, and the lifelong anti-rejection drugs that make a transplant successful, rather than relying on case-by-case coverage decisions. The change depends on federal approval before it can take full effect.

Key provisions

Section 1 adds new Code section 49-4-159.5, requiring the department to cover heart and lung transplants when a Georgia-licensed physician certifies they are medically necessary.
The same subsection extends coverage to related healthcare services provided before and after the transplant and to immunosuppressant drugs.
Subsection (b) requires the department to submit any Medicaid state plan amendment or waiver requests to the U.S. Department of Health and Human Services needed to implement the coverage.
Section 2 repeals any conflicting state laws.

Status timeline

2026-02-10Senate Read and Referred (Senate)
2026-02-09Senate Hopper (Senate)

Topics

Medicaid coverage
organ transplants
healthcare access
immunosuppressant drugs
Georgia health policy