HB 1502: Community Health, Department of; contracts with care management organizations for the provision of healthcare services for Medicaid or PeachCare for Kids recipients; establish requirements

Georgia's Medicaid and PeachCare for Kids programs contract with private care management organizations (CMOs) to provide healthcare services to enrollees on a prepaid basis. This bill adds a new section to Georgia law (O.C.G.A. § 49-4-159.5) spelling out how the Department of Community Health must handle those contracts once the current ones expire. The department would have to publicly post a request for new applications, give the public at least 60 days to comment before issuing it, and post a summary of comments and its responses. Any pending procurement without a final contract on the bill's effective date would be automatically cancelled. The department must set minimum quality standards for CMOs, let members choose among qualifying plans in their region, evaluate CMOs annually starting July 1, 2027, and recertify them every three to five years. CMOs denied a contract or terminated get a hearing and can appeal to Fulton County Superior Court. The law would take effect as soon as the Governor signs it or it becomes law without his signature.

• Requires the Department of Community Health to publicly post a request for applications from care management organizations once existing Medicaid and PeachCare for Kids contracts expire.
• Requires at least 60 days of public notice and comment before the department issues a new request for applications, and requires posting a summary of comments and responses.
• Automatically cancels any pending care management organization procurement without a final contract on the bill's effective date.
• Requires the department to set minimum quality and performance standards for evaluating care management organizations, considering cost, care quality, provider network size, and past experience.
• Requires annual evaluations of care management organizations starting July 1, 2027, and recertification every three to five years.
• Gives care management organizations that are denied contracts or terminated a right to a hearing, an appeal to the commissioner, and judicial review in the Superior Court of Fulton County.

The Department of Community Health, which must run the new application and evaluation process; care management organizations that contract with the state to serve Medicaid and PeachCare for Kids members; and the roughly two million Georgians enrolled in those programs, who would choose among the plans the department certifies.

The bill changes how the state picks and monitors the companies that manage healthcare for Medicaid and PeachCare for Kids members, adding public comment steps, quality checks, and appeal rights. That could affect which companies keep contracts, how quickly problems get corrected, and which health plans members can choose from in their region.

• Subsection (a) defines 'care management organization,' 'existing contracts,' and 'member' for purposes of the new Code section.
• Subsection (b) requires the department to post a request for applications after existing contracts expire, with 60 days' public notice and comment beforehand and a summary of comments posted 30 days before issuance.
• Subsection (c) automatically cancels any pending procurement without a final contract on the effective date.
• Subsection (d) requires the department to set minimum quality and performance standards considering cost efficiency, care quality, provider network size, and multistate experience.
• Subsection (e) lets each member choose any contracted plan offered in their region for which they are eligible.
• Subsection (f) requires annual evaluations starting July 1, 2027, published results, a corrective-action benchmark, and recertification every three to five years.
• Subsection (g) gives denied or terminated care management organizations a hearing, a 14-day appeal window to the commissioner, and judicial review in Fulton County Superior Court.
• Subsection (h) allows the department to require corrective action plans, suspend default enrollment, or terminate contracts for noncompliance; subsection (i) makes this the exclusive method for entering such contracts.

1. 2026-03-06House Second Readers (Cámara de Representantes)
2. 2026-03-04House First Readers (Cámara de Representantes)
3. 2026-03-03House Hopper (Cámara de Representantes)

• Trey Kelley (R, HD-016)Patrocinador principal
• Bruce Williamson (R, HD-112)
• Demetrius Douglas (D, HD-078)

• Medicaid
• PeachCare for Kids
• healthcare contracting
• managed care organizations
• Department of Community Health