HB 258: PeachCare for Adults Act; enact

Georgia currently has no state health coverage program aimed specifically at low-income adults who are not eligible for Medicaid. This bill would add a new article to Georgia's public assistance laws creating the PeachCare for Adults Program, run by the Department of Community Health. The Board of Community Health would have to apply for a federal waiver by January 1, 2026, seeking approval and enhanced federal funding to cover adults aged 18 to 64 with incomes at or below 133 percent of the federal poverty level. The Department of Community Health would then have to launch the program by January 1, 2027, offering coverage similar to Medicaid, including mental health and substance use treatment, vaccinations, and other essential health benefits. Premiums would be based on income, with no premium charged to people at or below the poverty level, and enrollment could not be tied to work requirements.

• Creates a new PeachCare for Adults Program in the Department of Community Health for adults 18 to 64 with incomes up to 133 percent of the federal poverty level who are not on Medicaid.
• Requires the Board of Community Health to apply for a federal Section 1115 waiver from the Centers for Medicare and Medicaid Services by January 1, 2026, to fund the program.
• Requires the program to launch no later than January 1, 2027, with Medicaid-level coverage including mental health, substance use, and vaccination benefits.
• Sets an income-based premium scale, exempting anyone at or below the poverty level from premiums and capping others at 2 percent of gross income or the cost of a benchmark marketplace plan.
• Bars the state from making enrollment contingent on work requirements.
• Automatically enrolls existing Medicaid providers as program providers and ties reimbursement rates to the Medicaid fee schedule.

Low-income adults aged 18 to 64 who earn too much for Medicaid but up to 133 percent of the federal poverty level, the Department of Community Health and Board of Community Health, healthcare providers who already participate in Medicaid, and state agencies including the Department of Revenue and Department of Administrative Services, which may help administer the program.

If enacted and the federal waiver is approved, tens of thousands of low-income Georgia adults who currently fall into a coverage gap between Medicaid eligibility and marketplace subsidies could gain access to health insurance, including mental health and substance use treatment, without facing work requirements.

• Section 49-4-201 defines an 'eligible person' as someone 18 to 64 years old with income at or below 133 percent of the federal poverty level who is not on Medicaid.
• Section 49-4-202 requires the Board of Community Health to submit federal waiver requests by January 1, 2026, and to pursue enhanced federal funding under the Affordable Care Act.
• Section 49-4-203 requires the program to launch by January 1, 2027, and sets minimum coverage standards, premium rules, and a ban on work requirements for enrollment.
• Section 49-4-203(f) requires an annual public report on enrollment numbers, services provided, and payments to providers, sent to the Governor.
• Section 49-4-204 makes existing Medicaid providers automatic program providers and ties reimbursement rates to the Medicaid fee schedule, allowing increases if funds are available.
• Section 49-4-204(e) allows the department to share applicant income information with the state revenue commissioner to verify eligibility, under confidentiality protections from Code Section 48-7-60.
• Section 49-4-205 authorizes the Department of Community Health to write rules and regulations to carry out the program.

1. 2025-02-06House Second Readers (Cámara de Representantes)
2. 2025-02-05House First Readers (Cámara de Representantes)
3. 2025-02-04House Hopper (Cámara de Representantes)

• Debbie Buckner (D, HD-137)Patrocinador principal
• Scott Holcomb (D, HD-101)
• Carolyn Hugley (D, HD-141)
• Billy Mitchell (D, HD-088)
• Karen Bennett (D, HD-094)
• Stacey Evans (D, HD-057)

• health coverage
• Medicaid gap
• PeachCare for Adults
• Department of Community Health
• low-income adults