SB 481: Medical Assistance; Medicaid coverage for heart and lung transplants when medically necessary; require

Georgia's Medicaid program is run by the Department of Community Health under Title 49 of state law. This bill adds a new section requiring the department to cover heart and lung transplants for Medicaid patients whenever a physician licensed in Georgia determines the transplant is medically necessary. Coverage would also extend to related healthcare services provided before and after the transplant, as well as immunosuppressant drugs, which patients need long-term to keep their bodies from rejecting a transplanted organ. Because Medicaid is a joint state-federal program, the bill directs the Department of Community Health to submit any state plan amendment or waiver request needed to the federal Department of Health and Human Services to actually put this coverage into effect. The bill repeals any conflicting laws but does not state a specific effective date beyond the Act's general terms.

• Adds a new Code section (O.C.G.A. § 49-4-159.5) requiring Georgia Medicaid to cover heart and lung transplants when a Georgia-licensed physician deems them medically necessary.
• Extends that coverage to healthcare services provided before and after the transplant, not just the surgery itself.
• Requires Medicaid to cover immunosuppressant drugs, the medications transplant patients need to prevent organ rejection.
• Directs the Department of Community Health to file any Medicaid state plan amendment or federal waiver request needed to carry out the new coverage requirement.

Georgians enrolled in Medicaid who need heart or lung transplants, the physicians who determine medical necessity, and the Department of Community Health, which administers Medicaid and would need federal approval to implement the change.

Transplant surgery, follow-up care, and lifelong immunosuppressant drugs are expensive. If enacted, Medicaid patients needing a heart or lung transplant would have a clearer guarantee of coverage for the surgery and the ongoing medications required to keep the transplant successful.

• Section 1 creates O.C.G.A. § 49-4-159.5(a), requiring Medicaid coverage for heart and lung transplants determined medically necessary by a licensed Georgia physician, plus related pre- and post-transplant care and immunosuppressant drugs.
• Section 1 creates subsection (b), requiring the Department of Community Health to submit any Medicaid state plan amendment or waiver request needed to implement the coverage to the federal Department of Health and Human Services.
• Section 2 repeals any state laws that conflict with the new requirement.

1. 2026-02-10Senate Read and Referred (Senado)
2. 2026-02-09Senate Hopper (Senado)

• Elena Parent (D, SD-044)Patrocinador principal
• Harold Jones (D, SD-022)
• Randal Mangham (D, SD-055)
• Kim Jackson (D, SD-041)
• Sally Harrell (D, SD-040)
• Sonya Halpern (D, SD-039)
• Tonya Anderson (D, SD-043)
• Kenya Wicks (D, SD-034)
• RaShaun Kemp (D, SD-038)
• Gail Davenport (D, SD-017)
• Nan Orrock (D, SD-036)
• Derek Mallow (D, SD-002)
• David Lucas (D, SD-026)
• Josh McLaurin (D, SD-014)

• Medicaid coverage
• organ transplants
• healthcare access
• immunosuppressant drugs
• health policy