The Centers for Medicare & Medicaid Services (CMS) announced that Georgia will no longer have authority to require work activities as a condition of Medicaid eligibility, or charge premiums beyond those allowed under the Medicaid statute, in its Georgia Pathways to Coverage demonstration. The decision, conveyed in a letter sent to the state today, supports the Biden-Harris Administration’s efforts to reduce health disparities while ensuring access to comprehensive, affordable, person-centered care.
In light of the ongoing disruptions caused by the COVID-19 pandemic, Georgia’s work requirements significantly compromise the state demonstration’s effectiveness in promoting coverage for intended beneficiaries. The lingering health consequences of COVID-19 infections further exacerbate the harms of these barriers to coverage for people with low income. Additionally, premiums can present a particular barrier to coverage. They can result in limited access to health care coverage for underserved communities, especially Black and low-income individuals compared to White and higher income peers.[1],[2]
Georgia had previously received section 1115 authority to charge premiums beyond those allowed under the Medicaid statute as a condition of eligibility for some individuals to receive demonstration coverage, but had not begun to implement the demonstration, including charging beneficiaries premiums under such authority. In the letter sent today, CMS notified the state that this authority, in addition to work requirements authority, is rescinded. For additional information, including details on approved portions of the demonstration and other specific terms and conditions, consult Georgia’s state waiver overview page on Medicaid.gov.
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