Limited Georgia Medicaid expansion launches this weekend

ATLANTA – Georgia Republicans have sought to go their own way in expanding Medicaid coverage for more than a decade since a U.S. Supreme Court ruling on the Affordable Care Act (ACA) passed by a Democratic Congress gave states that right.

Now, the “Georgia-centric” version of Medicaid expansion is about to take flight. The new Georgia Pathways program, a more limited expansion of Medicaid than its federal counterpart, is taking effect this weekend.

But Democrats in the General Assembly and health-care advocates say the state is missing an opportunity both to save taxpayer dollars and serve more low-income Georgians by not adopting a full-blown expansion of Medicaid coverage under the ACA, as 40 other states have done. Opponents are particularly critical of Georgia Pathways’ first-in-the-nation work requirement for Medicaid recipients.

Under Georgia Pathways, Georgia residents between the ages of 19 and 64 with household incomes up to 100% of the Federal Poverty Level will be eligible for Medicaid coverage. The program will not apply to low-income elderly Georgians or the disabled.

The federal program covers Americans with household incomes up to 138% of the poverty level, which is $30,000 a year for a family of four.

Recipients of Georgia Pathways coverage also must participate in at least 80 hours per month of “qualifying” activities, including work but also education, job training, or community service.

“This is not a work requirement,” said Caylee Noggle, commissioner of the state Department of Community Health (DCH), which oversees Georgia’s Medicaid program. “Work is one way to meet the requirement.”

Republican Gov. Brian Kemp first proposed a limited Medical expansion back in 2019, his first year in office. The administration of then-President Donald Trump approved Georgia Pathways in 2020 as a waiver from the requirement that states fully expand Medicaid coverage only to have the Biden administration reject the plan in 2021.

Georgia took the decision to federal court last year and won the right to move forward with the waiver.

The state estimates about 345,000 Georgians will potentially be eligible to enroll in Georgia Pathways, including about 200,000 current Medicaid recipients.

As the program ramps up, it will serve an estimated 100,000 during the first year. The DCH has budgeted $117 million in state dollars to cover the program initially, along with $227 million in federal matching funds.

Critics of Georgia Pathways say even if the program ultimately reaches that peak enrollment, it won’t cover all Georgians who are uninsured.

“Any program that doesn’t cover all 400,000 to 450,000 [uninsured] Georgians falls short of what Georgia needs,” said Laura Colbert, executive director of Georgians for a Healthy Future.

Supporters of full Medicaid expansion say Georgia would gain access to a much larger federal match than Georgia Pathways – with the feds providing 90 cents of every dollar spent on expansion through the ACA compared to 66 cents on the dollar Georgia’s Medicaid program currently gets.

In fact, full Medicaid expansion comes at no cost to states for the first two years, thanks in part to a one-time bonus of up to $1.2 billion the American Rescue Plan offers states that choose to expand coverage through the ACA. Congress passed the legislation in 2021 as a pandemic relief measure.

“It’s past time for us to bring home those federal funds,” said Leah Chan, senior health policy analyst with the Georgia Budget and Policy Institute, an Atlanta-based nonprofit.

But Garrison Douglas, a spokesman for Kemp, said Georgia Pathways offers a “sustainable solution” to Medicaid coverage that the ACA can’t guarantee would continue indefinitely.

“When you rely on the federal government, you don’t know who’s going to be in office,” Douglas said.

Chan said North Carolina resolved those concerns when it adopted full Medicaid expansion by including a provision in the legislation stating the Tar Heel State would pull out of the federal program if the federal match is significantly reduced.

Advocates for full Medicaid expansion say it also would provide an economic boost to Georgia, creating thousands of jobs and stabilizing rural hospitals.

“Our rural hospitals are in trouble,” said Dr. Len Lichtenfeld, an Atlanta oncologist and internist. “We’re losing their services and the employment and income they bring.”

Georgia Pathways’ supporters counter that many of the Georgians who would sign up for Medicaid under a full expansion already have health insurance coverage through their employers.

“The added cost of covering those already-covered Georgians pushes the price tag of Medicaid expansion far higher than proponents usually allow,” Kyle Wingfield, president of the Georgia Public Policy Foundation, a think tank that advocates free-market approaches to public policy, wrote in a column last winter.

Opponents of the new program also raise the issue of timing. The federal government stopped doing the usual eligibility screening of Medicaid enrollees during the pandemic but resumed that “redetermination” process in April.

“It’s a very turbulent time for tens of thousands of Georgians,” said Joe Binns, Georgia state director of Protect Our Care, a nonprofit health-care advocacy group. “This is a terrible time to be conducting an experiment on the health-care system in Georgia.”

Noggle turned that argument on its head.

“This is a perfect time for this,” she said. “This is more coverage. This is another option.”

Noggle said Georgia Pathways will begin with a “soft launch” this weekend. The DCH expects to have application forms on the agency’s website by Sunday morning, she said. A mobile application will be launched later in July.

Several state agencies getting new heads

Rick Dunn

ATLANTA – There’s been some major shuffling of posts inside the Kemp administration.

Gov. Brian Kemp Friday named Rick Dunn, currently director of the Georgia Environmental Protection Division (EPD) to take the reins at the Governor’s Office of Planning and Budget (OPB). Dunn will succeed OPB Director Kelly Farr, who is leaving state government for the private sector.

“I’m grateful for Rick’s continued willingness to serve his fellow Georgians as he returns to OPB, where he made valued contributions as the deputy director prior to his current role,” Kemp said.

To replace Dunn at the EPD, the state Board of Natural Resources voted Friday to appoint David Dove, the governor’s executive counsel, as interim director of the EPD. Dove also will continue serving as executive counsel.

The natural resources board also named Walter Rabon, currently deputy commissioner of the Georgia Department of Natural Resources (DNR), to move up into the commissioner’s post. Current DNR Commissioner Mark Williams is about to become executive director of the Jekyll Island Authority.

In other moves, Kemp appointed Russell Carlson, currently chief health policy officer for the state Department of Community Health, to step up to commissioner of the health agency. He will succeed Caylee Noggle, who is leaving for the private sector.

The new positions for Dunn, Dove, and Rabon take effect July 1. Carlson’s new job with the DCH starts Aug. 1.

Lawsuit looking to block ban on gender-affirming care for Georgia transgender youth

ATLANTA – A group of parents has filed a federal lawsuit challenging Georgia legislation limiting medical care for transgender children, two days before the law is due to take effect.

Senate Bill 140, which prevents Georgians under 18 from obtaining gender-affirming hormone replacement therapy or surgery, is scheduled to take effect Saturday. The lawsuit, filed late Thursday, is seeking a preliminary injunction in U.S. District Court for the Northern District of Georgia to stop that from happening.

The plaintiffs, represented by the ACLU’s Georgia chapter, the Southern Poverty Law Center and the Human Rights Campaign, argue the law is unconstitutional. 

“The ban infringes parents’ fundamental right to make medical decisions in the best interests of their children, and it singles out transgender minors for the denial of essential medical care, contrary to the Due Process and Equal Protection Clauses of the Fourteenth Amendment,” the plaintiffs wrote in their motion to block the law.

The Republican-controlled General Assembly passed Senate Bill 140 in March, voting along party lines. Supporters framed the law as a measure to protect children from irreversible physical changes. 

“As Georgians, parents, and elected leaders, it is our highest responsibility to safeguard the bright, promising futures of our kids – and SB 140 takes an important step in fulfilling that mission,” GOP Gov. Brian Kemp wrote at the time in a statement on Twitter.   

During the debate that led up to passage of the bill, legislative Democrats, parents of transgender youth, and major medical societies argued it would harm vulnerable transgender youths’ mental health. Opponents cited higher-than-average suicide rates among transgender teens.

At least 18 Republican-led states have adopted limits to medical care for transgender minors.

U.S. Supreme Court overturns affirmative action in college admissions

ATLANTA – The conservative majority on the U.S. Supreme Court ruled Thursday that colleges and universities can no longer use race in admissions decisions.

The 6-3 decision in lawsuits brought by the conservative group Students for Fair Admissions against Harvard University and the University of North Carolina, overturned affirmative action policies that have been in effect for decades.

The majority opinion, written by Chief Justice John Roberts, sides with the plaintiff’s argument that using affirmative action in college admissions violates the Equal Protection Clause of the Reconstruction-era 14th Amendment to the Constitution.

“Eliminating racial discrimination means eliminating all of it,” Roberts wrote.

In a concurring opinion, Justice Clarence Thomas of Georgia, the second Black to serve on the high court, criticized the affirmative action policies colleges and universities have been using as “rudderless, race-based preferences designed to ensure a particular racial mix in their entering classes.”

“While I am painfully aware of the social and economic ravages which have befallen my race and all who suffer discrimination, I hold out enduring hope that this country will live up to its principles so clearly enunciated in the Declaration of Independence and the Constitution of the United States: that all men are created equal, are equal citizens, and must be treated equally before the law,” Thomas wrote.

But Justice Sonia Sotomayor argued in a dissenting opinion that affirmative action has been used as an effective tool for promoting diversity and inclusion in higher education.

“This limited use of race has helped equalize educational opportunities for all students of every race and background and has improved racial diversity on college campuses,” Sotomayor wrote. “Although progress has been slow and imperfect, race-conscious college admissions policies have advanced the Constitution’s guarantee of equality.”

Lower courts had agreed to that interpretation, ruling in favor of the two schools because they were using race in a limited way to achieve the goal of ensuring diversity in university student bodies.

Kendra Cotton, executive director of the civil and voting rights group New Georgia Project and a member of the Black Southern Women’s Collaborative, said the decision denies the reality that more work needs to be done to end racism in America.

“While Black Americans and other Americans of color have made huge strides, especially in education and college admissions, no one can deny the fact that affirmative action has been a critical safeguard in ensuring Black and brown students, who already face so many system barriers, do not continue to get left behind,” Cotton wrote in a news release.

“So-called colorblind practices exist solely to ease the guilt of the more privileged and pay lip service to the fantasy of a post-racial society that, unfortunately, too many people in this country wrongly believe is reality.”

Joining Roberts and Thomas in the majority were justices Brett Kavanaugh, Neil Gorsuch, Amy Coney Barrett and Samuel Alito. Justices siding with Sotomayor in the minority were justices Elena Kagan and Ketanji Brown Jackson.

Georgia Lottery celebrates 30th anniversary

ATLANTA – Gov. Brian Kemp, Georgia Lottery officials, and heads of the state agencies that benefit from the scholarship program celebrated the lottery’s 30th anniversary Wednesday.

“That is a significant amount of time,” Kemp told reporters during a ceremony inside the governor’s office at the Georgia Capitol. “A whole generation of students have benefited, some twice.”

Since the first lottery ticket went on sale on June 29, 1993, the lottery has transferred more than $26.5 billion to education in Georgia. More than 2.1 million college students have benefited from the HOPE Scholarship and HOPE-related scholarship programs, while more than 2 million youngsters have been able to attend pre-kindergarten through the lottery.

Kemp and Gretchen Corbin, president and CEO of the Georgia Lottery Corp., highlighted the addition of $61 billion to the fiscal 2024 state budget to restore 100% of tuition coverage to the HOPE program. The additional coverage will save the average HOPE recipient about $400 a year.

HOPE was hit with benefit cuts in the aftermath of the Great Recession more than a decade ago and has been gradually building back toward full tuition coverage.

But Kemp said the success of HOPE amounts to more than dollars and cents.

“It is measured in the students with good-paying jobs because HOPE gave them the opportunity for higher education,” he said.

Greg Dozier, commissioner of the Technical College System of Georgia, said 51% of the students attending the state’s technical colleges are first-generation college students.

“When we change an individual, we change a family and a community,” he said.