On November 1, 2020, CMS and the Department of the Treasury approved Georgia’s request for a 1332 State Relief and Empowerment waiver (1332 waiver), permitting the state to implement a new healthcare plan to address growing healthcare access and affordability challenges facing Georgia residents. Section 1332 waivers permit states to implement new ways to provide access to healthcare that are currently not possible under the Affordable Care Act (ACA), as long as the new plan: (1) is as comprehensive and affordable as would be provided absent the waiver; (2) provides coverage to a comparable number of residents as would be provided absent the waiver; and (3) does not increase the federal deficit.
Currently, Georgia has one of the highest uninsured rates in the country at 13.7 percent, resulting in approximately 1.38 million uninsured people. The high uninsured rate has been attributed to numerous factors, including high premiums and out-of-pocket expenses, in addition to low carrier participation in the individual market in certain areas of the state. From 2016 to 2019, total individual market enrollment on the Federal Exchange in Georgia declined over 22 percent.
Georgia’s new healthcare program consists of two phases. Beginning in plan year 2022, Georgia will implement a reinsurance program that is expected to reduce annual premiums in the individual market by an average of 10 percent. During the second phase, Georgia’s individual market will be transitioned from the Federal Exchange to a private sector platform, the Georgia Access Model, beginning in Payment Year 2023. Through the Georgia Access model, health insurance consumers will shop for and buy coverage directly from insurers or through web brokers. Certain eligible consumers will be able to enroll in the subsidy-eligible qualified health plans and be assessed for Medicaid and the Children’s Health Insurance Program (CHIP) eligibility, simultaneously.
CMS’s news release regarding approval of Georgia’s 1332 waiver is available here, and the recent approval builds on its earlier approval of Georgia’s Section 1115 demonstration project to partially expand Medicaid coverage for adults who participate in certain qualifying activities like work and education.
