Medicaid expansion cost-share deal would stay put in Warnock, Ossoff bill

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A Georgia Senator has introduced a bill to expand Medicaid at 100% federal costs for states who did not take the money under ACA.



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Newly seated U.S. Sen. Raphael Warnock of Georgia unveiled legislation Friday, Feb. 5, to give states that skipped out on early Medicaid expansion equal federal cost-sharing coverage if they join later.

The bill, called the “States Achieve Medicaid Expansion (SAME)” Act, aims to quell concerns over possible future changes to the federal-state payment arrangement for Medicaid under the Affordable Care Act (ACA), which has been a stumbling block for many states opposed to full coverage expansion.

Its leader sponsors are Warnock and U.S. Sen. Mark Warner of Virginia. Georgia’s U.S. Sen. Jon Ossoff, who teamed with Warnock in the 2020 elections to flip both of the state’s Senate seats, is also joined on the bill.

Currently, the federal government pays 100% of the costs for the first three years for states that provide Medicaid to residents with incomes up to 138% of the federal poverty level, the definition of full coverage. Georgia is set to partially expand coverage this year but remains among about a dozen states that have declined full expansion.

Warnock, a Democrat who is Georgia’s first Black senator and remains senior pastor of Atlanta’s Ebenezer Baptist Church, campaigned on a platform to expand Medicaid, institute a national $15-an-hour minimum wage and bolster voting rights. He called his bill a push to blanket all Americans with health-insurance coverage.

“Health care is a human right, and for too long, too many Georgians have been denied access to affordable health care through Medicaid,” he said. “I’ve long believed that expanding Medicaid in Georgia is an important step toward making affordable health care for all a reality.”

Medicaid enrollment has spiked during the COVID-19 pandemic that began last March. In Georgia, Medicaid rolls increased by 338,000 between March and December 2020, raising the total number of children, adult and family recipients to roughly 2,104,000, according to state Department of Community Health (DCH) data.

Opponents have warned covering thousands more people could bust Georgia’s budget for Medicaid, even with the extra federal spending. Currently, the federal government pays about two-thirds of the more-than $10 billion Georgia spends on Medicaid each year.

Critics also worry policy changes now could saddle Georgia with costly terms for jumping on the full-expansion train late in the ballgame, years after other states joined the Obama-era health-care program.

“I don’t know if the federal government will ever return to a period of budget austerity,” Chris Denson, policy and research director for the nonprofit Georgia Public Policy Foundation (GPPF), said last week (week of Jan. 24). “But there’s always a chance that the feds will drop that matching rate.”

Medicaid coverage is now available for Georgia adults with incomes about 35% below the federal poverty line, as well as children in households making up to 138% above the poverty line and low-income senior, blind and disabled adults.

Gov. Brian Kemp, a Republican, gained federal approval last October from the Trump administration for a partial Medicaid expansion, covering adults earning up to 100% of the poverty level. That would cover about 50,000 Georgians, according to state estimates.

Kemp’s plan also requires Georgia Medicaid recipients to work, attend school or volunteer at least 80 hours each month – a controversial provision critics argue strips deserving low-income Georgians and families of a safety net.

Warnock’s bill leveling Medicaid cost-sharing percentages stands a good chance to win approval in Congress, thanks to his and Democratic co-campaigner Ossoff’s wins in last month’s runoff elections.

Warnock and Ossoff defeated Georgia’s two incumbent Republican senators, shifting control of both chambers in Congress to Democrats at the same time President Joe Biden – a Democrat – took office.

Ossoff, who is Georgia’s first Jewish senator and currently the chamber’s youngest member, called his colleague’s bill both a moral document and good incentive for states like Georgia that have not expanded Medicaid.

“This bill would ensure Georgia gets the same funding as other states that expanded Medicaid years ago – and create even more incentive for our state government to do what should have been done a decade ago and expand Medicaid for Georgia families,” Ossoff said.

Both of Georgia’s new senators have been busy since taking office on Jan. 20. They have called for showering Georgians with more dollars for COVID-19 pandemic relief, as well as bolstering voting rights even as Republican state lawmakers move to put new restrictions on absentee voting.


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