Earlier this month, this space featured a post on whether H.B. 990, which gave the Legislature the final say-so over Medicaid income thresholds, was in fact the final word on expansion.
Specifically, whether a workaround – perhaps like the ones adopted in Arkansas and elsewhere – might be possible.
This morning, House Speaker pro tem Jan Jones, R-Milton, sent over a thoughtful response that is well worth your time. To wit:
"I want to clarify Georgia requirements for Medicaid reform in response to a column you wrote June 11 entitled, "Lifting the lid on the debate over Medicaid expansion.
House Speaker pro tem Jan Jones, R-Milton. AJC file
The Arkansas Medicaid reform plan entails a federal Section 1115 waiver. A similar or other significant reform plan cannot be implemented in Georgia without prior legislative approval. In 2006, the Georgia General Assembly passed Senate Bill 572 requiring legislative action prior to significant Medicaid reform. The relevant Georgia code section is noted below. SB 572 did not address changes to income threshold requirements for Medicaid.
I believe SB 572 passed around the time Georgia implemented a managed care system for low-income Medicaid participants.
I authored House Bill 990 in 2014 to require legislative approval specifically for an increase in the income threshold in Medicaid expansion. At the time I worked on HB 990, I was aware of the existing requirement for legislative action for significant Medicaid modification and, thus, wrote it knowing that no "loophole" would be created in its narrow construction.
HB 990 was simply an extension of existing state policy requiring broad legislative participation in significant changes to Medicaid, a program that comprises 18 percent of the state general budget. Please note that every single Democrat in the Georgia General Assembly voted FOR legislative participation in 2006 through SB 572. In 2014, every single Democrat reversed course and voted AGAINST it through HB 990.
This income threshold issue became timely with the passage of Obamacare and after the U.S. Supreme Court ruled the federal government could not force states to increase the income threshold to expand Medicaid as a condition of continuing to participate in the program.
In the years I have been in the legislature, I recall Georgia modifying the income threshold once. The state reduced the income threshold to reduce costs and bring the state more in line with surrounding states.
As an aside, I suggest Senator Jason Carter reform his gubernatorial campaign rhetoric to conform to the facts. Expanding Medicaid by increasing the income threshold for able-bodied Georgians and putting taxpayers at risk is off the table, although he has claimed otherwise.
Additionally (as noted in the aforementioned column), Carter absurdly asserted that if we don't grab these federal dollars, our tax money will go to Medicaid expansion in other states. As a state legislator who has voted for state budget legislation, Carter should understand Medicaid is an entitlement program and, therefore, there is no fixed amount of federal Medicaid spending to be reallocated from state to state.
Unlike certain infrastructure grants, states that choose to participate do not have the opportunity to receive extra dollars when other states decline to participate. Every dollar we refuse to spend on Medicaid expansion is one dollar less that the U.S. has to borrow from China, not one dollar more that goes to another state. Georgia’s refusal to expand Medicaid does in fact help to reduce the growth in federal spending, which is yet another reason why every state should do the same.