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Georgia uses federally run health insurance exchange

Georgia utilizes the federally run health insurance exchange, so enrollments are performed via HealthCare.gov.

Open enrollment for 2021 Georgia health Insurance plans will last from November 1, 2020, to December 15, 2020. Outside of that window, residents with qualifying events can enroll or make changes to their coverage for 2020.

Effectuated enrollment in Georgia’s exchange stood at more than 396,000 individuals as of mid-2019. During the open enrollment period for 2020 health plans, 463,910 people signed up for private Georgia health insurance plans through the state’s exchange.

HHS estimated that 581,000 people in Georgia gained health insurance coverage from 2010 to 2015 due to the ACA. But Georgia hasn’t expanded Medicaid under the ACA, so the state has not taken full advantage of the ACA’s provisions. Currently, there are an estimated 255,000 people in the coverage gap in Georgia — ineligible for premium subsidies because they earn too little, and are ineligible for Medicaid because the state has not accepted federal funding to expand coverage. A new analysis by the Robert Wood Johnson Foundation estimated that Georgia’s uninsured rate would drop by nearly a third if it were to expand Medicaid.

After several years of insurer exits and fairly substantial rate rise, Georgia’s insurance market appears to stabilize. The average rate rises for 2019 was less than 4 percent, and average rates decreased slightly for 2020. And two new insurers — Oscar and CareSource — began offering coverage in Georgia’s exchange for 2020.

Georgia has proposed partial Medicaid expansion, reinsurance, and the elimination of an exchange platform. But due to COVID-19, the state wants to delay reinsurance until 2022 and modify some other provisions

Georgia enacted SB106, the Patients First Act, in March 2019. The legislation authorized the state to submit an 1115 waiver proposal to the federal government that could call for a partial expansion of Medicaid to cover people with income up to 100 percent of the poverty level (the legislation allows the proposal to go up to that amount, but not above it). SB106 also authorized the state to submit a 1332 waiver to the federal government with a proposal or proposals for improving the state’s individual health insurance market.

In May 2019, the state invited various consulting firms to submit proposals for working with the state to develop 1115 and 1332 waiver proposals. The state announced in June that Deloitte Consulting had been selected for the project.

Georgia is one of the states that hasn’t expanded medicaid.

Georgia is currently one of 14 states where no action has been taken to expand Medicaid. The state can partially expand Medicaid (up to 100 percent of the poverty level or some level below that). But based on the precedent in Utah, it’s unlikely that the federal government will agree to provide enhanced federal funding (i.e., Medicaid expansion level funding) if the state only partially expands coverage. But even a partial Medicaid expansion in Georgia would be a notable improvement over the status quo, as it would close the coverage gap in the state (an estimated 255,000 people are stuck in Georgia’s coverage gap; only Georgia and Texas currently have more people in the coverage gap).

The details of Georgia’s proposed 1115 waiver were unveiled in November 2019. It calls for a partial expansion of Medicaid, and would offer affordable Georgia health Insurance people with income under the poverty level — as long as they are compliant with a work requirement, and in some cases, paying premiums for their coverage. Although the full expansion of Medicaid (to cover people with income up to 138 percent of the poverty level) would include at least 400,000 low-income Georgia residents who need affordable Georgia health Insurance, the state’s modified expansion proposals are only expected to cover about 52,000 people, even after five years.

Resources and References:

• Healthcare.Gov in Georgia