Ga. hospitals hopeful Kemp health care waivers are a first step

Published 12:00 pm Thursday, November 14, 2019

ATLANTA — Heath care stakeholders have pushed for full Medicaid expansion in Georgia but are welcoming Gov. Brian Kemp’s partial expansion, hoping it will lead to more. 

While Kemp’s health care waivers will cover only a fraction of the Georgians that full Medicaid expansion would, the state’s hospitals say they hope it will lead to further expansion and financial support for rural and safety net medical providers. 

This month, Kemp unveiled his two-step health care waiver proposals package to tackle the high rates of uninsured Georgians: the 1115 Medicaid waiver and 1332 state innovation waiver. The Medicaid waiver addresses residents living under the federal poverty line while the state waiver provides increased private insurance options for people over the poverty line.

Kemp’s partial Medicaid expansion waiver and Georgia Access waiver would cost the state about $215 million to cover, by the state’s estimates, upwards of 80,000 Georgians by 2022.

The Medicaid waiver proposal has the capacity to cover 408,000 or so adult Georgians who make less than the federal poverty level but do not qualify for Medicaid. However, the governor’s office estimates only about 50,000 will be enrolled after five years — residents must also meet an 80 hour a month work requirement.

A Georgia Budget and Policy Institute report indicated that full Medicaid expansion would cost $2 million less and have the potential to cover over 486,000 Georgians by 2022.

Georgia is among a group of states with high rates of rural hospital closures — behind Texas and Tennessee — all part of the small coalition of states that refused Medicaid expansion.

According to a briefing in July, Deloitte consultants — hired by the state to help draft waiver proposals — seven rural Georgia hospitals have closed since 2010 and 26 facilities are at risk of closure.

‘Incremental steps’

According to the governor’s office, 408,000 Georgians living under the federal poverty line — about $12,000 a year for an individual — who do not currently qualify for Medicaid would have the opportunity to get insurance coverage through the Georgia Pathways 1115 waiver.

However the state estimates that by the end of five years, only 52,509 people will be enrolled.

The Georgia Hospital Association released a statement following the proposals stating that their “initial impression is that the ‘Georgia Pathways to Coverage’ Medicaid waiver does not significantly move the needle for the rural and safety net hospitals who care for the state’s uninsured patients” and hoped that the plan would have covered all of the eligible individuals under 100% of the federal poverty level.

Earl Rogers, president and CEO of the Georgia Hospital Association, said that he appreciates Kemp “breaking the drought” of health care expansion legislation — even if the state decided to opt for partial Medicaid expansion.

“We have some concerns that (the state) expects about 50,000 or so to get involved in this after the first couple of years,” Rogers told CNHI. “We would like to see more than that but listen, we understand how this works. As I mentioned before, these patients had no opportunity before and now they do. So, we think it’s a good first step moving forward. We are supportive of incremental steps.”

Rogers said that if the estimates of Georgia residents being covered were expected to stop at the 50,000 mark, that would concern the association because the number would not “significantly move the needle” for hospitals supporting uninsured populations.

Full expansion of Medicaid under the Affordable Healthcare Act, Rogers said, is not something he expects in Georgia’s future.

“I don’t believe we will ever have full Medicaid expansion under the Affordable Care Act,” Roger said. “But I do think that Governor Kemp has in mind to move as far in that direction as we can.”

For now, he said, we’ll wait and see if Kemp’s waivers work.

But Kemp’s health care proposals alone won’t keep rural hospitals from buckling under the demand of uninsured patients.

Recently released U.S. Census Bureau data ranked Georgia as the state with the third highest uninsured population in the country. While the percentage rose just slightly, up from last year, to 13.7 percent, it lost ground to other states.

Rural hospitals are hugely dependent on the Rural Hospital Tax Credit Program, Rogers said.

Effective on Jan. 1, 2017, the program allows residents and companies to make state tax deductible donations up to $10,000 to any of the 58 eligible rural hospitals across Georgia. The credit is capped at $60 million total — each hospital is able to achieve up to $4 million in donations annually.

“That has been a huge success for rural hospitals,” Rogers said. “Many of them have remained open because their community, the citizens in their community and the businesses in their community have realized that it is a perfect way to support their hospitals, while at the same time getting dollar for dollar tax credit back from the state.”

At the beginning of the program, individuals could see federal tax deductions from their donations but that benefit was done away with last year.

Rural hospitals are reliant on the rural tax program, he said, if the legislation had not been pushed by former state Rep. Geoff Duncan — current lieutenant governor — more hospitals would be in worse financial trouble.

“That has saved some of our rural hospitals,” Rogers said.

Some argued at the time the tax credit solution was another dodge of Medicaid expansion.

Drafts of Kemp’s waivers are posted and available for public comment. Ethan James, executive vice president of government relations for the hospital association said that their comments to the proposals are still being drafted and should be released by Nov. 21.