November 21st, 2019 – 2:30 PM
Ethan Garrett –
On Thursday morning, the Georgia Department of Community Health held a public forum at West Rome Baptist’s “The Well” building to cover the topic of the Pathways to coverage 1115 demonstration waiver.
The state of Georgia is requesting approval of an 1115 Demonstration Waiver to implement new policies that will further the State’s vision of creating “A Healthy Georgia.” The State recognizes too many of its working, low-income citizens do not have access to or are unable to afford healthcare coverage. The State is creating a new eligibility pathway focused on encouraging and incentivizing work and other employment-related activities, for low-income Georgians who are not otherwise eligible for Medicaid coverage.
To further support Georgians on their journey to self-sufficiency and the destination of commercial health insurance coverage, Georgia Pathways is embracing private market policies and principles, such as premiums, copayments, member rewards accounts, and prospective Medicaid eligibility, for a segment of the Georgia Pathways population and the Transitional Medical Assistance (TMA) population.
Georgia is using the following policies to implement Georgia Pathways:
• Georgia Pathways – Provide a pathway to Medicaid coverage for working Georgians with household incomes up to 95% of the Federal Poverty Level (FPL), which includes a 5% of the FPL income disregard (referred to as incomes up to 100% of the FPL), and serves as an incentive for participation in work and other employment-related activities for those not currently engaged.
• Consumer Tools – Introduce consumer-engagement elements into the Medicaid program to prepare Georgia Pathways participants to transition into the commercial health insurance market once their income exceeds 100% of the FPL.
• Employer-Sponsored Insurance (ESI) – Provide premium assistance to those who become Medicaid-eligible through Georgia Pathways and who have access to ESI through a mandatory Health Insurance Premium Payment (HIPP) program.