CMS approves Georgia’s reinsurance program waiver

CMS on Sunday announced it had approved Georgia’s request to lower individual market insurance premiums by establishing a reinsurance program and enabling people to buy coverage directly through web brokers or insurance companies instead of

Georgians will be able to use state subsidies to buy plans that aren’t compliant with the ACA, including association health plans, so long as the policies cover pre-existing conditions and are not priced based on health status. The plan also allows employers to contribute money to health reimbursement arrangements that employees could use to buy coverage on the individual market.

“Today’s approval of the state’s waiver will usher in a groundswell of healthcare innovation that will deliver lower costs, better care, and more choice to Georgians in the individual market,” said CMS Administrator Seema Verma.

Between 2016 and 2019, total individual market enrollment on the Affordable Care Act marketplace exchange in Georgia declined 22%, with over 129,000 consumers fleeing the market, according to a press release announcing the approval.

Georgia continues to have one of the highest uninsured rates in the country at 13.7%, according to CMS. That leaves about 1.38 million people uninsured across the state.

Earlier this month, Georgia received the green light to expand Medicaid to about 50,000 poor adults with the condition that they work, job train, volunteer or pursue education for at least 80 hours a month.

The plan, dubbed Georgia Pathways, will expand Medicaid or provide access to an employer-sponsored health insurance plan to adults making less than 100% of the federal poverty level, which is about $12,500. Currently, non-disabled adults without children are not eligible for Medicaid in Georgia, which chose not to expand Medicaid under the Affordable Care Act.

Georgians who qualify would also be required to pay a premium for coverage based on a sliding fee scale, which they could use to purchase healthcare necessities, including eyeglasses, prescription drugs and hygiene products, according to the announcement by Republican Gov. Brian Kemp. Enrollees would also be rewarded for healthy behaviors.


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