LISTEN: Gov. Brian Kemp says his Medicaid waiver program is a better way to provide health care for low-income Georgians. But analysts with the Georgia Budget and Policy Institute say a full federal Medicaid expansion would save taxpayer money. GPB’s Ellen Eldridge reports.

a woman looks at a chart about Medicaid expansion

Sen. Tammy Baldwin, D-Wis., peers at a chart while Sen. Raphael Warnock, D-Ga., right, tells reporters they want to include specific provisions of their legislation, the Medicaid Saves Lives Act, in the larger economic package known as the Build Back Better Act to address the Medicaid coverage gap and provide an immediate fix to close the gap in Georgia and several other states, at the Capitol in Washington, Thursday, Sept. 23, 2021.

Credit: (AP Photo/J. Scott Applewhite)

The state legislature has a $6.6 billion surplus heading into the next fiscal year, and the Georgia Budget and Policy Institute says a lot more resources are being directed at the governor's Medicaid expansion plan.

Gov. Brian Kemp's plan adds eligibility for Medicaid coverage to Georgians earning less than $12,000 a year, but only if they are working, attending school or involved in job training.

The governor's office previously called the approach a "conservative reform" that reflects the state's values as a place that "honors work" and "champions individual responsibility."

Kemp said access to health insurance is not a "handout."

But the Carter Center said in 2019, when the waivers were first proposed, that the requirements are a step backward for the state, which already ranks poorly for many health-related issues including maternal care.

"Many people who are uninsured in Georgia suffer from mental illness and addiction, and these people may be unable to meet the work requirements outlined in the 1115 plan," the statement reads. "Therefore, they will not be able to access Medicaid coverage. These Georgians need access to health insurance first, so that they can stabilize their conditions and become capable of holding a steady job to support themselves in the long term."

Director of Legislative Strategy and Senior Fiscal Analyst with the Georgia Budget and Policy Institute Danny Kanso said that all Georgians enrolled in Medicaid or PeachCare for Kids will have to prove eligibility.

Those people, mostly children, have had continuous health coverage under the federal government's emergency protection for more than two years.

That’s because the ongoing federal COVID-19 Public Health Emergency, set in March 2020, increased federal funding for Medicaid subject to states’ implementation of continuous enrollment.

Now, these people risk losing access to affordable health care without interruptions. 

The enrollment projections have continued to shift as the state gets ready to take on an extraordinary process of redetermining Medicaid eligibility, Kanso pointed out.

Kanso said fully expanding the federal Medicaid program would be a better way to cover more Georgians than the waiver plan. That's because, under the American Rescue Plan, the state would also qualify for a bump of 5% in its regular Medicaid match rate — in addition to the 90% match for new enrollees — if Medicaid is expanded fully.

That's up from about a 66% match to 71%, and it would fund at least the first two years of expansion, Kanso said.

"Certainly, if we just look at the numbers, it is plainly obvious that fully expanding Medicaid would be the most fiscally responsible direction and the best way to cover the most people at the lowest cost," Kanso said.

The cost per enrolled person would be about $2,500, Kanso said, and the current state budget allocates $118 million. So, that would cover about 47,000 Georgians.

The GBPI estimates half a million Georgians don't have access to health care in Georgia without Medicaid.