CMS Approves Georgia and Nebraska Medicaid Expansion with Work Requirements

On October 15, 2020, CMS approved an 1115 Waiver for Georgia called the Georgia Pathways to Coverage demonstration, which will partially expand Medicaid and impose premiums and work requirements on beneficiaries. The demonstration expands Medicaid coverage to low income adults ages 19 through 64 with incomes up to 100% of the federal poverty level. As a condition of eligibility, applicants and beneficiaries of the expansion must complete a minimum of 80 hours of work, community service or other qualifying community engagement activity a month. Additionally, individuals who earn between 50% and 100% FPL will be required to pay monthly premiums to maintain coverage. The waiver is approved to run through September 30, 2025 and the state may implement it effective July 1, 2021.

Several days later on October 21, 2020, CMS approved an 1115 waiver for Nebraska to go into effect in April 2021. Nebraska implemented Medicaid expansion coverage earlier this summer following the state's approval through a vote in 2018. The new waiver will allow the state to create a two-tier Medicaid program where individuals aged 21-64 who are not pregnant or medically frail can opt-out of the "Basic" plan and enroll in the "Prime" plan where they can earn extra benefits like dental, vision, and over-the-counter drug coverage. In exchange for the additional benefits, Prime enrollees must meet specific wellness requirements and beginning on April 1, 2022, complete 80 hours a month of community engagement activities.

A full copy of the approved waiver for Georgia is available here: https://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-Topics/Waivers/1115/downloads/ga/ga-pathways-to-coverage-ca.pdf

A full copy of the approved waiver for Nebraska is available here: https://www.medicaid.gov/medicaid/section-1115-demonstrations/downloads/ne-hha-ca.pdf

Categories: Healthcare

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