State outlines arguments against Medicaid ‘waiver’

The state’s Medicaid agency has all but ruled out Grady Health System’s “waiver’’ proposal to cover more uninsured Georgians.

Photo of the Georgia Capitol Building

“We’re not going to move forward on this at this time,’’ Clyde Reese, commissioner of the Department of Community Health, said at an agency board meeting Thursday.

He cited “significant costs to the state” to implement the proposal.

Reese added that federal officials indicated they would consider the waiver proposal only if Georgia was willing also to expand its Medicaid program. That is something Georgia political leaders have emphatically declined to do.  

Georgia Health News reported earlier this month that cost was the major snag in the state’s pursuing the Grady plan, which would use federal matching Medicaid dollars to help set up pilot sites that would give coverage to the uninsured.

Participating medical providers would then manage these patients’ care.

Grady Memorial Hospital
Grady Memorial Hospital

Such a move would fall far short of Medicaid expansion under the Affordable Care, which would increase the number of low-income people eligible for the Medicaid program. More than half the states have approved expansion, but Georgia leaders say it would be too costly.

Grady officials were not immediately available for comment on the state’s decision Thursday.

Under the 1115 waiver plan, Grady in Atlanta, Memorial Health in Savannah, and a small group of rural hospitals are seen as the initial sites in the coverage program.

Reese told reporters Thursday that the waiver plan as outlined would not be workable in rural areas.

Overall administrative costs to the state were estimated at $3.5 million, he said.

Community Health still would be willing to look at a counterproposal from Grady, Reese said. “You never say never,” he said.

Grady officials have said the waiver program would be modeled after the Cleveland MetroHealth Care Plus program in Ohio – one that a recent study found to produce unexpectedly low costs.

In developing its proposal, the Grady system has teamed up with five federally qualified health centers in Fulton and DeKalb counties and a philanthropic consortium that includes the Tull Foundation, the Community Foundation for Greater Atlanta, and Kaiser Permanente of Georgia.

Cindy Zeldin
Cindy Zeldin

Cindy Zeldin of the consumer group Georgians for a Healthy Future said Thursday that the Grady pilot program “held the potential to identify promising and innovative approaches to health care delivery for the population that Grady serves. We are disappointed that uninsured Georgians currently served by Grady won’t be able to gain coverage.”

Zeldin also noted that without Medicaid expansion, hundreds of thousands of low-income Georgians remain in a “coverage gap.” That means they’re not eligible for the current Medicaid coverage, but don’t earn enough income to qualify for subsidies in the health insurance exchange created under the ACA.

”We encourage state leaders to consider ways to close this gap,” she said.