Georgia defends insurance waiver as company interest builds

Georgia officials have pushed back against a federal health agency’s request for more financial information on the state’s insurance waiver plan.

A letter dated July 2 says that Georgia’s approach to replace the Affordable Care Act’s enrollment set-up with a privately run process has already been approved by the feds. The Georgia “Section 1332’’ waiver has also attracted much interest from insurers and potential vendors, the state says.

The letter asserts that the federal Centers for Medicare and Medicaid Services’ recent request for more financial information “came as a surprise’’  and does not follow the approved waiver process.

Kemp discussing waiver plans last year.

The political context of the dispute is that while the Trump administration approved the state’s waiver requests, the Biden administration has taken a more critical view, and is re-evaluating them.

The letter from Georgia to the feds was signed by Grant Thomas, director of the newly created Governor’s Office of Health Strategy and Coordination.

That office is charged with, among other duties:

** Developing approaches for lowering health care costs and improving access to care

** Facilitating coordination among various state agencies on health issues

** Reviewing existing state health care contracts.

States use waiver applications to seek federal permission to make changes in certain health care programs.

Georgia recently postponed the launch of another waiver — to increase Medicaid enrollment for low-income adults — as the feds continue to review it.

The conflict over the ‘‘Section 1115’’ waiver stems from an eligibility rule for recipients that the state put into its plan. Under this rule, to qualify for the Medicaid coverage, a low-income adult must put 80 hours a month into a job, an education program, a volunteer organization or another designated activity. Because of the eligibility requirements, the waiver would cover many fewer people than a full Medicaid expansion as outlined under the ACA. Georgia, citing costs, is one of 12 states that have not expanded Medicaid.

A February letter from CMS criticized Georgia’s policies “that condition health care coverage on meeting work or other community engagement requirements.’’

The administration of Gov. Brian Kemp fired back at the CMS letter, appealing the new federal position. The Georgia letter said the waiver’s possible revocation by the Biden administration would be “an arbitrary and unlawful bait-and-switch,’’ and would prompt a state challenge in court.

CMS is still reviewing the Medicaid waiver plan, according to the agency’s website.

Common ground on one issue

The tone of the state’s letter on the insurance coverage waiver, sent to CMS Administrator Chiquita Brooks-LaSure, was much less confrontational.

Under this waiver, a provision to start a “reinsurance’’ program in the state appears certain to get federal approval.

Reinsurance aims to stabilize health insurance premiums by capping the cost that insurers incur in covering people with high medical costs. State officials estimate will cut insurance premiums for individual coverage by an average of 10 percent. The reinsurance provision has been embraced by both supporters and opponents of the ACA.

But there’s much debate about the state plan to replace the enrollment system with a new online platform that people will use to sign up for insurance coverage. Under the plan, individuals would enroll directly through insurers, local brokers or agents, or through private-sector broker sites.

A letter to Georgia from Brooks-LaSure last month said the state platform would be funded “by uncertain and unquantified private sector efforts, not by the state.’’

She added that the regular insurance exchange, with enhanced subsidies and an extended enrollment window, is working well nationally and in Georgia. The feds asked Georgia for updated actuarial analysis by July 3 for the Georgia enrollment model, which is scheduled to debut in 2023.

Thomas argued that the platform is a “one-size-fits-all federal solution’’ that “can be cumbersome, confusing, and exceedingly difficult to navigate.’’

The letter says that almost 1 million Georgians who are eligible for subsidies in the exchange are still uninsured.

Thomas said the feds’ request for more financial analyses raises concerns and suggests that the feds “wish to reopen the approval of the waiver,’’ which he said is not permitted under the agreement’s terms and conditions.

Five new insurance carriers are entering the Georgia market, Thomas said.

The state insurance department said Wednesday that new or returning companies filing to sell individual policies on the health insurance exchange for next year are Aetna Health, Bright Health, Cigna HealthCare, Friday Health Plans, and UnitedHealthcare.

Thomas’ letter added that eight “enrollment vendors’’ have expressed interest in the Georgia insurance shopping process.

“More than 20 private-sector organizations have collaborated with the state and have made their own investments,’’ he added.

Laura Colbert of the consumer advocacy group Georgians for a Healthy Future said Wednesday that “coverage under a waiver must be at least as affordable and comprehensive as under the ACA and cover a comparable number of people.’’

“The Trump administration, which approved Gov. Kemp’s waiver, interpreted these guardrails so loosely that it allowed for rollbacks of fundamental consumer protections,” she said. “The Biden administration has proposed re-interpreting this part of the law so that consumer protections are maintained. The federal government seems to be asking Georgia to prove that this plan meets these re-interpreted standards.”

She noted that Georgia enrollment in the insurance exchange has risen by thousands in recent months, spurred by new financial help for consumers, an expanded enrollment window and increased sign-up assistance.