- The Biden administration is suspending Georgia's plan to transition its individual market for Affordable Care Act plans from the federal exchange to a private-sector-run platform, unless the state corrects the waiver by July 28.
- The controversial plan was approved by the Trump administration in late 2020, and was originally slated to go into effect later this year. However, the CMS began reviewing the waiver approval over the summer, following concerns it would result in a fragmented enrollment system and could lead to tens of thousands of people losing coverage in a state with one of the worst uninsured rates in the country.
- In a Friday letter to Georgia announcing the waiver's suspension, CMS Administrator Chiquita Brooks-LaSure said the plan would provide coverage to fewer people than are currently enrolled in ACA plans, and that it no longer complies with federal law and other policies.
Georgia received the federal green light for its plan to dismantle use of the Healthcare.gov federal insurance marketplace, without replacing it with a state-based marketplace, in November 2020. Instead of one government-run marketplace, the waiver would transition the state to a private sector platform called the Georgia Access Model.
The state argued the 1332 waiver would result in lower premiums and increased consumer choice in a private insurance market.
But removing the federal platform would fragment the insurance market, which could confuse consumers and make it more difficult to enroll, researchers said at the time. According to a report from the Center on Budget and Policy Priorities, Georgians could already enroll in coverage through private pathways like web brokers if they choose through a process called direct enrollment, so Georgia's waiver would actually eliminate consumer choice by nixing the one-stop-shop of Healthcare.gov.
Some academics and top Democrat lawmakers slammed the waiver as ill-formed and illegal.
Brooks-LaSure agreed in the new letter to the office of Georgia Gov. Brian Kemp, a Republican.
The CMS conducted an analysis of the waiver with Acumen that found as a result of the new model, total non-group enrollment is expected to decline in all waiver years. The decrease is estimated to range between 4.4% to 8.3% in the 2023 plan year, and reach 8.4% each year in the 2024 through 2027 plan years, relative to the baseline with no Georgia Access Model.
Georgia also hasn't responded to multiple requests from the Biden administration for an updated analysis on how the waiver would impact coverage, Brooks-LaSure said.
"The waiver, with the Georgia Access Model in place, does not meet the statutory requirement that it will provide coverage to at least a comparable number of residents as without the waiver ... in light of changes in federal law, policy, and other circumstances since the Departments' initial approval," Brooks-LaSure wrote.
Those other circumstances include the more than 700,000 Georgians signed up for coverage through the ACA marketplace during the 2022 open enrollment period, according to the CMS administrator.
The CMS said Georgia must provide a corrective action plan within 90 days to demonstrate how it will improve the model to ensure no coverage losses, including a revised outreach and communications plan, if it wants to institute Georgia Access.