25 LC 52 0689
House Bill 258
By: Representatives Buckner of the 137
th
, Holcomb of the 101
st
, Hugley of the 141
st
, Mitchell
of the 88
th
, Bennett of the 94
th
, and others
A BILL TO BE ENTITLED
AN ACT
To amend Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to public
1
assistance, so as to establish the PeachCare for Adults Program; to provide for a short title;2
to provide for definitions; to provide for submission of federal waiver requests; to provide3
for requirements; to provide for providers; to provide for administration of the program; to4
provide for rules and regulations; to provide for related matters; to repeal conflicting laws;5
and for other purposes.6
BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:7
SECTION 1.8
Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to public assistance,9
is amended by adding a new article to read as follows:10
"ARTICLE 10
11
49-4-200.12
This article shall be known and may be cited as the 'PeachCare for Adults Act.'13
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49-4-201.14
As used in this article, the term:15
(1) 'Board' means the Board of Community Health.16
(2) 'Department' means the Department of Community Health.17
(3) 'Eligible person' means an individual between and including the ages of 18 and 6418
years who has income less than or equal to 133 percent of the federal poverty level and19
who is not enrolled in Medicaid.20
(4) 'Enrolled person' means an eligible person who is enrolled in the PeachCare for21
Adults Program.22
(5) 'Medicaid' means the program of medical assistance conducted pursuant to Article 723
of this chapter, the 'Georgia Medical Assistance Act of 1977.'24
(6) 'PeachCare for Adults Program' or 'program' means the program for health coverage25
established pursuant to this article.26
49-4-202.27
(a) In order to implement the PeachCare for Adults Program pursuant to this article, the28
board shall submit any waiver request to the Centers for Medicare and Medicaid Services29
of the United States Department of Health and Human Services pursuant to Section 111530
of the federal Social Security Act necessary to add coverage for adults between and31
including the ages of 18 and 64 years with incomes less than or equal to 133 percent of the32
federal poverty level.33
(b) The board shall take all necessary steps to secure the enhanced federal match available34
under the applicable provisions of Section 2001 of the federal Patient Protection and35
Affordable Care Act (P.L. 111-148).36
(c) The board shall submit all necessary waiver requests pursuant to this Code section no37
later than January 1, 2026.38
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49-4-203.39
(a) The department shall establish the PeachCare for Adults Program. Such program shall40
be implemented no later than January 1, 2027.41
(b) The program shall include, at a minimum:42
(1) The same coverage provided to recipients of Medicaid, including, but not limited to,43
the essential health benefits as provided in 42 U.S.C. Section 18022;44
(2) Any healthcare benefits specified in the federal Patient Protection and Affordable45
Care Act (P.L. 111-148) with respect to health insurance coverage or health insurance46
products;47
(3) Coverage for all vaccinations recommended for children and for adults by the48
Advisory Committee on Immunization Practices of the federal Centers for Disease49
Control and Prevention; and50
(4) Coverage for the treatment of mental health and substance use disorders at least as51
extensive as that provided for the treatment of physical illnesses.52
(c) Only eligible persons may enroll in the program.53
(d) The program shall include an affordability scale for premium based on income:54
(1) For an enrolled person with an income greater than 100 percent of the federal poverty55
level, the premium shall be the amount of premium for an enrolled person with an56
equivalent income to enroll in the second-lowest cost silver-level plan offered in the57
state's health insurance marketplace or 2 percent of an enrolled person's gross income,58
whichever is lesser; and59
(2) An enrolled person with an income less than or equal to 100 percent of the federal60
poverty level shall not be charged a premium.61
(e) Enrollment in the program shall not be contingent on work requirements.62
(f) The department shall publish in print or electronically an annual report, a copy of which63
shall be provided to the Governor, setting forth the number of enrolled persons in the64
program, the health services provided, the amount of money paid to providers, and other65
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pertinent information with respect to the administration of the program. The department66
shall not be required to distribute copies of the annual report to the members of the General67
Assembly but shall notify such members of the availability of the report in the manner68
which it deems to be most effective and efficient.69
49-4-204.70
(a) Any healthcare provider that is a Medicaid provider shall be deemed to be a provider71
in the program.72
(b) Healthcare provider reimbursement rates shall be based on the Medicaid fee schedule. 73
Contingent upon available funds, the department may increase reimbursement rates for74
healthcare providers.75
(c) The department, through the Department of Administrative Services or any other76
appropriate entity, may contract for any or all of the following: the collection of premiums,77
processing of applications, verification of eligibility, outreach, data services, and78
evaluation, provided that such contracting achieves administrative or service cost79
efficiency. The department, and other state agencies, as appropriate, shall provide80
necessary information to any entity which has contracted with the department for services81
related to the administration of the program upon request.82
(d) All state agencies shall cooperate with the department and its designated agents by83
providing requested information to assist in the administration of the program.84
(e) As necessary to enforce the provisions of this article, the department or its duly85
authorized agents may submit to the state revenue commissioner the names of applicants86
for healthcare benefits or payments provided under this article, as well as the relevant87
income threshold specified therein. If the department elects to contract with the state88
revenue commissioner for such purposes, the state revenue commissioner or his or her89
agents or employees shall notify the department of whether or not each submitted90
applicant's income exceeds the relevant income threshold provided. The department shall91
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pay the state revenue commissioner for all costs incurred by the Department of Revenue92
pursuant to this subsection. No information shall be provided by the Department of93
Revenue to the department without an executed cooperative agreement between such94
departments. Any tax information secured from the federal government by the Department95
of Revenue pursuant to express provisions of Section 6103 of the Internal Revenue Code96
shall not be disclosed by the Department of Revenue pursuant to this subsection. Any97
person receiving any tax information under the authority of this subsection is subject to the98
provisions of Code Section 48-7-60 and to all penalties provided under Code Section99
48-7-61 for unlawful divulging of confidential tax information.100
49-4-205.101
The department shall be authorized to promulgate rules and regulations consistent with and102
necessary to carry out the provisions of this article."103
SECTION 2.104
All laws and parts of laws in conflict with this Act are repealed.105
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