Georgia 2025-2026 Regular Session

Georgia House Bill HB97 Compare Versions

Only one version of the bill is available at this time.

Old	New	Differences
1	1	25 LC 52 0636
2	2	House Bill 97
3	3	By: Representatives Park of the 107
4	4	th
5	5	, Griffin of the 149
6	6	th
7	7	, Jackson of the 128
8	8	th
9	9	, and Herring
10	10	of the 145
11	11	th
12	12
13	13	A BILL TO BE ENTITLED
14	14	AN ACT
15	15	To amend Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated,
16	16	1
17	17	relating to medical assistance generally, so as to provide for the expansion of Medicaid; to2
18	18	provide for definitions; to authorize the Department of Community Health to utilize3
19	19	appropriations for the purposes of funding Medicaid expansion; to provide for the submission4
20	20	of requests for waivers, amendments to waivers, and state plan amendments; to authorize the5
21	21	office of the Commissioner of Insurance to certify qualified health plans; to provide for6
22	22	reporting; to provide for rules and regulations ; to provide for related matters; to provide for7
23	23	legislative notification and approval; to repeal conflicting laws; and for other purposes.8
24	24	BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:9
25	25	SECTION 1.10
26	26	Article 7 of Chapter 4 of Title 49 of the Official Code of Georgia Annotated, relating to11
27	27	medical assistance generally, is amended by adding a new Code section to read as follows:12
28	28	"49-4-142.6.
29	29	13
30	30	(a) As used in this Code section, the term:14
31	31	(1) 'Eligible individual' means an individual who:15
32	32	H. B. 97
33	33	- 1 - 25 LC 52 0636
34	34	(A) Is an adult between 19 and 65 years of age with an annual income that is equal to16
35	35	or less than 138 percent of the federal poverty level;17
36	36	(B) Has been authenticated to be a United States citizen or a documented qualified18
37	37	alien as defined in Section 431 of the Personal Responsibility and Work Opportunity19
38	38	Reconciliation Act of 1996, (P.L. 104-193), as amended; and20
39	39	(C) Is not determined to be more effectively covered through the standard Medicaid21
40	40	program, such as an individual who is medically frail or other individual with22
41	41	exceptional medical needs for whom coverage as provided under this Code section is23
42	42	determined by the department to be impractical, overly complex, or would undermine24
43	43	continuity or effectiveness of care.25
44	44	(2) 'Healthcare coverage' means healthcare benefits as defined by rules promulgated by26
45	45	the Commissioner of Insurance for the certification of qualified health plans.27
46	46	(3) 'Medicaid expansion program' or 'program' means an expansion of the Medicaid28
47	47	program in accordance with this Code section.29
48	48	(4) 'Qualified health plan' means a health insurance plan certified by the office of the30
49	49	Commissioner of Insurance for the Medicaid expansion program.31
50	50	(b) On or before October 31, 2025, in consultation with the office of the Commissioner of32
51	51	Insurance, the department shall submit to the United States Department of Health and33
52	52	Human Services Centers for Medicare and Medicaid services pursuant to Section 1115 of34
53	53	the federal Social Security Act a waiver request along with other necessary amendments35
54	54	for the Medicaid expansion program under the federal Patient Protection and Affordable36
55	55	Care Act (P.L. 111-148), as amended by the federal Health Care and Education37
56	56	Reconciliation Act of 2010 (P.L. 111-152) and the American Rescue Plan of 202138
57	57	(P.L. 117-2), and any regulations or guidelines issued under such acts in accordance with39
58	58	this Code section. The waiver request shall provide for:40
59	59	(1) The enrollment of certain low-income individuals making less than 138 percent of41
60	60	the federal poverty level in the eligibility category created b y42
61	61	H. B. 97
62	62	- 2 - 25 LC 52 0636
63	63	Section 1902(a)(10)(A)(i)(VIII) of the federal Social Security Act, 42 U.S.C. Section43
64	64	1396a, into qualified healthcare plans offered on the state marketplace established under44
65	65	Section 1332 of the federal Patient Protection and Affordable Care Act (P.L. 111-148);45
66	66	and46
67	67	(2) The full payment of any premiums or other direct costs associated with enrolling in47
68	68	qualified healthcare plans for eligible individuals making less than 138 percent of the48
69	69	federal poverty level who are enrolled in the program.49
70	70	(c) The department is specifically authorized to pay premiums and supplemental50
71	71	cost-sharing subsidies directly to the qualified health plans for eligible individuals enrolled51
72	72	in the program.52
73	73	(d) The office of the Commissioner of Insurance shall certify qualified health plans53
74	74	providing minimum requirements for healthcare coverage.54
75	75	(e) If the Medicaid expansion program provided for in this Code section is approved, the55
76	76	department shall immediately report to the General Assembly that such expansion is56
77	77	operational and annually on or before November 1 of each year shall report to the General57
78	78	Assembly:58
79	79	(1) The number of individuals enrolled in the Medicaid expansion program;59
80	80	(2) Costs incurred by the state for the Medicaid expansion program;60
81	81	(3) Estimated costs for the implementation of the Medicaid expansion program for the61
82	82	current and following state fiscal year; and62
83	83	(4) Recommendations to control costs of the Medicaid expansion program.63
84	84	(f) The department and the office of the Commissioner of Insurance shall be authorized64
85	85	to promulgate rules and regulations consistent with and necessary to carry out the65
86	86	provisions of this Code section."66
87	87	H. B. 97
88	88	- 3 - 25 LC 52 0636
89	89	SECTION 2.
90	90	67
91	91	This Act shall be considered legislative notification for purposes of Code Section 49-4-142.168
92	92	and legislative approval for purposes of Code Section 49-4-142.2.69
93	93	SECTION 3.70
94	94	All laws and parts of laws in conflict with this Act are repealed.71
95	95	H. B. 97
96	96	- 4 -