Georgia: Not QUITE out of the woods yet: Kemp still has 10 days to try and "justify" his horrible "Access Model"


Back in April, I did some minor champagne cork popping after the Centers for Medicare & Medicaid Services rightly put the kibosh on the so-called "Georgia Access Model" waiver pushed by GOP Governor Brian Kemp:

The Georgia Access model would eliminate the use of, transitioning consumers to decentralized enrollment through private web-brokers and insurers. The state would establish its own subsidy structure to allow for 1) the subsidization of plans that do not comply with all the ACA’s requirements; and 2) enrollment caps if subsidy costs exceed federal and state funds.

There's not a single part of the paragraph above which shouldn't be setting off major alarms:

Georgia expects the waiver to increase enrollment in the individual market by about 30,000 people for plan year 2022. This is a significant number of individuals, but the waiver could result in coverage disruption for the more than 450,000 individuals who are already enrolled in ACA coverage through The 30,000 number also pales in comparison to the 1.4 million people who are uninsured in Georgia, more than half of whom are already eligible for ACA subsidies but not enrolled.

It's important to note that this proposal wouldn't simply move Georgia from HealthCare.Gov over to a state-based ACA exchange the way that 18 other states already have; those are basically just state versions of the federal website. Health insurance policies sold on them are still required to be ACA compliant, and ACA subsidies are still restricted to enrollees in those policies, as they should be.

What Georgia's waiver would do is something very different which would completely undermine many of the primary reasons the Patient Protection & Affordable Care Act was passed in the first place.

Well, five months later I'm pleased to report that the Centers for Medicare & Medicaid Services (CMS) have done the right thing:

NEW: Fed'l govt. suspends Gov. Kemp's plan to separate GA from HealthCare.Gov with no replacement. CMS points to expected coverage losses for Georgians. GA has 90 days to submit a corrective plan but this may be the beginning of the end... #gapol

— Laura Colbert (@ColbertLLC) April 29, 2022

CMS even gave me a personal shout-out for my public comment opposing the "Access Model:"

...Commenters also asserted that Georgia’s initial assumptions in its waiver application are now incorrect given the major changes that have impacted the baseline. For example, one commenter noted that monthly QHP effectuations for 2022 will be at least 140,000 people higher than Georgia assumed it would be, perhaps as much as 200,000 higher due to the COVID-19 SEP and the enhanced subsidies under the ARP.36 Additionally, these commenters noted that the changes have impacted the baseline such that as of December 15, 2021, nearly 654,000 Georgians selected Marketplace plans, 37 exceeding Georgia’s target enrollment for the Georgia Access Model by 261,000 people.

Commenters noted that changes in law (e.g., ARP), policy (e.g., increased outreach, the COVID19 SEPs), and other circumstances (e.g., regulations such as the extended 2022 OEP, and the new SEP opportunity for those at or below 150 percent FPL) increased enrollment, thereby impacting the State’s initial baseline analysis and projections for the Georgia Access Model.

36 Charles Gaba – Individual public comment, available here.

37 Centers for Medicare & Medicaid Services, “Marketplace Weekly Enrollment Snapshot: Week 6,” December 22, 2021. Available here.

Sure enough, I'm comment #101 (page 79 - 81). Huh.

Unfortunately, as I warned at the time:

In accordance with STC 17, Georgia will have 90 days from the receipt of this notice to respond with a written challenge to the Departments’ current determinations or to submit a corrective action plan, consistent with the process discussed below.

Well, "90 days from the receipt of this notice" happens to be July 28, 2022...ten days from today.

Hopefully nothing will come of it, but it's something I'll be keeping a close eye on for the next week and a half...