Demonstrating Tension Between State And Federal Power In Medicaid: The Price Of Georgia’s Waiver Fight

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Just days before the end of President Donald Trump’s term, the Secretary of the Department of Health and Human Services (hhs) approved the “Georgia Pathways” waiver proposal, which would extend Medicaid coverage to people earning up to 100 percent of the federal poverty level provided they pay premiums and fulfill work requirements. Georgia contends that the waiver for this demonstration project would provide Medicaid coverage to those not currently eligible. But, the waiver does not fulfill the terms of the Affordable Care Act (ACA) Medicaid expansion, and by imposing eligibility restrictions not permitted by federal law, the waiver would reach only a small subset of people who would be eligible if Georgia implemented Medicaid expansion according to the ACA. Also, other beneficiaries could be disenrolled due to the waiver’s new requirements. The Biden administration revoked approval for the work and premium requirements before Georgia’s implementation began but after providing the state of Georgia with an opportunity to show that the plan would promote the purposes of Medicaid. Georgia responded by suing HHS. In challenging the Secretary’s authority to grant and oversee waivers of federal law, Georgia has made novel arguments that seek to narrow federal authority and significantly expand state power within federal spending programs.

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