Georgia budget allows state to seek Medicaid changes

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ATLANTA (AP) — The top executive at Georgia's largest safety-net hospital said Thursday he is pleased to see signs that state officials could seek federal approval to make changes to its Medicaid program.

The state budget awaiting Republican Gov. Nathan Deal's signature includes a provision allowing state health officials to seek a waiver from federal Medicaid authorities. The same strategy, called a Section 1115 waiver, has been used in conservative states where governors resisted full Medicaid expansion under the Affordable Care Act but worked with federal officials to craft alternatives that still covered more people.

Deal and other Republican leaders in the state continue to oppose full expansion, arguing it will cost the state too much in the long run. Georgia's General Assembly last year passed a law requiring their approval for any changes to Medicaid eligibility.

Officials with the Georgia Department of Community Health declined comment on the budget item Thursday. A spokeswoman for Deal also declined.

John Haupert, CEO of Atlanta's Grady Health System, said he hopes state leaders will seek a waiver aimed at people who don't have insurance coverage but regularly use hospital services. He said Grady is likely Georgia's largest provider of uncompensated medical care, costing more than $200 million a year.

Outside metro Atlanta, a state panel classified 15 of the state's rural hospitals as financially fragile and recommended a "hub-and-spoke" model pairing hospitals with other health care providers to stave off closures. The panel also found rural hospitals' emergency rooms too often see patients with conditions better addressed by primary care physicians.

Developing and negotiating a waiver request can be a long process if the state moves ahead. The waiver process also has been used for Medicaid changes with less political heat. Georgia's already approved waivers include one item allowing coverage of in-home care for seniors in addition to residential facilities.

Democratic members of the Georgia Senate on Thursday said the state should seek nothing less than full Medicaid expansion.

"It's unfortunate that we're going to intentionally hamstring the state with an inferior product just so Republicans can claim they did something that's not Obamacare," said state Sen. Vincent Fort, D-Atlanta.

Haupert said health care professionals must work within the "political confines" of their states.

"If the governor is adamantly opposed to expansion of Medicaid under the Affordable Care Act with full-blown expansion, I'd rather see us take incremental steps than nothing at all," he said.

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