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Kemp Announces Lawsuit Against CMS to Reclaim Implementation Time of Georgia Pathways

Governor Kemp announced that the state of Georgia has filed a lawsuit against the Centers for Medicare and Medicaid Services and others, due to implementation time of the Georgia Pathways to Coverage was improperly delayed:

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At the direction of Governor Brian P. Kemp, the State of Georgia filed a lawsuit in the United States District Court for the Southern District of Georgia Brunswick Division against the Centers for Medicare and Medicaid Services (CMS), the United States Department of Health and Human Services (HHS), and related parties within the Biden administration seeking to reclaim stolen implementation time of the Georgia Pathways to Coverage (Georgia Pathways) 1115 Demonstration Waiver. The launch of Georgia Pathways, an innovative program voluntarily expanding Medicaid coverage to tens of thousands of otherwise-ineligible, low-income Georgians, was improperly delayed by CMS’s arbitrary decision to rescind core elements of the program despite an already agreed upon federal-state waiver approved in October of 2020.

“After the Biden administration’s lengthy, failed attempt to interfere with Georgia’s innovative plan to afford thousands of Georgians the opportunity to receive quality healthcare, they are back at it again,” said Governor Brian Kemp. “We beat them in court then, and now we are again asking for the federal government to adhere to the terms they agreed to rather than play politics by refusing to give us back the time they stole from delaying the Pathways rollout and implementation.”

“Our team at DCH has been working diligently to get the word out to eligible Georgians and enroll them in the plans that are right for them and their families,” said Department of Community Health Commissioner Russel Carlson. “I applaud Governor Kemp for working to give our team the opportunity to continue implementing this innovative program.”

The bi-partisan passage of Georgia’s Patients First Act in 2019 by the Georgia General Assembly allowed the Georgia Department of Community Health (DCH) the authority to provide Medicaid coverage to previously ineligible Georgians for the first time. This was a carefully negotiated effort between the Office of the Governor and related departments and members of the Georgia General Assembly. And, for more than two years, efforts were underway to implement the will of the legislature. Culminating in the submission and ultimately federal approval of the Section 1115 Demonstration project, Georgia Pathways provided an innovative approach to coverage – modeled after the existing Temporary Assistance for Needy Families (TANF) program – which promotes an “engagement” component to eligibility.

After multiple public comment periods, CMS approved Georgia Pathways on October 15, 2020. CMS also later confirmed on January 4, 2021, that Georgia Pathways reflected a binding contract between Georgia and the federal government. But, just weeks after President Biden was inaugurated, CMS sent Georgia a letter declaring that it was reconsidering its previous approval of Georgia Pathways and had preliminarily determined that the demonstration’s qualifying hours requirement would not further the objectives of Medicaid. Several months later, on December 23, 2021, CMS formally rescinded its approval of the terms at the heart of Georgia Pathways — primarily its qualifying hours and premium requirements.

To combat this egregious federal overreach, the State of Georgia filed suit in January of 2022 to allow implementation of the agreed-upon terms. In August 2022, the federal court ruled in Georgia’s favor and allowed DCH to again begin preparations for Pathways’ launch. The program launched in July of 2023, years after its original planned implementation date. Since then, DCH has ramped up outreach efforts while continuing to juggle both the rollout of a program years later than expected due to federal overreach and the redetermination process required by the expiration of the federal public health emergency.

A copy of the complaint is available upon request to garrison.douglas@georgia.gov.

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