Today, U.S. District Judge Lisa Godbey Wood ruled that the Centers for Medicare and Medicaid Services (CMS) made an “arbitrary and capricious” decision to rescind its approval of the Georgia Pathways Medicaid Waiver and granted the state summary judgment in the case.
Kyle Wingfield, President and CEO of the Georgia Public Policy Foundation, made the following comment about the ruling:
“We applaud this ruling, which recognizes CMS was wrong to rescind its prior approval of the Georgia Pathways Medicaid Waiver. This waiver was a well-considered effort to offer a path to health coverage for low-income Georgians in a better way than traditional Medicaid – exactly the kind of demonstration project that Section 1115 of the Social Security Act is meant to encourage.
“Allowing the Georgia Pathways Medicaid Waiver to proceed to implementation will allow these Georgians to obtain coverage that in many cases will be better than what they would have under traditional Medicaid, including private insurance offered by their employer. This kind of coverage offers them better access to more healthcare providers, which in turn should lead to better health outcomes. It also minimizes the disruption of changing plans should they earn more money and lose Medicaid eligibility, because they will already be on their employer’s plan. That eliminates a key disincentive for Medicaid recipients to seek higher wages and improve their finances.
“We call on CMS to join Georgia in supporting this demonstration project, as we are confident it will prove to be an effective option for thousands of Georgians.”
Background: In 2019, the Georgia General Assembly approved Gov. Brian Kemp’s request for authority to pursue federal waivers from provisions of both Medicaid and the Affordable Care Act. The Kemp administration filed its Section 1115 waiver application for Georgia Pathways later that year, saying it could offer coverage to as many as 50,000 Georgians who met certain qualifications such as income limits and engagement in work or other approved activities for at least 80 hours per month. CMS approved the application in October 2020. In early 2021, CMS told Georgia it was reconsidering that approval. Georgia suspended implementation of the project in June 2021, and CMS officially rescinded its approval in December 2021. The agency has not commented on today’s ruling but is expected to appeal it.
