Launching its own healthcare exchange under the Affordable Care Act gives the state of Georgia extra options to address coverage challenges presented by ongoing Medicaid eligibility changes, according to a state insurance official.
Earlier this month, Georgia Gov. Brian Kemp signed SB 65, which will allow the state to create a state-based exchange (SBE) website for ACA compliant healthcare plans instead of using the federal government's system.
By managing its own SBE, the state will reduce the fees it pays to use the federal site while also having the option to experiment with new methods to better serve residents, said Gregg Conley, executive counsel for the Georgia Office of Insurance and Safety Fire. One potential benefit is having the ability to better market the new service to potential users, including those who might lose Medicaid coverage as redetermination continues.
Medicaid redetermination — the process by which states annually determine who is qualified for federal/state funded healthcare — is something everyone in the healthcare space in concerned about, Conley said. The review process resumed in April after three years of COVID-19-related delays. Redetermination is being handled in batches by the Department of Community Health, Conley said, adding that he does not expect the creation of an SBE to confuse consumers.
"I do think that one of the advantages is as a state, because we're only talking to our own people, we have the ability to better target people who are rolling off of Medicaid and to point them toward the SBE," Conley said.
Logistics
Creating an SBE poses some logistical difficulties for both the Office of Insurance, which will have to manage the exchange, and consumers, many of whom are going through the Medicaid redetermination process, said Laura Colbert, executive director of Georgians for a Healthy Future, a consumer advocacy group focused on health policy issues in the state.
"The challenges for our state are that our Department of Insurance has historically not been well resourced, and they would be the ones leading this proposal for the state-based marketplace," Colbert said. "That is starting to shift, but it will require a lot of staff and money to put together a really good state-based marketplace that works well for consumers."
Colbert said she is concerned that by launching the SBE during the redetermination process, some consumers may be caught in the middle and lose access to insurance.
"The Department of Insurance has demonstrated they've been pretty thoughtful about putting together this plan [for an SBE], but adding one more change and one more piece of confusion for consumers to navigate during the unwinding … is not a wise decision," Colbert said.
Additionally, other states that launched SBEs have seen temporary enrollment drops between the transition from a federal to a state marketplace, Colbert said. By placing people within impacted communities who can answer questions, Colbert said she believes an enrollment drop can be mitigated.
Despite the challenges an SBE might initially face, Conley said the Department of Insurance believes an SBE will quickly prove to be as beneficial to Georgia as they have been to other states.
"All the states can be little laboratories for insurance portals," Conley said. "This gives us a chance to innovate … to hopefully get more people signed up and get more plans offered by more companies in the state."
ACA numbers
SBEs are currently used in 17 states and the District of Columbia and represent 4,102,826 ACA consumers out of a total number of 16,306,448, according to the Centers for Medicare & Medicaid Services (CMS). About 879,084 Georgians are currently enrolled in individual health plans, according to the CMS.
The largest underwriter of individual health insurance in Georgia is Centene Corp., which posted 425,652 covered lives in 2022, according to a data analysis by S&P Global Market Intelligence. The individual lines of business do not solely represent plans that fall within the ACA, former President Barack Obama's healthcare law.
The second-largest individual underwriter is Elevance Health Inc., the parent company for Blue Cross Blue Shield, which insured 133,379 lives in 2022, followed by Oscar Health Inc., which had 85,349.
Approval still needed
The SBE legislation comes in the wake of attempts by Georgia to create its own private healthcare marketplace outside of the ACA, an effort that was approved via waiver by the Trump administration before being revoked by President Joe Biden in 2022.
Georgia's SBE will require approval from the Biden administration, but Conley said that he does not anticipate any pushback because SBEs are already built into the architecture of the ACA. The only pushback could be in response to the state's planned launch date of Nov. 1, Conley said.
However, flexibility in the open enrollment period is among the advantages that an SBE offers, Conley said, pointing to other states that chose to open enrollment outside of the typical fall period amid the COVID-19 pandemic.