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Request a DemoLawmakers eye Medicaid expansion and more mental health services
In the weeks leading up to the 2024 legislative session that starts Jan. 8, State Affairs is taking a look at key issue areas likely to lead to proposed legislation and vigorous debate at the Statehouse. Our first story focuses on health care-related legislation.
Medicaid expansion tied to more hospital construction?
Georgia’s Republican-controlled Legislature’s stiff resistance to expanding Medicaid coverage for low-income Georgians may be wavering a bit, with the prospect of concessions from lawmakers who want to change how new hospital construction projects are greenlighted.
Georgia is one of 10 states that has not fully expanded Medicaid per the Affordable Care Act. Expansion of the joint federal and state health program could provide health insurance coverage to an additional 450,000 people in the state whose income is at or below 138% of the federal poverty line. Republican lawmakers and Gov. Brian Kemp have long resisted calls to expand the program from Democrats and a wide array of health care advocates, citing the ongoing annual expense (despite a federal match that would cover 90% of the cost), opting instead for a so far unpopular and more limited Medicaid plan that requires recipients to work, volunteer or go to school in order to receive benefits.
But some GOP legislators now seem interested in the cost savings realized by other states that have expanded Medicaid while eliminating Certificate of Need laws, which prevent new medical facilities from being built in certain geographic areas, unless there’s a significant unmet demand for the proposed services.
Georgia has an acute need for more hospitals and medical services in many areas of the state, particularly in rural areas, and CON laws have kept some new facilities from opening.
Last month, a House study committee on modernizing CON laws heard from experts who detailed how states such as North Carolina have repealed Certificate of Need regulations in exchange for expanding Medicaid. Of keen interest to Georgia lawmakers was a presentation by officials in Arkansas who described how they’ve used Medicaid waivers to provide uninsured people with private health insurance, doubling the number of people in the state now covered by Medicaid, and saving the state hundreds of millions of dollars.
At the time, House CON committee member Lee Hawkins, R-Gainesville, said to Arkansas officials, “This sounds incredibly good and sensible.” This week Hawkins, who also chairs the House Health Committee, told State Affairs, “Whether we'll move in that direction has yet to be decided. We’ve got to have all the final figures on what this will cost the state because you’ve got premium insurance payments that we’ll have to pay for, and we can't run a deficit. When we do a program like this, it's not a one-year program. It's going to go into the future until something else replaces it.”
Hawkins added that he was open to any type of progress in health care that improves access and quality of care and noted that the House isn’t likely to completely eliminate Certificate of Need regulations, one of 28 “options” listed in the committee’s final report.
“We do not need to totally and should not totally repeal CON,” he said. “Because CON means different things in different areas of this state. CON regulations would affect rural hospitals much differently than metropolitan and inner city hospitals. So we're going to modernize CON regulations.”
The Senate study committee on Certificate of Need Reform did recommend a full repeal of CON in its final report, stating that “the CON process is used by market incumbents to prevent competition and deny patients the benefits therefrom.” If the General Assembly doesn’t agree, the report recommended changes including ending CON requirements for obstetrics services, birth centers, neonatal intensive care units, hospitals, and new inpatient psychiatric services.
Rep. Mary Margaret Oliver, D-Decatur, who is secretary of the House Public Health Committee, told State Affairs she’s “hoping for a serious discussion that gets into the weeds and looks at the math” of repealing or rolling back CON regulations in exchange for expanding Medicaid.
Oliver noted that the Republican leadership in both chambers comes from rural Georgia, “where the health care system is on the brink.” That list includes Rep. Matt Hatchett, R-Dublin, who is chairman of House Appropriations; Rep. Butch Parrish, of Swainsboro and chair of the House CON committee and Sen. Blake Tillery, R-Vidalia; chairman of Senate Appropriations. “These are serious and sophisticated people who know numbers and know the gaps in health care, particularly in rural counties, and they know that their hospitals are teetering,” said Oliver.
Last year HB 38, a bill aimed at expanding Medicaid coverage, didn’t advance out of the House Public Health Committee, and SB 99, a bill that would have exempted most rural hospitals from CON regulations, passed the Senate 42-13, with a strong push from Lt. Gov. Burt Jones, but didn’t move in the House. Both bills or similar legislation coupled together in a ‘Medicaid for CON deal’ are likely to receive renewed attention next year.
Rural Medical Personnel
In an effort to attract more medical school graduates and to retain the existing health care workforce in rural areas, the Senate Rural Medical Personnel study committee recommended expanding the amount and scope of service cancelable loan programs and creating tax incentives for medical professionals who live and work in rural areas.
The committee also proposed amending state law governing certified registered nurse anesthetists to enable them to work autonomously, in part to address the shortage of physician anesthesiologists in rural areas and statewide.
Among the 26 recommendations in its final report, the study committee called for establishing an international medical licensing task force to examine the barriers facing immigrant and refugee health workers, and to identify career and licensure pathways to get foreign-trained medical practitioners who move to Georgia to qualify for the workforce faster.
Mental Health Workforce and Facilities
Several legislators and mental health care advocacy organizations are planning to pursue elements of HB 520, a bill introduced last session that was focused on implementing the expansive Mental Health Parity Act of 2022. HB 520 passed in the House but stalled in the Senate.
Oliver, a co-sponsor of both mental health bills, said her top legislative recommendation for 2024 is “to implement the results of the Medicaid [behavioral] health provider review,” which found that many of Georgia’s providers of mental health and addiction recovery services receive Medicaid reimbursements at rates significantly lower than providers in other states.
“We are so off from both the private market and the other states on what we're paying our mental health service workers, we have to implement this, in order to build our workforce,” she said, noting that the crisis in staffing beds at state psychiatric hospitals has led to the state paying for beds at private psychiatric hospitals “to the tune of about $40 million a year.”
The Department of Behavioral Health and Developmental Disabilities plans to work with legislators and the governor to “address workforce shortages, expand our continuum of crisis and forensic services and enhance our provider network,” said communications manager Camille Taylor.
Besides “bringing the pay of critical positions closer to market rate,” the department will focus on expanding its crisis bed capacity to meet projected demands for the next decade. Commissioner Kevin Tanner’s amended fiscal year 2024 budget submitted to the governor includes a 3% increase of $44 million to the $1.4 billion in state funds previously approved by Kemp. A bed study commissioned by the Department of Behavioral Health and Developmental Disabilities this year found that it will need to build five new adult behavioral health crisis centers and significantly increase staff salaries at existing centers by 2025, at a cost of $118 million.
Increasing the behavioral health workforce is also a top priority of the National Alliance of Mental Illness - Georgia chapter, which wants to see higher reimbursement rates to attract more providers to health insurance networks, including both private insurers and Medicaid managed care organizations.
“Increasing rates and the number of in-network behavioral health providers are key components to achieving parity with medical providers,” said Kim Jones, executive director of the Georgia chapter. She’d like to see the state provide more “robust oversight and enforcement” of parity requirements, which would help to eliminate existing rate disparities and ensure more Georgians can get appointments with in-network mental health providers.
The National Alliance of Mental Illness is also calling for Georgia to establish and fund a statewide comprehensive screening system for perinatal mood and anxiety disorders to prevent suicides among post-partum women, which is the second leading cause of maternal death in Georgia, according to a recent report.
And, Jones said, her organization will push the Legislature to fund more forensic beds for pre-trial detainees with a history of mental illness who are held in Georgia jails. That includes more than 2,000 people who are currently awaiting evaluations to determine if they’re competent to stand trial, some for months at a time, as well as people who’ve been found to be incompetent and who are in need of mental health restoration services.
Licensing Reform
The Senate Occupational Licensing study committee’s final report recommended expediting the licensing process for advanced practice registered nurses and military medics, and moving toward universal recognition of out-of-state licenses of a variety of skilled professionals, including health care practitioners.
Senators also recommended passing SB 157, which would eliminate barriers to work and create a preclearance process for people with criminal records who apply for licenses from more than 40 state licensing boards, including those regulating health care professions. This would allow applicants to know if they’re going to be allowed to practice before investing years and tens of thousands of dollars into education and training. The bill passed in the Senate unanimously last session but did not get a floor vote in the House.
To address a backlog of license applications and renewals, the committee also recommended “adequately funding” the state boards overseeing nurses and doctors, and to support the funding requests of the Secretary of State’s office, which is currently revamping its web portal for professional licensing.
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New middle Georgia House district up for grabs due to influential incumbent’s departure
The Gist
For the first time in over a decade, voters in parts of middle Georgia’s Bibb and Houston counties will vote for a new state House representative.
House District 143 is a newly redrawn district that now extends from Macon to Warner Robins. That redistricting prompted the departure of longtime incumbent Rep. James Beverly, D-Macon. His term ends in January.
Democrat Anissa Jones and Republican Barbara Boyer are vying for Beverly’s seat. Both are uncontested in the primary.
The two appear on the May 21 primary ballots, but the primary is, in effect, a dress rehearsal for the Nov. 5 general election because neither has a primary opponent.
Jones is a chiropractor who has held numerous seats on civic and local government boards. Boyer is a retired attorney who now runs an antique shop. Georgia is an open primary state, meaning voters can choose the party ballot they wish to vote for.
What’s Happening
House Minority Leader Beverly announced in March he would not seek re-election, in part, because his district had been redrawn. A federal judge ordered state lawmakers to redo their electoral maps because they diluted Black voting power.
Before the remapping, House District 143 was largely Democrat, majority Black and consisted primarily of Macon County. The redrawn district now includes parts of Macon and extends 20 miles south to Warner Robins and remains majority Black.
Boyer, a political newcomer, said Republicans asked her to run because of her legal background. She sees the redistricting as good for middle Georgia.
“Macon and Warner Robins have always sort of been merged together in a lot of ways, and I just don’t see there’s a problem with it.”
The new House district, for example, now includes parts of nearby Houston County, which has “a pretty good school system,” Boyer said.
“I’m interested in how they run their school system compared to how Bibb County runs theirs,” she added. “Our [Macon-Bibb] district really needs a lot of help with their school system.”
If elected, Boyer said she would work to improve education, curb crime and bring more businesses to middle Georgia.
“I think I cross party lines pretty good,” she said. “I have a lot of Democratic friends and a very diverse group of friends. So I think I have a better chance of getting some Democrat and independent votes.”
Jones is a Macon native. She is the former vice chair of the Macon Water Authority Board, an alum of Leadership Macon and a past president of the Main Street Macon Board.
Jones did not return calls from State Affairs for comment.. Her top issues include public safety, economic development and more investment in infrastructure, according to her website.
Why It Matters
The winner of House District 143 will fill a vital seat that Beverly has held since 2011. He often advocated for legislation addressing health inequities, including a last-minute proposal by state Democratic leaders to expand Medicaid.
The Peach Care Plus Act would have let the state get a federal waiver to buy private health insurance for people who make around $20,000 a year. The measure failed. Beverly, a Macon optometrist, also pushed for legislation that would reduce maternal mortality among Black women.
He also led the Democrats’ effort to pass the Safe at Home Act, a bipartisan bill to protect tenants’ rights. The bipartisan bill requires rental properties to be “fit for human habitation.” Landlords must give three days’ notice and can’t shut off cooling before an eviction. Gov. Brian Kemp signed the bill into law in April.
Beverly said his decision to leave was also based on the likelihood that Democrats will not win a majority in the 180-member House.
In addition to Beverly’s departure as House minority leader, the Senate also will lose its minority leader, Sen. Gloria Butler, D-Stone Mountain. She has served since 1999. The two are among 16 legislators who are retiring. Most of the 236-member Georgia General Assembly will be running for office, many unopposed.
What’s Next?
Early voters casting ballots in person have until Friday at 5 p.m. Poll officials, however, have the discretion to keep the polls open until 7 p.m., a Georgia Secretary of State official said. Polls will reopen Tuesday, primary election day, from 7 a.m. to 7 p.m.
Residents voting in Tuesday’s primary can check their precinct location here.
Boyer and Jones will face each other in the Nov. 5 general election. The winner will succeed Beverly, who will leave office in January.
Meet the House District 143 primary candidates
Barbara Boyer
Age: 68
Residence: Macon
Occupation: Retired attorney who now owns an antique store in Macon. “I love to stay busy.”
Party affiliation: Republican
Top issues: Improving education, attracting more businesses and addressing public safety, especially encroaching crime.
Campaign cash on hand: $600 as of May 7
Family: She and husband Wesley, a bankruptcy attorney, have a daughter and granddaughter
Dr. Anissa Jones
Residence: Macon
Occupation: Chiropractor
Party affiliation: Democrat
Top issues: Public safety, economic development, more investment infrastructure.
Campaign cash on hand: $30,679.92 as of May 6
Have questions, comments or tips? Contact Tammy Joyner on X @lvjoyner or at [email protected].
All you need to know heading into the May 21 primary
Gist
Georgia’s primary is only days away, and there’s a lot to unpack.
The May 21 primary will be the first time some Georgians will be voting in new districts for state and congressional candidates. They’ll also be voting in local races for sheriff, judges, school board or county commission members. Primary winners who have challengers will go on to compete in the Nov. 5 general election. Georgia is an open primary state, meaning voters can choose the party ballot they wish to vote for.
This year, Georgians who voted by absentee ballot in the primary could face challenges due to mail delivery delays.
What’s Happening
North Georgia and metro Atlanta are seeing significant mail delivery delays. The holdup, according to media reports, appears to be at the United States Postal Services’ new Regional Processing and Distribution Center in Palmetto. The problem has led to dangerous situations in which people are not getting critical medication.
Georgia’s U.S. Sen. Jon Ossoff recently grilled USPS Postmaster General Louis DeJoy on the delays. Ossoff told DeJoy during an April 16 hearing that on-time delivery rates were abysmal. He said 66% of outbound first-class mail had been delivered on time while 36% of inbound mail had been delivered on time in the past three months.
DeJoy blamed the problem on the difficulty in condensing operations at the facility.
With the approaching primary, state lawmakers are concerned mail delays could disrupt the election process.
Mike Hassinger, a spokesman for the Secretary of State, told State Affairs that Georgia voters are ready.
“Georgia voters are already registered,” he said. “They know how they like to vote. More than half of them vote early. About 5% vote absentee by mail, just in general, and then the rest are voting on election day. So we’ve been able to set up systems that are familiar with Georgia voters so that the percentage who might be worried about their absentee-by-mail ballots are relatively small.”
Why It Matters
Georgia emerged as one of the country’s most important political battleground states during the 2020 election. The Peach State will once again play a key role in deciding who wins the 2024 presidential election in November.
In the May 21 primary, Georgia voters will whittle down their choices for whom they’ll send to Congress and to the state capitol next year.
Under a federal court-approved redistricting process last year, Georgia now has new congressional and state district electoral maps. Those maps created one majority Black seat in the U.S. House of Representatives, five new majority-Black districts in the state House and two in the state Senate.
The redistricting resulted in new seats, intriguing matchups and former politicians returning to the fray. You can see the newly drawn maps here.
What’s Next?
Here’s what you need to know to ensure a smooth voting process:
To vote early.
Early voting is April 29 to May 17. Find your polling place here.
To vote absentee.
Here’s what you can do to avoid problems if you vote absentee:
- Get your absentee ballot application done early. You can request an absentee ballot here. (The registration deadline for the May 21 primary was April 22.)
- Track your application through Georgia BallotTrax. You must have a valid absentee request on file with your county board of elections to see your absentee ballot status in Georgia BallottTrax.
- If you’ve been having mail delays, place your completed absentee ballot in an official drop box during advanced voting instead of using the United States Postal Service. Check your county voter registration and election office for drop box locations. And, yes, your absentee ballot counts. It is counted in the final tally, not just close races.
- If you change your mind about voting absentee and decide to vote in person, take your absentee ballot to your local election office, where workers will void it.
- If you need to contact your county election office, find that information here.
Update: This story has been updated with the mail-in ballot registration deadline for the May 21 primary.
Have questions, comments or tips? Contact Tammy Joyner on X @lvjoyner or at [email protected].
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Education activist Beth Majeroni challenges state Sen. Ben Watson in GOP primary
The Gist In a rare primary challenge, incumbent Republican Sen. Ben Watson faces conservative education activist Beth Majeroni in the state Senate District 1 race in the Savannah area. Watson has run unopposed or handily defeated Democratic challengers in seven previous general elections and hasn’t faced a Republican challenger since 2010, when he won 65% …
Senate District 53 incumbent Colton Moore draws criticism, challengers in his re-election bid
Senate District 53 is in the far northwest corner of Georgia, home of Lookout Mountain, Civil War reenactments and conservative firebrand U.S. Rep. Marjorie Taylor Greene. It’s a mostly white and Republican working-class pocket of the state where some people identify more Tennessean than Georgian.
Like Taylor Greene, state Sen. Colton Moore gained national attention and made a name for himself in the district through the same type of incendiary politics.
Moore’s antics have drawn Republican challenger Angela Pence for the May 21 primary election. Democrat Bart Bryant will be on the primary ballot next week and will face the Republican primary winner in November’s general election.
Pence, in March, told State Affairs: “While Moore grandstands for retweets and shares, real crises in his district, like toxic water contamination in our schools and skyrocketing property taxes — due to an outdated education funding formula — have gone unaddressed.”
Moore’s predecessor, Jeff Mullis, is supporting Pence.
“He doesn’t represent his district very well,” Jeff Mullis, who represented Senate District 53 for 22 years before retiring in 2022, told State Affairs. “He has been in the House for two years and now in the Senate, and he has never passed a bill of any kind that is his. He can’t influence a bill. He can’t even pass gas.”
The Senate Republican Caucus kicked Moore out last September after he launched verbal attacks against fellow Republicans for refusing to go along with him in his call for a special session to take action against Fulton County District Attorney Fani Willis.
Willis is prosecuting former President Donald Trump for election interference. Moore predicted a civil war if Trump doesn’t win in November.
Then, in March, the state House of Representatives banned Moore from the chamber after a tirade against the late Speaker of the House David Ralston.
Moore and Ralston crossed swords numerous times during Moore’s time in the House, where in 2018 he became the youngest elected official in Georgia history at 24, representing District 1. He was elected to the Senate in 2022.
Moore repeatedly voted against dozens of key bills in this year’s session, including ones involving child trafficking and law enforcement. He was the only senator to vote no on the state’s fiscal year 2025 budget, which included tax cuts.
“He’s refused to help his local communities, cities and counties when they’ve had a request,” Mullis said. “He’s stopped grants for the area because of his actions.”
State Affairs repeatedly tried unsuccessfully to reach Moore for a response and to learn of his legislative priorities if he were to win a second term in the Senate. He said in March that criminal justice reform was a priority.
Moore has said previously that he and his staff spend hours, sometimes days, reviewing legislation coming up for votes. He said he follows “a strict standard of principles.”
“When it comes to a piece of legislation, and in my opinion, any piece of legislation that misuses taxpayer money, it’s not the proper role of government. I typically vote against that,” Moore told State Affairs in March. “Bills that subdue individuals’ freedoms that shouldn’t be subdued, legislation that I think grants government power that it shouldn’t have, anything like that.”
Moore’s politics have been heavily influenced by the Georgia Freedom Caucus, for which he is the vice chair. It favors social conservatism and small government and opposes immigration reform.
Moore’s challengers say his behavior is keeping things from getting done in their district, which includes Chattooga, Dade, Walker and Catoosa counties. The district also includes northwest Floyd County and the unincorporated Floyd County community of Armuchee.
Democratic challenger Bart Bryant said Moore’s Ralston rant prompted him to run against the incumbent. Bryant planned to run against Taylor Greene but ceded the race to fellow Democrat Shawn Harris, a retired Army brigadier general.
“Mr. Colton Moore has zero respect,” said Bryant, an electrician living in Menlo. “That doesn’t represent me. We need to respect one another. I’m running on respect to start with.”
Bryant said issues in the district are going unaddressed, such as mental health and overcrowded jails. As a former sheriff’s deputy, he’d work to get better pay for law enforcement personnel.
Pence also did not respond to State Affairs for comment but in the March interview zeroed in on Moore’s performative representation.
“The people don’t need any more unhinged sideshows — they need someone who will roll up their sleeves, put in the real work and score concrete wins that positively impact their daily lives,” she said.
Pence is a former Libertarian who tried unsuccessfully to get on the Georgia ballot to run against Taylor Greene in 2022. The small-business owner believes in limited government as well as economic and individual freedom. She is a lifelong North Georgia mountain resident who homeschools her children.
Incumbent Colton Moore
Age: 30
Residence: Trenton
Occupation: auctioneer and truck driver
Party affiliation: Republican
Key platform issues: Criminal justice reform
Previous public service experience: Georgia House of Representatives from 2019 – 2021; Georgia Senate, January 2023-present.
Campaign cash on hand: $24,410.33**
Family: Information not available
**Data as of May 8. Information is from the Georgia Campaign Finance Commission
challenger angela pence
Age: Early 30s
Residence: Chickamauga
Occupation: Small-business owner
Party affiliation: Republican
Why I’m running: “I’m running to be the voice for ordinary citizens who want real results,” she told The Mountain-Valley Independent.
Key platform issues: She is anti-abortion.. She is against government funding of gender-affirming care for minors. She is an advocate for “true school choice” and will work to “remove government tape and ridiculous requirements so that we can get the power back into the hands of the educators.”
What is your advantage over the other candidates?: She plans to bring principled, effective leadership to a district that has gone unheard.
Previous public or community service experience: She has coached youth sports and is active in the local chamber of commerce as well as various civic and grassroots initiatives.
Campaign cash on hand: $1,701.65***
Family: Military wife and mother who homeschools her nine children.
***Data as of May 7. Information is from the Georgia Campaign Finance Commission
Challenger Bart Alexander Bryant
Age: 58
Residence: Menlo
Occupation: Electrician
Party affiliation: Democrat
Why I’m running: He says the incumbent’s behavior in the Legislature is disrespectful.
Key platform issues: Mental health issues: They’re “a problem statewide.” Second Amendment: “If you haven’t committed crimes and you want to own a firearm, you can own it.” Abortion rights: “I hate abortion but there’s a place for it in our society.” Better pay for law enforcement.
What is your advantage over the other candidates?: “I’ve worked a real job all my life. I kind of have my finger on the pulse of what the public talks about. [Being a senator is] not a real hard job. All you have to do is listen and vote appropriately. I’ll be able to communicate across the [political] aisle.”
Previous public or community service experience: He has been a longtime member of the International Brotherhood of Electrical Workers, where he served as a shop steward, a liaison between union leaders and members. He is a former Chattooga County deputy sheriff. “Being a peace officer, you have to make some hard decisions.”
Campaign cash on hand: Bryant said he is financing his campaign with about $500 of his own money.
Family: Married to wife April for 36 years.
Have questions? Contact Tammy Joyner on X @lvjoyner or at [email protected].