Happy New Year, and welcome back to legislative session! Last week, the General Assembly reconvened; legislative leaders laid out their priorities for this year during the annual Georgia Chamber of Commerce’s Eggs and Issues breakfast; Governor Brian Kemp delivered his sixth State of the State address; and the appropriations process started last Thursday with the unveiling of the governor’s AFY24 and FY25 budget recommendations. The first week of session typically sets the tone and content of debate over issues that are forthcoming over the next several weeks. In general, legislation involving voting, gambling, in-state cannabis cultivation, school choice, and tax code changes are widely anticipated. In the health care arena, CON modernization; renewal of the Hospital Provider Payment Program (“bed tax”); renewal of the Rural Hospital Tax Credit program; insurance reforms; PBM reforms (including “white bagging”); health professional education and workforce-related legislation; licensure and scope of practice; and potential legislation and/or appropriations to address Medicaid redetermination or expansion of coverage to currently ineligible populations.
Since this is year two of the legislative biennium, all bills and resolutions left on the table at the conclusion of regular session in March 2023 remain “live” for this session. Additionally, new legislation is introduced each day. NGHS Government Affairs will keep you updated each week through the 12-week session ahead as bills move through the process.
For the second time in as many years, the House and Senate also passed an Adjournment Resolution spanning the full 40-day session. Important dates to watch:
| “Crossover Day” | February 29th | Deadline upon which a bill must pass and “cross over” from one chamber to the other. |
| Adjournment Sine Die | March 28th | Conclusion of the 2024 regular session. |
Key takeaways from last week’s legislative events:
- Certificate of Need (CON) modernization: Speaker Jon Burns signaled his interest in finding compromise with the Senate to streamline the CON program but has stated on a number of occasions he does not support full repeal of the law. Governor Jones has endorsed full repeal, or at a minimum, substantial relaxation of the program. To date, Governor Brian Kemp has not officially weighed in on the issue. Other than passing remarks, CON was noticeably absent from discussion among elected leaders last week.
- Tort reform: Brian Kemp tempered expectations of major tort reform legislation this year and instead signaled his intent to pursue a multiyear approach on the issue.
- Medicaid Expansion: Speaker Jon Burns gained national attention when he attended a legislative study committee meeting on CON in December that veered into the topic of Medicaid Expansion. Until this week, the prospect of full expansion in Georgia during this session was viewed as increasingly possible. However, during remarks at the Eggs and Issues breakfast, Speaker Burns signaled that the issue needs to be evaluated more fully before taking further action. Section 1115 waiver-based expansion may still be a possibility, although it is now considered unlikely this session. However, if enabling legislation proceeds, there is high likelihood that is somehow connected to CON changes.
- Budget: Brian Kemp’s AFY24 and FY25 budget recommendations generated attention on two primary fronts: More than $2 billion in new state spending, and Georgia’s Revenue Shortfall Reserve (aka “rainy day fund”) has eclipsed $16 billion. Gov. Kemp has also pledged to pursue legislative approval to accelerate a state income tax cut that is expected to pass. Among new spending items, the Governor included $205 million in additional funding for mental health services through DBHDD.
Amended FY2024 Budget Recommendation Highlights*:
*Amounts are rounded. This is not an exhaustive list and is inclusive only of items selected because of its associated dollar value and/or topic area.
Department of Community Health (DCH)
| State Funds | Total Funds | |
| Aged, Blind, and Disabled (ABD) Medicaid growth | $120M | $366M |
| Skilled Nursing Facility (SNF) 2021 cost report update (statutorily required) | $92.9M | $280.9M |
| Recognize collection of new Ambulance Provider Fee | $39.4M | $39.4M |
| Low Income Medicaid (LIM) reduction to projected growth | ($152.9M) | ($462.5M) |
| LIM funds swap: Replace $20M state general funds with hospital provider fees | Yes | $0 |
| Georgia Board of Healthcare Workforce: Use existing $100k to conduct statewide specialty assessment to evaluate gaps in healthcare services | Yes | $0 |
| Georgia Board of Health Care Workforce: Eliminate funding for mental health professional loan repayment program until authorizing legislation is passed. | ($850k) | ($850k) |
Department of Behavioral Health and Developmental Disabilities
| State Funds | Total Funds | |
| Capital improvements for DBHDD regional psychiatric hospitals | $60M | $60M |
| Skilled Nursing Facility (SNF) 2021 cost report update | $92.9M | $280.9M |
FY2025 Budget Recommendation Highlights*:
*Amounts are rounded. This is not an exhaustive list and is inclusive only of items selected because of its associated dollar value and/or topic area.
Department of Community Health (DCH)
| State Funds | Total Funds | |
| 20 new staff positions for CMO contract management and oversight | $1.5M | $1.5M |
| Eliminate grants up to $1M for hospitals with GME programs | ($4M) | ($4M) |
| ABD Medicaid growth | $68M | $201M |
| Backfilling expiration of temporary federal Medicaid match increase due to Covid-19 in ABD Medicaid | $137M | $137M |
| SNF 2022 cost report update (statutorily required) | $118M | $348M |
| ICWP, CCSP, and SOURCE Waiver provider rate study implementation (rate increases) | $40M | $116M |
| Community Behavioral Health Rehabilitation Services (CBHRS) provider rate study implementation (rate increases) | $4.2M | $50M |
| LIM growth reduction | ($104M) | $98M |
| Backfilling expiration of temporary federal Medicaid match increase due to Covid-19 in LIM Medicaid | $135M | $135M |
Department of Behavioral Health and Developmental Disabilities (DBHDD)
| State Funds | Total Funds | |
| Annualize 500 slots, and add 100 additional slots, for NOW/COMP Waiver participants with I/DD | $11.6M | $11.6M |
| NOW/COMP Waiver provider rate study implementation (rate increases) | $80M | $316M |
| Annualize operational cost of BHCCs in Fulton Co., Dublin, and Augusta |
Department of Public Health
| State Funds | Total Funds | |
| Increase funds to the Trauma Care Network Trust Fund to reflect FY 2023 “super speeder” ticket collections | $1.9M | $1.9M |
Office of the Commissioner of Insurance (OCI)
| State Funds | Total Funds | |
| Increase funds for Georgia Access reinsurance program | $20M | $20M |
| Skilled Nursing Facility (SNF) 2021 cost report update | $92.9M | $280.9M |
The Joint Appropriations Committee will begin meeting tomorrow morning, Jan. 16th, to begin work on both appropriations acts. The House and Senate will reconvene for Legislative Day 6 on Monday, January 22nd.