The Berry Letter comes as the federal government creates new incentives for states to achieve much larger increases in Medicaid enrollments through regular expansion of the program under the Affordable Care Act, which most states have already done.

Medicaid provides health insurance to low-income and disabled residents, including approximately 2 million in Georgia.

Georgia’s waiver states that a person must invest 80 hours per month in a job, education program, volunteer organization, or other qualifying activity in order to receive Medicaid coverage.

However, a February letter from CMS criticized Georgia’s guidelines “which make health insurance dependent on working conditions or other community engagement requirements.”

The federal government’s letter highlighted uncertainties related to the COVID-19 pandemic, including vocational training and other activities to meet work and other requirements, as well as access to transportation and affordable childcare.

Twelve states received federal approval under the Trump administration to enforce Medicaid’s work requirements. But federal courts have blocked labor requests in Arkansas, Kentucky, and elsewhere, and the U.S. Supreme Court is expected to pick up a case this month.

In his letter, Berry said state officials “have worked in good faith with CMS to adopt an innovative program that will cover a new category of people and help them build important skills and become more independent and self-sufficient.”

The Berry letter said Georgian officials agreed to allow virus-related exemptions from coverage requirements and the COVID-19 pandemic has now subsided.

CMS officials were unable to be reached Wednesday for comment on the Georgia letter.

The Trump administration opposed the ACA and supported lawsuits against it and efforts by Congress to overturn it. CMS officials under Trump approved the Georgia waiver as an alternative to a standard Medicaid extension.

However, President Joe Biden is a staunch supporter of the ACA, which became law as Vice President.

Georgia is one of 12 countries that have so far chosen not to expand their Medicaid programs, as outlined by the ACA. However, the newly approved COVID-19 Relief Act provides these states with improved financial incentives to launch an expansion.

States that expand the program at this point would receive an additional 5 percentage point increase in their regular Medicaid matching rate for two years. During that time, even after factoring in the cost of implementing the expansion, Georgia would raise $ 700 million under the new incentives, according to the Kaiser Family Foundation.

The Kemp waiver plan now outlined is much less ambitious. According to consumer advocacy group Georgians for a Healthy Future, it would cost $ 75 million in the first year and only cover 31,000 low-income adults. The national game under the Kemp waiver plan would be the regular 67% of the cost.

A standard extension would allow Medicaid to service 480,000 to 600,000 people in the state, said Laura Colbert, the group’s executive director.

“Medicaid’s expansion has always been the moral and cost-effective choice for Georgia,” she said recently. The new incentive package, she said, “only reinforces that choice.”

Democrats, including Georgia’s newly-elected US-American Sens. Jon Ossoff and Raphael Warnock, have pointed to the state’s potential gains from Medicaid’s expansion, including helping hospitals and other medical providers.

“If Georgia doesn’t expand Medicaid,” Warnock recently told the Atlanta Journal Constitution, “we are literally leaving money on the table that could save the lives of Georgians.”

Andy Miller is the editor and CEO of Georgia Health News.