Extending Medicaid coverage for women who have given birth. Higher pay for physicians serving Georgia’s poor. More money for rural health care.

In many ways, health care is getting a boost in Gov. Brian Kemp’s budget.

Kemp’s proposed budget envisions a record $30.2 billion in state spending next year. The highest-profile items include $5,000 pay raises for state employees, $2,000 bonuses for teachers, and a $1.6 billion tax refund for Georgians.

State tax collections — boosted by federal pandemic relief funds sent to Georgians — have increased since mid-2020, and those revenues have further soared as the economy recovered, the AJC reported. The state has piled up a record surplus.

Democrats would like to see more of the surplus spent on state programs than Kemp is proposing. They point out that amid the health care features in his budget, there is no sign of extending coverage to hundreds of thousands of uninsured Georgians through Medicaid.

In his State of the State speech Thursday, the governor made no mention of Georgia’s federal Medicaid waiver proposal, which the feds recently approved in general while rejecting its work requirement.

He also said nothing in the address about Medicaid expansion, which is outlined in the federal Affordable Care Act (ACA) and has been adopted by most states over the past decade. Expansion adds more low-income individuals to Medicaid rolls.

Kemp and his fellow Republicans who control Georgia’s government have repeatedly rejected Medicaid expansion, citing its cost. Last year, Congress approved new financial incentives for states to pursue expansion, but that has not softened the resistance here.

Georgia’s rate of people without health coverage is 13 percent, third-highest in the United States.

“The governor failed our health, our state and our economy. The money is on the table to expand health care to 500,000 Georgians and it’s been there for years,” said state House Minority Leader James Beverly (D-Macon) after the governor’s address.

State Sen. Gloria Butler (D-Stone Mountain) said of Georgia’s surplus: “The first thing that would be on my list is to expand Medicaid.”

A health care proposal expected to draw support from both political parties is Kemp’s request to extend Medicaid coverage from six months to 12 months for women on the program after they give birth.

The lengthening of coverage could help reduce Georgia’s high rate of maternal mortality. The rates of pregnancy-related deaths for Black women in Georgia are three to four times higher than for White women, the Georgia Budget and Policy Institute noted.

Hearings on Kemp’s budget will be held this week in the General Assembly.

Reinsurance and ‘attestations’

In his Thursday address, Kemp touted the competition and lower prices in Georgia’s health insurance exchange, which was created by the ACA – a law, ironically, that Republican leaders have consistently condemned.

A Georgia waiver pushed by the Kemp administration includes creating a reinsurance program that caps the costs for health insurers in the exchange that have a large number of expensive medical cases. Reinsurance has been shown to lower exchange premiums in other states. Other factors, including enhanced discounts pushed by the Biden administration for exchange customers, have been cited in premium reductions.

The Kemp fiscal blueprint includes $15 million (along with $8 million in the current fiscal year amended budget) to create a new Georgia exchange set-up, which would be run by private insurers and brokers. This apparatus, which for Georgia consumers would replace the federally run healthcare.gov website, has so far not been approved by federal health officials, who question its efficacy and cost.

The budget also proposes additional spending on mental health and developmental disabilities services, though experts say this money won’t fill the major funding gaps in these care systems.

To bolster Georgia’s health care workforce, Kemp asked for $1 million for the University System of Georgia to expand nursing programs to support up to 500 students a year for five years, and funds for the Technical College System of Georgia to add up to 700 nursing students.

His plan also would invest $2.5 million for 136 residency slots and allocate $1 million to Mercer University to address rural physician shortages.

“Physicians and nurses are in short supply across the country, but especially in rural Georgia,” Kemp said.

The FY 2023 budget includes an additional $85 million for physicians through improved Medicaid provider rates and the elimination of an unusual “attestation” requirement.

That rule “has been a huge issue for us,’’ said Dr. Hugo Scornik, a Conyers pediatrician who’s president of the Georgia chapter of the American Academy of Pediatrics.

The roots of the problem date back to when the ACA raised the pay rates nationwide for primary care doctors treating Medicaid patients. To get the pay bump, physicians had to “attest’’ in the years 2013 and 2014 that they practiced in pediatrics, family medicine or internal medicine and were board-certified. The reimbursement boost was funded entirely with federal dollars.

The ACA pay hikes were phased out at the end of 2014. Starting in 2015, the Georgia Medicaid program, with state funding, restored higher pay rates for some medical visit reimbursement codes, then added more the following year. But doctors who had not attested during 2013 and 2014 were not eligible for that new pay bump.

As a result, some providers “have been paid less than they should be,’’ Scornik said last week. “They have like a scarlet letter on their chest.”

The ending of the attestation rule, if enacted, “will put all the providers on an even playing field,” Scornik said.