ATLANTA (AP) -- Following Republican Gov. Nathan Deal's lead, Georgia's community health commissioner said Friday the agency is holding off on an overhaul of the state's Medicaid program because of uncertainty at the federal level.
Commissioner David Cook cited the November presidential election and Congress' ongoing attempts to address the law as factors that could affect how states deal with Medicaid. He said the recent Supreme Court decision upholding much of the federal health care overhaul raises more questions about how the program will operate.
"There are a whole host of questions that are up in the air right now," Cook said. "Frankly, we're going to need a lot more clarity from Washington. It became pretty clear after the Supreme Court decision that the best course of action would be to not pursue a wholesale restructuring."
Cook says the agency is moving forward on several initiatives, including streamlining the administrative process and improving accountability and efficiency in the system.
Last month's Supreme Court ruling preserved most of President Barack Obama's health care law, including its requirement that virtually all Americans carry medical insurance. But the court gave states the option of saying no to a Medicaid expansion expected to provide coverage to more than 15 million people, mainly poor adults who don't have children. Officials in some Republican-led states are already saying they'll opt out.
Deal was noncommittal on whether Georgia would expand its Medicaid program. His administration estimates 620,000 people would join the government-run health plan in 2014 if the state makes such an expansion.
The state's Medicaid program now covers about 1.7 million Georgians. Georgia and the federal government share the cost of the Medicaid program for existing users. The federal government would cover all the costs of the newly eligible recipients for three years. Afterward, the U.S. government would pay for 90 percent of those costs.
Deal has questioned whether Georgia could pay its share of the $4.5 billion cost of expanding the Medicaid program over a decade. Such an expansion would secure $35 billion in federal funding. Georgia is facing a $300 million Medicaid shortfall this fiscal year.
Deal spokesman Brian Robinson said the governor supports Cook's decision.
"A lot of good work went into this (Medicaid) redesign, but there are simply too many unknowns at this time to move forward fully with a program that has significant upfront costs," Robinson said in a statement Friday. "The state isn't saying `no.' The state is saying `not yet.'"
Deal has signaled he is in no rush to implement the law, hoping instead for the election of Republican presidential candidate Mitt Romney in November. Romney has vowed to repeal the health care law.
State officials must tell the federal government by Nov. 16 whether Georgia will operate required health insurance exchanges - networks that will allow residents to buy approved plans under the law - or let the federal government do it. The state could also decide to manage some parts of the exchange, but not others. The decision must be made within days of the presidential election, and Deal has said he may ask for an extension until state lawmakers convene in January.
In Georgia, an estimated 2 million Georgians - nearly one in five - lack health insurance. Many of those could be helped by the expansion, said Timothy Sweeney, director of health policy for the Georgia Budget and Policy Institute.
"The court has ruled, the law is intact, and the federal funding is available for the state to expand coverage," said Sweeney, who dismissed the notion that uncertainty was a reason to delay action. "I think using that as an excuse not to move forward is problematic on some level. I think the uncertainty is at the state level, uncertainty as to whether the state is going to adhere to the provisions in the Affordable Care Act that increase expansion."
Sweeney said the state agency's decision to address reforming service delivery for long-term care for the aged, blind and disabled is positive progress, but more work will need to be done in that and other areas.