2019 Georgia Legislative Recap

Georgia House of Representatives

State lawmakers wrapped up the 2019 legislative session around midnight Tuesday after a long day of furious last-minute maneuvering. Several major proposals had already been passed and sent to Gov. Brian Kemp, including Medicaid waiver legislation and a bill that moves the state to new touch screen voting machines that print a paper ballot for backup.

Gov. Kemp signed 21 bills on the last day of the session, a pace far ahead of his predecessors, who signed very few bills until after the session was over. 

Below is a brief update on what passed the Georgia House and Senate during the 40-day legislative session.


State lawmakers approved a record $27.5 billion budget, more than $1 billion more than last year. When you add in federal funding for various programs, the state will be responsible for spending a total of $48 billion. The new 2019-2020 budget includes a $3,000 pay raise for public school teachers and a 2% pay hike for tens of thousands of state workers. The proposed budget also includes $23 million to implement health and foster care recommendations from the governor’s Commission on Children’s Mental Health.

Certificate of Need (CON)

HB 186 by Rep. Ron Stephens provides for an increase in capital expenditure thresholds to $10 million and an increase to $3 million for equipment. It clarifies that freestanding emergency departments are required to obtain a Certificate of Need regardless of project expenditures. It also allows for Cancer Treatment Centers of America (CTCA) to convert to a general cancer hospital but requires it to get a CON prior to converting, thus being subject to the same CON regulations as all other hospitals. Importantly, the bill does not provide for any exemptions to CON, including no exemptions for multi-specialty Ambulatory Surgical Centers (ASCs), Legacy Sports Institute, and cardiac procedures in ASCs. The legislation also allows for funds from the sale or lease of a hospital authority to be used for health care for indigent and charity care for the community.

Medicaid Waivers

SB 106 was passed by both the House and Senate on March 25 and signed by Gov. Kemp two days later. This top priority of the Governor gives his office new powers to pursue “waiver” programs that could pave the way for a limited Medicaid expansion and ease insurance costs for some poor and middle-class Georgians. SB 106 allows Kemp to pursue two separate waivers from the Trump administration seeking more flexibility to use federal funds. The legislation was opposed by many Democrats, who wanted full Medicaid expansion, but in the end, multiple Democrats crossed party lines to vote in favor of the bill. 

Hospital Provider Fee for Medicaid

HB 321, sponsored by Rep. Jodi Lott, extends the hospital payment program. That program draws down approximately $1 billion into the state’s Medicaid fund, including about $330 million for Georgia hospitals – money that is matched on a 2-to-1 ratio by the federal government. This legislation also contains strong financial disclosure requirements for nonprofit hospitals. The bill enables Georgia hospitals that care for a large number of Medicaid patients to receive higher rates and potentially recoup their fees.


SB 115 and SB 118 will enhance telehealth services. The first bill lays out regulations for participation by out-of-state physicians, while the second requires health insurance companies to cover professionals on both ends of a telehealth consultation.

Multi-State Medical Providers

Several pieces of legislation were designed to make life easier for troops and their families stationed in Georgia. Lawmakers passed the Psychology Interjurisdictional Compact (HB 26) and the Physical Therapy Licensure Compact (HB 39) to help out-of-state medical providers cross state lines and increase access to such services. Additionally, SB 168 extended the sunset for Multistate Licensure of Nurses and SB 16 authorized the Georgia Composite Medical Board to administer the Interstate Medical Licensure Compact for all the professions under its jurisdiction.

Step Therapy

HB 63 was designed to make the step therapy process less difficult and time-consuming for patients. In step therapy, insurance companies required that patients fail with one or more low-cost drugs before the insurers will pay for higher-cost drugs.


Georgia lawmakers narrowly adopted House Bill 481, which outlaws most abortions from the moment a doctor can detect a heartbeat in an embryo – as early as six weeks. Current Georgia law allows abortions to be performed until 20 weeks. The measure passed over the objections of a broad coalition that included influential medical groups, Hollywood celebrities, and a small band of suburban Republicans.

Voting Machines

The Legislature passed a measure to replace Georgia’s electronic voting machines with a touch screen system that prints out paper ballots. House Bill 316 rewrites election laws dealing with voter registration cancellations, recounts, and precinct closures that surfaced during the 2018 governor’s race between Kemp and Stacey Abrams.

Medical Marijuana

Georgia lawmakers struck a deal hours before the legislative session ended to allow medical marijuana patients to buy the cannabis oil they already were legally allowed to use. House Bill 324 legalizes the cultivation and distribution of medical marijuana through small growers, state universities, and licensed sellers.

Offshore Drilling

Pushback against the Trump administration is not an everyday thing in the Republican-controlled Georgia House, but HR 48 put the House on record as opposing oil exploration as a danger to the fishing and tourism industries along the coast. Immediately after the resolution was passed, Congressman Buddy Carter of Savannah referenced it in a letter to the Acting Secretary of the Interior.

Study Committees

The Legislature created a wide variety of committees and commissions to study issues of growing importance to the state ahead of the next legislative session, including several areas related to health care: maternal mortality, barriers to access to adequate health care, a floor and trade charity care system, waste reduction in health care, and mental health reform and innovation.

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