Georgia officials are facing backlash for including a pro-transgender line of questioning in the procurement process to award a multi-billion dollar Medicaid contract — and spurned insurers warn over one million vulnerable Georgians could be left in the lurch.
In what The Atlanta Journal-Constitution described in December 2024 as “potentially the biggest shake-up of Georgia’s Medicaid system since 2006,” Georgia’s Department of Community Health granted new contracts to four insurers last year, while shutting out Amerigroup and Peach State Health Plan, companies which had both long managed Medicaid care for the state.
During procurement, overseen by Georgia’s Department of Administrative Services, ten companies bidding for the contract in December 2023 had to answer 65 hypothetical questions, one of which was about how the company would handle the case of “[a] 14-year-old, transgender White female (assigned male sex at birth but identifies as a female) member living in a rural area [who] has been diagnosed with major depressive disorder.”
“[Republican Georgia Gov.] Brian Kemp, call your office. Georgia just decided that 1.7M people will be forced to change their health insurance because GA bureaucrats decided to mix their liberal agenda with a state procurement,” Conservative journalist and political commentator Jack Posobiec said in a post to X, bringing attention to the transgender facet of the story, which was not reported on by local media. “This is ACTUAL text of the use of a transgender question to spend tax dollars.”
The question (linked in AJC’s reporting), obtained from a Sentara Health Care (one of the insurers who was not awarded a contact) complaint protesting the state’s decision and asking the Department of Administrative Services to start the process over reads:
A fourteen (14) year-old, transgender White female (assigned male sex at birth but identifies as a female) member living in a rural area has been diagnosed with major depressive disorder. She has been seeing a therapist in another town but has missed recent outpatient sessions. In addition, she has anorexia nervosa and will additionally require cognitive behavioral therapy (CBT), group therapy, physical exams, labs and other care. She has two younger siblings, and she shares a bedroom with her younger brother. Her family lives 40 minutes from her provider and 2 hours from the nearest hospital, in rural Southern Georgia. Describe the Supplier’s approach to engaging the member in a course of treatment. Include in the Supplier’s response how the Supplier may coordinate both the use of telehealth and in-person appointments to deliver care and ensure care continuity.
“Soooo GA bureaucrats decided to base potential life saving healthcare decisions for 1.7 million people on one dysphoric person? Did I get that right, Brian Kemp?” former NCAA swimming champion and women’s sports activist Riley Gaines reacted.
“The woke mind virus is alive and well…in Georgia,” Chair of Students for Trump Ryan Fournier responded. “What’s with this absurd transgender test the State of Georgia is using to spend tax dollars? The Brian Kemp team is asleep at the wheel.”
Breitbart News reached out to Gov. Kemp’s office for comment about the transgender-related question in procurement. Kemp spokesperson Garrison Douglas said “the governor does not play a role in the state’s Medicaid procurement process.”
“That said, after signing numerous pieces of legislation effectively banning boys from playing in girls’ sports, outlawing medical procedures that permanently mutilate the bodies of our children, and prohibiting indoctrination in our classrooms, the facts and Governor Kemp’s record on this issue is clear and unwavering,” Douglas added.
It should be noted that in 2022, the ACLU settled a lawsuit with the Georgia Department of Community Health over its exclusion of so-called “gender-affirming surgery” in the state’s Medicaid program. According to the ACLU of Georgia, part of the settlement included the Department of Community Health removing its exclusion for transgender surgeries from Georgia Medicaid and including benefits and clinical guidelines for gender dysphoria treatment.
Another rejected insurer, Peach State, who has held a portion of the state’s Medicaid contract since 2006 under the parent company Centene, said in its 48-page complaint (also linked in AJC’s coverage) that while questions around hypothetical scenarios are not uncommon in the process, “at least one evaluation question appears politically motivated and designed to draw responses to ‘test’ the Supplier’s progressive leanings.” The insurer was specifically referring to the transgender-related question.
“It is not uncommon for evaluation questions in a Medicaid managed care procurement to include hypothetical scenarios to which the proposer is asked to respond. But the number of extreme scenarios presented in this procurement is atypical from national norms and suggests an underlying agenda that has no place in a competitive procurement for taxpayer-funded healthcare services,” the complaint reads.
Breitbart News reached out to the Georgia Department of Community Health and the Georgia Department of Administrative Services for an explanation but did not receive a response by time of publication. At least two state evaluators allegedly involved in the process and listed in rejected insurers complaints appear to have donated to ActBlue, per Federal Election Commission (FEC) filings.
In its legal filing, Peach State said it currently covers more than 700,000 Georgians and alleged that its ousting would “upend the way vulnerable Georgians receive their healthcare.”
“Georgia has never experienced a disruption of this magnitude,” the complaint alleges, further warning that a change would force 1.17 million Georgia Medicaid recipients to change health care providers and leave others with gaps in coverage.
“The Georgians who rely on these important programs for their healthcare, and the taxpayers who pay for these programs, deserve better,” the filing reads.
In contrast, the successful bidders — CareSource, Humana Employers Health Plan of Georgia, Molina Health Care and United Health Care of Georgia — say they will implement a streamlined system to provide health coverage to poor children and adults, including disabled people, and elderly people in nursing homes, AJC reported.
Currently, Georgia pays three insurance firms more than $4 billion a year to run the federal-state health programs, according to AJC.
“Peach State Health Plan manages care for roughly 45 percent of Georgia’s Medicaid patients; Amerigroup covers 30 percent; and CareSource oversees about 25 percent,” the report states. “Amerigroup also handles the smaller contract for Georgia Families 360, which covers health care for about 33,000 foster care children and young adults.”
The bidding war began in September of 2023, when the state’s health agency sought proposals to manage Georgia Families, a program “which covers Georgia Medicaid and PeachCare recipients, and Georgia Families 360, which covers children, teens and young adults in foster care,” according to the report. The state also said it plans to move approximately 200,000 elderly, blind, and disabled people into managed care agreements under the new contracts.
“Much is on the line. Georgia expects to spend about $4.5 billion on Medicaid and PeachCare, the program for uninsured kids, in the next year. The Medicaid program is administered jointly by federal and state governments, so the feds chip in billions of dollars more,” according to the report.
Renu Gupta, an office manager for one of South Georgia’s largest psychiatric practices, told the outlet she is one of several health care providers who opposes the overhaul.
“It’s not easy to deal with insurance companies, and I’m worried it’s going to be a terrible transition,” Gupta said. “It’s not fair for the doctors or their practices. And, I’m telling you, these patients are going to suffer for it.”
Katherine Hamilton is a political reporter for Breitbart News. You can follow her on X @thekat_hamilton
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