Nonprofit says Georgia Pathways to Coverage program enrollment levels hurt barriers to access

ATLANTA — A new analysis of the experimental Georgia Pathways to Coverage medical insurance program says that barriers to access, particularly among uninsured Georgians in rural communities and among Georgians of color, had a negative impact on how many residents were able to enroll in the program.

The main findings of the analysis, produced by the Georgia Budget and Policy Institute (GBPI), is that enrollment in the Pathways to Coverage program “fell far short of expectations and need,” in part due to “a cumbersome enrollment process and restrictive eligibility criteria.”

The Georgia Pathways to Coverage program is the first state-managed Medicaid program in the United States to have work requirements for access.

The program launched in July 2023 after several court battles with the federal government. As Channel 2 Action News reported at the time, Georgia officials in favor of the program said hundreds of thousands of residents would be eligible to enroll.

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Gov. Brian Kemp announced during his 2023 State of the State address that he expected more than 345,000 Georgians could qualify to access healthcare through Pathways.

During the same speech, Kemp said that unlike expanding Medicaid, the Pathways program would not kick 200,000 Georgians off of private health insurance.

The most recent data available obtained by Channel 2 Action News from the state showed that while officials predicted hundreds of thousands of participants, just 4,231 patients were actively enrolled in Pathways within the first year the program was active. More than 100,000 had applied to be in the program.

A response from the Governor’s Office said the most recent count on enrollees had reached 5,120 as of Oct. 25 actively, and have been a total of 7,200 since the program’s start. The office said the numbers changing shows that the Pathways program does what it was designed to do: set people up for success to encourage eventual participation in private insurance.

2023 also saw the Medicaid unwinding process begin when COVID-era health provisions expired. Due to Medicaid unwinding throughout the United States, Channel 2 Action News reported in May that nearly 600,000 Georgians had been removed from Medicaid in the state. More than 300,000 were children.

More recent data from the state of Georgia was not publicly available and has been requested.

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The Georgia Budget and Policy Institute (GBPI) published an audit of the Pathways program, “intended to educate and spark action among policymakers, state agency leadership, advocates and others” and dealing what they say are key takeaways from the program’s first full year of operation.

The GBPI report says that more than 40% of counties in Georgia had fewer than 10 people enrolled in the program, even though Georgia as a state has “one of the highest percentages of uninsured populations in the nation.”

In terms of burdens on the program applicants, GBPI said the program’s lack of success was partially a result of what they called a steep paperwork burden, with long online and paper applications and a large number of documents to be submitted for verifying qualifying activities and hours for the work requirement.

GBPI said a somewhat lowered participation estimate was reported by the state in its Comprehensive Health Coverage Commission Presentation, putting the number at just over 240,000.

Based on the available data, and the expected amount from the presentation, only about 1.7% have actually been enrolled in Georgia’s Pathways to Coverage program.

The Georgia Pathways to Coverage program was greenlit to operate on a testing basis for function through Sept. 30, 2025. Due to the length of the court battles before the program officially started, state officials sued the U.S. Centers for Medicare and Medicaid Services to extend the run time to 2028 so they could meet the originally planned operation length of five years.

Channel 2 Action News reported in July when a federal judge rejected the lawsuit but left it open for other methods to seek a program extension for Georgia’s government.

In response to Channel 2 Action News regarding the GBPI audit of Pathways, the governor’s office provided the following response:

“Georgia Pathways, working in concert with Georgia Access, offers an innovative approach to addressing Georgia’s specific healthcare needs and is covering more people up to 138% FPL with private health insurance than traditional Medicaid expansion would’ve covered. Put another way, had Georgia followed the advice of those who pushed traditional Medicaid expansion, less Georgians would be covered by higher quality insurance while receiving lower quality, government-run care instead. As we remain committed to this innovative, first-of-its kind program in the nation and as DCH furthers its marketing and outreach efforts, this administration will also continue to explore additional ways to make Georgia Pathways more accessible and efficient as we grow and refine the program.”

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