Georgia’s push for work requirements on some Medicaid coverage set to start

ATLANTA — Georgia’s limited expansion to Medicaid launches Saturday, making the Peach State the first in the country to tie work requirements to some Medicaid benefits.

The program, called Pathways to Coverage, was first passed by the Georgia General Assembly in 2019, but faced a battle in the courts to enact it after President Joe Biden took office.

The Pathways program was first greenlit by former President Donald Trump in October 2020.

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In December 2021, the Centers for Medicare and Medicaid Services, part of the U.S. Department of Health and Human Services, sent a letter to Georgia officials citing concerns over how the policies would “ potentially create access barriers to health care coverage and cause harm to beneficiaries.”

Outside of this limited expansion, Georgia is one of just 10 states that has not expanded Medicaid eligibility since the passage and enactment of the Affordable Care Act.

As previously reported, the Georgia plan expands coverage to adults who earn up to 100% of the poverty line.

This means any single individual who earns $14,580 per year, or a family of four whose household income is $30,000.

Georgia Pathways is expected to cover about 64,000 Georgians, according to Georgetown University Health Policy Institute.

The coverage is only an option for those beneficiaries if the adults show they are working, volunteering, studying or in vocational rehabilitation for 80 hours each month.

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The program was approved to run through September 2025 by CMS.

In addition to concerns about patients losing their health coverage as a result of the policy, organizations focused on policy and economic issues in Georgia said the plan would also be more expensive than a normal Medicaid expansion.

The Georgia Budget and Policy Institute reported that the Pathways program would cost Georgia taxpayers roughly $249 million.

Gov. Brian Kemp said in January that up to 345,000 Georgians may be able to qualify over the program’s course, with the first year opening to between 31,000 and 100,000. He said unlike a Medicaid expansion, Georgia Pathways will not kick 200,000 Georgians off of private insurance.

Georgia Pathways is expected to help between 12% to 14% of the state population, according to Georgetown University.

The report also said the way Pathways is designed could leave workers out of eligibility due to the monthly reporting requirements, mostly in the food service and retail industries.

Speaking to the Associated Press, Caylee Noggle, commissioner of the Department of Community Health said Georgia has put a pause on removing people from their coverage during the unwinding process if the individuals are potentially eligible to transfer into the Pathways program.

“I think we are going to make it as easy as possible as we can for our members to verify their eligibility,” Noggle told the AP.

The program enrollment starts July 1, with the coverage set to begin in September.

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