Georgia is suing the Biden administration to extend the Medicaid program with work requirements

ATLANTA (AP) — Georgia sued the Biden administration on Friday to try to preserve the state's new health plan for low-income residents, which is the only Medicaid program in the country with a work requirement and runs through 2028.

Georgia Pathways launched in July and is expected to expire at the end of September 2025.

The lawsuit, filed in U.S. District Court in Brunswick, Georgia, says the Biden administration's decision to repeal the work requirement and another aspect of Pathways delayed the program's implementation. This shortened the originally approved duration of the program from five years to just over two years.

A judge later ruled that the revocation was illegal.

“This case is about whether the federal government can profit from its own unlawful conduct,” the lawsuit says.

It is seeking a court order forcing the U.S. Centers for Medicare and Medicaid Services to extend the Pathways program through September 30, 2028. A CMS spokesperson said in an email that the agency does not comment on pending litigation.

CMS denied the extension request in October and again in December. The agency was unable to consider it because the state did not meet the requirements for an extension, including a public notice and comment period, Daniel Tsai, deputy administrator and director of the CMS, said in a Dec. 22 letter .

Georgia Gov. Brian Kemp said in a news release announcing the lawsuit that the Biden administration is again trying to “interfere with Georgia's innovative plan.” He accused the government of playing politics “by refusing to give us back the time they stole by delaying the launch and implementation of Pathways”.

In his December letter to the state, Tsai said the agency did not prevent Georgia officials from implementing other aspects of Pathways when it revoked work requirements and a plan to charge some Medicaid recipients monthly premiums. And he said an implementation period shorter than the originally approved timeline was not unique to Georgia.

“Many states are experiencing delays in the implementation of their demonstration projects (or initiatives within a demonstration project) for various reasons,” he said.

Georgia's plan provides health insurance coverage to able-bodied adults who earn up to the poverty level – $14,580 for an individual or $24,860 for a family of three. However, to be eligible, people must demonstrate 80 monthly hours of work, study, rehabilitation or volunteer work.

Republicans have portrayed the plan as a fiscally responsible alternative to a full expansion of Medicaid services under the Affordable Care Act, although they oppose a full expansion seems to have subsided. Georgia is one of 10 states without more comprehensive Medicaid coverage.

The Kemp administration has estimated that Pathways could add 100,000 poor and uninsured Georgia residents to the Medicaid rolls, but enrollment has been slow so far, with just under 2,350 people enrolled as of mid-December.

The work requirement was approved by then-President Donald Trump's administration, but the Biden administration announced in December 2021 that it was revoking that authorization and the bonus requirement. That prompted Georgia officials to sue.

A federal judge reinstated both parts of the program in 2022, saying the revocation was arbitrary and capricious.