Georgia launches Medicaid expansion in closely watched test of job requirements

ATLANTA (AP) – Georgia is offering some adults without health insurance a new bargain starting Saturday: Go to work or school and the state will pay for it.

But proponents condemn the plan, which will cover far fewer people than a full expansion of the state Medicaid program, as unnecessarily restrictive and expensive.

The program is likely to be closely watched as Republicans in Congress push to allow states to require some current Medicaid participants to work.

Madeline Guth, a senior policy analyst at the Kaiser Family Foundation, said Democratic President Joe Biden’s administration is unlikely to approve the labor requirements, but a future Republican president will.

“I think a lot of eyes will be on Georgia,” Guth said.

Georgia is one of the 10 remaining states that has not expanded Medicaid eligibility to individuals and families earning up to 138% of the state poverty line, or $20,120 per year for an individual and $41,400 for a family of four .

Expanding Medicaid was an important part of President Barack Obama’s 2010 health care reform, but many Republicans have campaigned against it, including Georgia Gov. Brian Kemp, a Republican.

Instead, Kemp limits expanded coverage to adults earning up to 100% of the poverty line — $14,580 for a single person or $30,000 for a family of four. And insurance coverage only exists if adults able to work document that they work 80 hours a month, do voluntary work, study or are in vocational rehabilitation.

It fits with Kemp’s argument that the GOP needs to show tangible conservative gains for the common people as he seeks to drag his party away from former President Donald Trump

“In our state, we want more people to have coverage at a lower cost and to give patients more options,” Kemp said in his January state of the state address.

Those who earn more are still entitled to subsidized insurance cover, often without premium costs, on the federal market place. Kemp’s administration argues that commercial coverage is better because it pays providers more than federal Medicaid rates.

Eventually, the Trump administration gave 13 states permission to place work requirements on some Medicaid recipients. The Biden administration revoked all of those exemptions in 2021, decision making is not a primary purpose of Medicaid. But Kemp’s administration won a battle in federal court last year to uphold Georgia’s plan, in part because it applies to new participants rather than current Medicaid recipients.

Caylee Noggle, commissioner of the Department of Community Health, told The Associated Press this week that Pathways to Coverage is a “Georgia-specific approach” that could cover up to 100,000 people in the first year.

But 100,000 is far fewer than the nearly 450,000 uninsured Georgians the Urban Institute estimates could be insured if Medicaid were fully expanded.

Others say the nearly $118 million in state money, along with another $229 million in federal money, is nowhere near enough to meet that goal. The liberal-leaning Georgia Budget & Policy Institute estimates the funds will serve fewer than 50,000 people.

And state taxpayers will pay a lot more per person. Partly at the behest of Georgia Senator Raphael Warnock, the federal government is offering to pay 95% of all Medicaid extensions for two years and 90% thereafter. Instead, Georgia will deny federal generosity and continue to pay the same 34.2% of the state’s contribution to its existing Medicaid program and refuse promised additional federal funding.

“The inappropriately named ‘Pathways to Coverage’ will cost Georgia more money and cover fewer people than if the state simply joined 40 other states in expanding Medicaid,” Warnock said in a statement to the AP.

“While state politicians continue to gamble with people’s lives, Georgians are dying because they cannot afford the health care they need,” he said.

Noggle and other Georgia officials say that working, studying or volunteering leads to improved health — a major argument for why these requirements should be part of a health insurance program.

But those who treat uninsured people say many are unable to work because of poor health.

“The reason they have their challenges and are unable to work is because they have a mental illness or medical condition that affects their ability to do so,” said Dr. Reed Pitre, an addiction psychiatrist and interim chief medical officer at Mercy Care, a federally funded nonprofit in Atlanta.

Enrolling people in the new program is a priority for Mercy Care, Pitre said, noting that no one will qualify until a month after determining compliance with job requirements.

The Kemp government expects the program will benefit people in low-wage jobs who cannot afford employers’ insurance, as well as students. The state is also reassessing eligibility for 2.4 million adults and children currently covered by Medicaid.

Georgia has delayed making decisions about people it believes are ineligible for regular Medicaid but could transition into the Pathways program, Noggle said.

Either way, once people enroll in the new program, they will have to meet activity requirements or lose coverage starting the following month, which could impact thousands. When Arkansas introduced work restrictions for some adults in 2018, more than 18,000 people lost their insurance coverage in less than a year.

It will be different in Georgia, Noggle argued, saying recipients only need to provide certification for the first three months of the year.

“I think we’re going to make it as easy as possible for our members to verify their eligibility,” she said.

But only time will tell. Kemp’s Georgia expansion plan could be a blueprint for other states and fellow Republicans who want to charge more from Medicaid recipients.