Georgia’s Medicaid program — the only one in the U.S. with a work requirement — has enrolled just 1,343 residents in three months

Republican Gov. Brian Kemp speaks at an event hosted by conservative radio host Erick Erickson on August 18, 2023 in Atlanta, Georgia. Megan Varner – Getty Images

Georgia Gov. Brian Kemp’s new health plan for low-income adults enrolled just 1,343 people as of the end of September, about three months after its launch, The Atlanta Journal-Constitution reports.

The Georgia Department of Community Health estimates that up to 100,000 people could ultimately benefit from Georgia Pathways to Coverage. But the nation’s only Medicaid program that requires recipients to meet a work requirement is off to a very slow start.

“We will continue to work to educate Georgians about Pathways’ innovative and unique opportunity and recruit additional individuals in the coming months,” Kemp’s office said in a statement.

The program’s slow progress reflects fundamental deficiencies compared to Medicaid expansions in other states, including the added burden of submitting and verifying work hours, experts say. And some critics point out that this comes at a time when the state is removing tens of thousands of people from its Medicaid rolls — at least some of whom could be eligible for Pathways — as part of a federally mandated review.

“Pathways to Coverage falls far short of these commitments to uninsured Georgians. Expanding Medicaid would be a more effective way to provide meaningful care to citizens and connect them to care,” Laura Colbert, executive director of the advocacy group Georgians for a Healthy Future, said in a statement Friday.

The state Department of Health had refused to provide enrollment numbers to the newspaper until the Journal-Constitution notified Kemp’s office that it would report that the state appeared to be violating its open records law. The ministry then made the documents available, but denied any violation of the law.

The Biden administration has already tried to revoke Georgia’s Medicaid plan once and is monitoring it, so any missteps could have broader consequences. They could also hinder future Republican efforts to make Medicaid eligibility contingent on work.

The state launched Pathways on July 1 as it began verifying Medicaid eligibility following the end of the COVID-19 public health emergency. Federal law prohibited states from removing people from Medicaid during the three-year state of emergency.

The state had previously said it had delayed reassessment of 160,000 people who were no longer eligible for traditional Medicaid but could qualify for Pathways to help them maintain health insurance. But observers said they saw little outreach to specific populations.

Thirty-nine states have expanded Medicaid eligibility to nearly all adults with incomes up to 138% of the federal poverty level, $20,120 a year for a single person and $41,400 for a family of four. North Carolina will become the 40th state to do so in December. None of these states require recipients to work to qualify.

This broader expansion of Medicaid was a key part of President Barack Obama’s health care overhaul in 2010, but many Republican governors, including Kemp, opposed it. In addition to requiring employment, Pathways limits coverage to able-bodied adults earning up to 100% of the poverty level — $14,580 for an individual or $30,000 for a family of four.

Kemp has argued that a full expansion would cost too much money. State officials and Pathways supporters say the work requirement will also help convert Medicaid recipients to better private health insurance, arguing that working, studying or volunteering leads to better health.

Critics say many low-income people have difficulty logging the required 80 hours per month for work, volunteer work, study or vocational rehabilitation.