Georgia Gov. Brian Kemp signed papers creating a new state health plan for low-income residents three years ago in the state Capitol to a great deal of fanfare.
However, experts and public health advocates say that since its inception on July 1, state officials appear to have done little to fund or enroll people in the country’s only Medicaid program, which requires recipients to meet a work requirement.
The Georgia Department of Community Health, which anticipates that up to 100,000 people could ultimately benefit from Georgia Pathways to Coverage, had only approved 265 applications as of early August.
“If we’re talking about targeted population outreach that would most likely be eligible and interested, I didn’t see anything,” said Harry Heiman, a professor of health policy at Georgia State University.
Heiman and other experts say the program’s slow start reflects fundamental deficiencies absent from Medicaid expansions in other states, including the added burden of submitting and verifying work hours. And some critics point out that this comes at a time when the state is removing tens of thousands of people from its Medicaid lists — at least some of whom may be eligible for Pathways — as part of a federally mandated review.
“We have chosen a much more complicated and lengthy process that will take a long time, even for the few people who have insurance,” said Laura Colbert, executive director of the advocacy group Georgians for a Healthy Future.
The Biden administration has previously attempted to rescind Georgia’s Medicaid plan and will be monitoring this, so missteps could have wider consequences. They could also hamper future Republican efforts to make Medicaid eligibility conditional on work.
A spokesman for the governor’s office, Garrison Douglas, said enrollment will increase as applications continue to be reviewed.
“While the federal government has initiated and mandated a process to redefine the qualifications of traditional Medicaid recipients, Georgia is the only state in the country that is simultaneously offering a new path to healthcare and opportunity,” he said in a statement.
The state Department of Community Health said it is engaging with stakeholders, community partners and others to help spread the word about the program. Details of this effort were not disclosed.
“There is still work to be done for Pathways,” Lynnette Rhodes, executive director of DCH’s Medical Assistance Plans Division, said at a meeting this month. “But overall the program works.”
The state started Pathways when it began reviewing 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 emergency.
Georgia has already eliminated more than 170,000 adults and children from Medicaid benefits and thousands more are expected to be eliminated as the year-long review of all 2.7 million Medicaid recipients in the state continues. Nationwide, more than a million people have been disqualified from Medicaid, most of them for not completing the forms.
The Department of Community Health said it delayed reevaluating 160,000 people who were no longer eligible for traditional Medicaid but could qualify for Pathways to help them maintain health coverage. It wasn’t immediately clear if the state reached out to these people and helped them apply for Pathways.
“From what we’ve seen so far, they’re not doing anything positive to get these people enrolled in Pathways,” said Cynthia Gibson, an attorney with the Georgia Legal Services Program, which helps people get Medicaid insurance .
In contrast, Oklahoma officials, who introduced a voter-approved expansion of Medicaid in 2021, moved people in existing state insurance programs directly into the expansion pool without requiring a new application, according to the Oklahoma Health Care Authority. Nearly 100,000 people signed up for the expanded program within days of its launch.
“States have many tools that they can use to make this process smoother,” said Lucy Dagneau, a Medicaid expansion advocate with the American Cancer Society’s Cancer Action Network.
Oklahoma and 39 other states have expanded Medicaid eligibility to almost all adults with incomes up to 138% of the state poverty line, $20,120 per year for an individual and $41,400 for a family of four. None of these states require recipients to work to qualify.
This broader expansion of Medicaid was an important part of President Barack Obama’s 2010 health care reform, but many Republican governors, including Kemp, opposed it. In addition to requiring employment, Pathways limits coverage to working-age adults earning up to 100% of the poverty line—$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 into better, private health insurance, and that working, studying, or volunteering will result in improved health.
“I am pleased that we are moving in this direction,” said Jason Bearden, president of CareSource Georgia, one of the state’s Medicaid health plans. “That’s good progress.”
Critics say many low-income people have informal jobs and fluctuating work hours that make it difficult for them to document the 80 hours a month required for work, volunteering, study or vocational rehabilitation. They also complain about the lack of a work exemption for parents and other carers.
For Amanda Lucas, the workload is currently insurmountable.
Lucas said she had no idea Pathways was launching in July, but even if she did, she wouldn’t qualify because she was competing in Warner Robins, a town about 100 miles (160 km) south of Warner Robins 84-year-old father must take care of Atlanta. He had a stroke and needed her to shop for groceries, prepare food, pick up prescriptions, pay bills and do countless other chores, she said.
Because she has risk factors for skin cancer, she worries about living without health insurance.
“I try to keep an eye on my own birthmarks,” she said. “I’m increasingly concerned because I’m 46.”
