Why Georgia’s Medicaid job requirements are a crucial test case

Georgia is expected to be the only state in the country to impose work requirements on Medicaid recipients, and the success or failure of that plan could be a test case for other states planning ahead for the next Republican White House.

The new program, scheduled to start this weekend, will allow working-age adults who have never qualified for Medicaid to participate. It could provide health insurance coverage to tens of thousands of additional residents — but only if they can show they work 80 hours a month or participate in vocational training or other activities.

Conservatives are focusing again on Medicaid work requirements, and while the Biden administration is unlikely to approve a state proposal, an incoming Republican president is likely to do so.

Medicaid’s work requirements were a priority for the Trump administration, which approved 13 such programs. But after a federal judge denied two permits in 2019 and the Biden administration quietly revoked 10 more, the momentum for introducing work requirements stopped.

House Republicans resumed the push last spring, and labor requirements for several federal programs became a sticking point in debt ceiling negotiations. They were not included in the final compromise legislation because President Biden and Democrats said the policy was nonsense.

The Congressional Budget Office (CBO) estimated that Medicaid’s work requirements would save the government $109 billion but would not result in more people working.

It said about 600,000 adults would lose Medicaid protection under the law, although the Department of Health and Human Services said it could have been many more.

“Despite evidence that Medicaid’s job requirements do not serve its stated purpose of promoting employment, it persists and interest in certain states persists,” said Joan Alker, executive director of the Georgetown University Center for Children and Familys.

“And I wouldn’t be surprised if that policy would be expressed again if there was a change in government.”

Republicans have long argued that job requirements are necessary to encourage people to lift themselves out of poverty, and conservatives say Georgia’s program has great potential.

“I think the benefits of this program are that it’s ultimately a way to get health insurance, but Medicaid coverage isn’t the end goal,” said Chris Denson, policy and research director of the Georgia Public Policy Foundation, a libertarian think tank . “Ultimately, it’s a way to get commercial insurance instead of continuing to receive Medicaid.”

Some Republican state officials are now trying various tactics to circumvent the previous legal challenges.

In Arkansas, state officials presented the Biden administration with a new exemption earlier this month, asking the federal government to allow work requests for individuals under its expanded Medicaid program.

Gov. Sarah Huckabee Sanders (right), who served as White House press secretary during the Trump administration, said the revival of labor requirements will “address our state’s workforce challenges and enable thousands of Arkansans to escape the trap of the… to escape dependence on the government.”

A federal judge blocked the previous program in 2019 after about 18,000 people lost their insurance in the first seven months of its implementation.

However, the new approach will not exclude anyone who does not comply. Instead, they’re being transitioned from the private insurance used for Arkansas’ expansion to the traditional, fee-based Medicaid program, which is less generous.

Biden health officials have not commented on the pending waiver requests.

Georgia’s application for its Pathways to Coverage program was approved in the final days of the Trump administration. In early 2021, the Biden White House lifted work requirements and a rule requiring certain beneficiaries to pay a monthly bonus.

Gov. Brian Kemp (R) sued and a federal judge ruled in favor of the state, ruling that there will be a net gain in insurance coverage even if people are fired for not meeting job requirements. Surprisingly, the Biden administration did not appeal, allowing the program to go into effect.

But the state’s estimates of how many people will benefit vary.

When Kemp’s plan was first unveiled, it was estimated that around 50,000 people would be covered. The latest estimate put the number at around 345,000 people, but advocates were skeptical that many would be able to meet the reporting requirements.

Georgia has one of the strictest Medicaid requirements in the country, only covering parents earning up to about 30 percent of the state poverty line (an annual income of no more than $8,000 for a family of three).

The state has refused to adopt a full extension under the Affordable Care Act (ACA) for a decade. Critics say it loses significant federal funds and the Pathways program will cost more to serve far fewer people than full expansion.

“We know that if the state expanded Medicaid, more than 400,000 Georgians would be covered in Georgia,” said Laura Colbert, director of Georgians for a Healthy Future.

Leah Chan, director of health equity at the left-leaning Georgia Budget and Policy Institute, said expanding Georgia to include 100,000 people would cost state taxpayers $10 million more a year than full expansion.

In addition to the ACA’s promise that the federal government would pay 90 percent of expansion costs, supporters say Georgia is also waiving the American Rescue Plan’s temporary bonus, which is intended as an additional incentive to expand coverage.

The KFF estimates that this bonus would total more than $1.3 billion over two years.

The Pathways program will partially extend Medicaid coverage to people with incomes below the state poverty line: less than $25,000 a year for a family of three. However, in order to apply, applicants must demonstrate that they already meet the 80-hour requirement, and there is no grace period — with exceptions for full-time carers of young children or other relatives.

Those who have standard Medicaid coverage can retain their coverage without completing work requirements.

Denson of the Georgia Public Policy Foundation said he believes the partial expansion aspect of the Georgia program makes it unique and makes it a success.

“We are very confident that this will show other states how they can lead the way in caring for this population,” Denson said.

Find the latest news, weather, sporting events and streaming video at The Hill.