Georgia’s new Medicaid work requirements plan kicks into gear on Saturday, linking health insurance coverage for adults in the safety-net program to work, school or volunteering hours.
“Georgia Pathways to Coverage” — the only work requirement in effect in the nation — is a test case for other Republican-led states looking to curtail Medicaid, which is often the No. 1 or No. 2 line item on state’s budgets.
Advocates have slammed the plan as restrictive, arguing it will insure fewer people than a full expansion of Medicaid under the Affordable Care Act. It’s also going to cost Georgia more, according to a new analysis.
By only enacting a partial expansion through Pathways, the state is forgoing an additional $1.1 billion in federal funding it would receive under a full Medicaid expansion, according to the Georgetown University Center for Children and Families, which authored the report. The cost to Georgia on a per-capita basis in Pathways’ first year is expected to be five times higher than the first year of a full expansion.
Georgia’s program is “fiscally foolish and sets up a structure that discriminates against patients,” the GUCCF said in a statement.
Georgia, which has some of the worst health outcomes and the third highest uninsured rate in the nation, is one of 10 remaining states that have yet to expand Medicaid eligibility to individuals earning up to 138% of the federal poverty line.
Instead, Georgia Gov. Brian Kemp, a Republican, is expanding coverage to adults earning up to 100% of the poverty line. Able-bodied adults are required to document that they’re working, volunteering or studying for 80 hours each month.
Pathways’ reporting requirements have no exceptions for caregiving or high child-care costs. As a result, those documentation requirements will disproportionately impact healthcare access for parents, along with low-wage workers who most commonly work in sectors like retail or hospitality with fluctuating work hours, according to the GUCCF.
Georgia’s Department of Community Health estimates its plan will insure up to 100,000 people in its first year. That’s fewer than a fourth of Georgians that would receive Medicaid coverage under a full expansion in the state.
Georgia is one of 10 Medicaid expansion holdouts
A number of states attempted to institute work requirements during the Trump administration, which ultimately approved 13 demonstration waivers. The Biden administration revoked the waiver approvals in 2021, but Kemp appealed the decision and won an appeal to preserve Georgia’s plan.
Some Republicans in Congress back legislation that would require more adults on Medicaid nationwide to work, train for a job or perform community service to keep their coverage, arguing the requirements incentivize Americans to get employment and rely less on government aid.
However, past research suggests Medicaid beneficiaries lose coverage following work requirements, not due to a lack of qualifying hours, but because of documentation or administrative errors, like not properly filling out paperwork.
In Arkansas, one in four people who were required to work lost coverage as a result of work requirements instituted in 2018, according to the Center on Budget and Policy Priorities. Many of those losses were due to compliance hurdles, including a lack of awareness, KFF found.
No Medicaid enrollees have lost coverage in the last three years due to the COVID-19 public health emergency, as states pledged to keep beneficiaries on Medicaid rolls in exchange for higher federal reimbursement. That changed in April, as states resumed eligibility checks for the coverage.
As of Thursday, at least 1.5 million Medicaid enrollees have been disenrolled, according to a KFF tracker. That figure is almost certainly an undercount, as not all states publicly report data on disenrollments.
Earlier this month, the HHS granted states a number of flexibilities meant to minimize coverage losses.
