Georgia work requirement health insurance set to launch this week

Gov. Brian Kemp with several Georgia Supreme Court justices at his 2023 State of the State address on Jan. 25 at the Georgia state Capitol. (Matthew Pearson/WABE)

Georgia is set to launch its controversial Pathways to Coverage program, a limited Medicaid expansion for some low-income adults who complete work, volunteering and other eligible approved activities every month.

Pathways’ start would make Georgia the first state in the nation to operate such a program. 

The Trump administration initially approved the coverage model. The Biden administration later blocked it. Then last summer, a federal judge allowed it to move ahead.

A spokesman for Gov. Brian Kemp’s office said they are budgeting for around 90,000 Georgians to participate. The figure is disputed by most Georgia health advocacy groups that say far fewer applicants would actually be able to meet the requirements.

“A lot of that will depend on how easy it is for folks to submit their proof of qualifying activities or proof of exemption,” Whitney Griggs, senior policy manager for the group Georgians for a Healthy Future, said in an emailed statement.

Kemp spokesman Garrison Douglas said Monday the administration would provide more details about Pathways’ participant verification requirements later this week.

Courts had previously blocked states’ so-called Section 1115 waivers to mandate work requirements in exchange for Medicaid health insurance coverage.  And last spring, after the Biden administration withdrew the Trump administration’s approvals, the U.S. Supreme Court dismissed pending appeals in cases challenging the approvals as unlawful. 

KFF News reports the U.S. Supreme Court’s dismissal doesn’t, “preclude future presidential administrations from approving new Section 1115 work requirements. To survive an expected legal challenge, the administrative record in any future approvals would likely have to support the conclusion that such waivers would further Medicaid program objectives.”

Georgia health policy analysts are expressing concern about the timing of Pathways’ rollout, which coincides with the ongoing national Medicaid unwinding. During the unwinding, states are recertifying the eligibility of every Medicaid and children’s health insurance program recipient for continued coverage. In Georgia, that’s roughly 2.8 million people with Medicaid and PeachCare. 

The state has reported that hundreds of otherwise-eligible recipients have already lost their coverage for avoidable reasons, including a failure to complete the recertification process. State agencies have also struggled with staffing during the unwinding.

As the unwinding continues amid the added pressure of launching Pathways this summer, Griggs said it’s difficult to gauge the state’s readiness to launch Pathways. 

“A lot of it is up in the air as we see what the full impact of the unwinding is, as well as how difficult it is for people to navigate both the work requirements and the premium payments,” said Griggs. “I think we’ll likely have a better sense and can make some predictions in the early fall. By that time, we will have seen a much larger portion of Medicaid enrollees go through the renewal process, as well as have some early data on how many people are enrolling in Pathways.”

Also still unknown is whether Pathways staff would assist applicants in need of eligible employment, volunteer or educational activities with finding those opportunities in order for them to complete their applications for coverage.    

The governor’s office told WABE it expects approximately 345,000 people to initially apply for Pathways. 

State officials are expected to release more details on Pathways later this week.