How Georgia’s new Medicaid work requirement program will work

After years of legal wrangling, the countdown to the July 1, 2023, launch date of Georgia's Medicaid work requirements program is underway.

The new plan – officially called Pathways to Coverage – will require enrollees to complete 80 hours of work, education, job training, or community service per month to get Medicaid health insurance. Many will also have to pay a monthly premium.

Once the program begins, Georgia will be the sole state with work requirements for Medicaid. Adults between ages 18 and 64 who earn less than 100% of the federal poverty level – and who are not otherwise eligible for Medicaid – are the targeted group. For 2022, the federal poverty level was $13,590 for a single person and $27,750 for a family of four.

Though exact numbers are difficult to calculate, it’s expected that the Pathways program will provide insurance to only a small percentage of the 1.3 million Georgians without health insurance.

State officials estimate around 345,000 Georgians would be eligible for the new program. Back in 2020, they said they expected only about 64,000 people to actually enroll in the program.

Now that the program is becoming a reality, the Georgia Department of Community Health (DCH), the state Medicaid agency, has requested funds to cover up to 100,000 people in the upcoming budget, said spokesman David Graves.

“Georgia leadership has put in place barriers that they know, that they have calculated, will prevent … people from enrolling,” said Leonardo Cuello, research professor at Georgetown University’s Center for Children and Families, about the discrepancy between the number of eligible people and the number expected to enroll.

Critics of Pathways contend the program will cover far fewer Georgians and cost more than a full expansion of Medicaid, as 39 states have done.

Leah Chan, senior health analyst at the Georgia Budget and Policy Institute, a left-leaning think tank in Atlanta, said the new program will cost around $2,420 per enrollee while it would cost only $496 per enrollee if the state fully expanded Medicaid.

“New financial incentives under the American Rescue Plan sweeten the deal [for full Medicaid expansion] and more than offset the state cost of expansion for at least the first two years,” Chan said.

Enrollees in Georgia Pathways will need to certify their employment each month. Those who earn more than 50% of the federal poverty level will also be required to pay a monthly premium ranging from $7 to $11, with an additional surcharge for people who use tobacco products.

The program will provide a two-month grace period for people who do not pay their premiums. But after three months of nonpayment, they will lose the insurance. They can be reinstated if they make at least one monthly payment within 90 days.

The state plans to use the existing benefits portal, Georgia Gateway, for program applicants to manage their work-requirement reporting, said Graves, the DCH spokesperson. He said Georgians can expect to learn more about the details of the program over the coming months.

Critics say the machinery necessary to track enrollee work records and payments will dramatically increase bureaucratic burdens both for Medicaid recipients and the state.

“When you think about working families in Georgia, they are busy with their jobs, getting kids to school and the doctor, paying the stack of bills that come in every month, and the last thing they need is additional red tape … every month just to keep their health insurance from getting terminated,” Cuello said.

Cuello said the state will have to develop “expensive administrative processes” to ensure compliance with the work requirements. The [congressional Government Accountability Office] and states have estimated costs ranging from $70 million to $270 million a year to implement and run this type of program, he said.

DCH has not yet decided whether it will need to hire additional staff to help run the program, Graves said.

The Pathways program allows some exceptions to the work-requirement rules. Enrollees will be allowed 120 hours of “noncompliance,” that is of not meeting the work requirements, in every 12-month period.

But routine child care is not on the list of exceptions. Other states that previously attempted work requirements ensured that caring for young children was a valid reason for not meeting the requirements and would not result in losing insurance.

“A stay-at-home parent taking care of two young kids in a family that lives at half of the poverty level … can’t afford child care, and they can’t just leave two young kids at home alone,” Cuello said. “Georgia's plan makes no exceptions for these parents, and they will be denied health insurance.”

The plan has federal approval to operate until Sept. 30, 2025.

This story is available through a news partnership with Capitol Beat News Service, a project of the Georgia Press Educational Foundation.