ATLANTA — Low-income Georgians who would not generally qualify for traditional Medicaid can now qualify for a new Medicaid program that adds work-type reporting requirements.
Instead of a full Medicaid expansion, Gov. Brian Kemp is preparing to launch the Pathways to Coverage Medicaid waiver program July 1, which is estimated to add more than 60,000 uninsured Georgians to a Medicaid plan.
However, unlike any other Medicaid plan in the country, those who enroll in the Pathways program will have to complete a minimum of 80 hours per month of work, job training, education, volunteering or similar activities.
Georgetown University Health Policy Institute’s Center for Children and Families’ analysis of the new Georgia program said its work, school or training requirement is the most restrictive Section 1115 waiver approved during the Trump Administration.
And requirements will likely not factor in caregiving or high child care costs. The analysis referenced reporting difficulties in a work requirement health program in Arkansas where applicants had limited exemptions for disabilities, mental health and substance abuse treatment.
“Low-wage uninsured workers in Georgia disproportionately work in sectors that are less likely to offer employment insurance or paid leave benefits, specifically in retail, hospitality, or construction industries,” the analysis stated. “These individuals are also more likely to have fluctuating work hours and informal work arrangements, making work reporting very difficult. In addition, research finds that the majority of Medicaid adults are already working without a work requirement in place; those that are not working have barriers to work such as caregiving responsibilities, illness or school attendance.”
Currently, Georgia residents must meet family gross income requirements of no more than 211% of the federal poverty level (FPL) to qualify for Medicaid. That equates to less than $4,372 per month or $52,464 per year for a three-person household.
Provisions of the Pathways to Coverage program expand eligibility to parents 35-100% FPL and childless adults 0-100% of the FPL, with enrollment conditioned on compliance with work, training, education, etc. requirements and premiums. For instance, under Pathways, households with incomes of up to 100% of the federal poverty level ($23,030 for a family of three) would qualify.
Georgia is one of nearly a dozen states that has not fully expanded Medicaid to cover more low-income Americans up to age 64 by expanding to incomes up to 138% of the federal poverty level.
The federal government would increase its share of the costs to 90%, and the states would bear a 10% cost under a full expansion. More than 550,000 Georgians could be receive health insurance under a full Medicaid expansion.
Kemp and Georgia Republicans have cited cost concerns in opposition to a full Medicaid expansion, championing instead the Pathways program, which was challenged by the Center for Medicare & Medicaid Services in 2022.
In early 2022, Kemp filed a lawsuit against CMS and related parties under the Biden Administration for rescinding the state’s plan for the Pathways program that was approved under former President Donald Trump in 2019.
CMS had said at the time of its rejection of the state’s plan that the hours requirement didn’t meet the objectives of Medicaid, which is to provide coverage for low-income or poorer Americans.
A Georgia federal court judge later ruled to allow the state to move forward with the plan; Kemp included $52 million in the FY 2024 budget, which starts July 1, to implement the Pathways program.
“Simply put, the Biden administration is obstructing our ability to implement innovative health care solutions for more than 50,000 hardworking Georgia families rather than rely on a one-size-fits-none broken system,” Kemp said.
The program launch date of July 1 is amid the country’s “Medicaid unwinding,” in which 2.8 million Georgia Medicaid recipients are being reevaluated, and upwards of 250,000 Georgians could lose their Medicaid coverage authorized by the federal government during the COVID-19 pandemic.
Those who gained coverage during the pandemic period could potentially transition to the Pathways, according to Leah Chan, senior health analyst at the Georgia Budget and Policy Institute.
Chan said hospitals and health care facilities will likely experience revenue losses when uncompensated care is expected to increase as people drop off of Medicaid.
“We know that here in Georgia, it is children and communities of color that will be disproportionately harmed by Medicaid unwinding, and that rural and safety net hospitals that have been temporarily propped up by pandemic-era federal funding will again feel that mounting financial strain of uncompensated care,” she added, noting that 70% of those covered by Medicaid and PeachCare for Kids in Georgia are children.
How to apply to Georgia’s “Pathways to Coverage” Medicaid Program
Applications to the program can be downloaded at dch.ga.gov/georgiapathways to be submitted by mail or in person to a local DFCS office.
Applications will also be accepted online at gateway.ga.gov starting July 2. Georgia residents can also apply by phone at 1-877-423-4746 or 711 for those who are deaf, hard of hearing, deaf-blind or have difficulty speaking.
Eligible Georgia residents must be between ages 19 to 64, be a U.S. citizen or legally residing non-citizen, have a household income of up to 100% of the federal poverty level, not be enrolled in the traditional Medicaid program, and not be incarcerated.
Program documents state eligibility will be based on one or more qualifying activities for a total of 80 hours per month: full-time or part-time employment, on-the-job training, job readiness assistance programs, community service, vocational educational training, enrollment in the Vocational Rehabilitation program of the Georgia Rehabilitation Agency, or higher education.
Coverage is expected to start one month after the application is approved.