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Georgia’s Pathways to Coverage program requires participants to document work, school, or other qualifying activities in order to gain and keep Medicaid coverage. But three years in, the numbers tell a complicated story, and the people living inside those numbers tell an even more complicated one.

Paul Mikell knows that firsthand. As an essential worker, Paul shared his journey of enrolling in Pathways. Although he was eligible through SNAP (the Supplemental Nutrition Assistance Program, or food assistance), the process was far from easy. Even after approval, keeping his coverage meant constantly navigating confusing paperwork and reporting requirements just to prove he still qualified.

His experience reflects a pattern the data keeps confirming.

A Program Falling Short of Its Potential

As of April 30, 2026, 16,782 Georgians are actively enrolled in Pathways to Coverage, a number that sounds significant until you consider the scale of the need. About one in every three of Georgia’s low-income adults remains uninsured, and for many of them, Pathways to Coverage has not been the on-ramp it was promoted to be.

The barriers start at the application stage. According to an analysis of the program by the Georgia Budget and Policy Institute, about 60 percent of Pathways to Coverage applications were denied in the first two years. Failure to meet the minimum required work or activity hours accounted for 11 percent of those denials. Applicants may also struggle with documenting qualifying activities, gathering required paperwork, understanding program requirements, or navigating the online application process.

For those who do get approved, staying enrolled is another challenge. During the renewal period, a majority, 64 percent, of disenrolled Georgians lost coverage because they did not return their renewal forms. For some enrollees, maintaining coverage means keeping up with reporting requirements, responding to requests for information, and meeting renewal deadlines while balancing work, school, caregiving, and other responsibilities.

The program’s reach has also been uneven across the state. Almost half of Georgia’s counties still had 25 or fewer residents who had ever been covered under Pathways after two years of enrollment.

The cost picture raises questions about efficiency. Through June 2025, the Pathways to Coverage program cost taxpayers about $110 million. Less than a third of every dollar spent went toward actual health care benefits, like doctor visits and prescription refills.

Georgia Is Not Alone for Long

Georgia has been the only state in the country operating a Medicaid work reporting requirement, but that is changing. Thanks to HR 1, the federal government is now requiring all states to adopt similar requirements, making Georgia’s experience with Pathways a preview of what millions of people enrolled in Medicaid across the country could soon face. Starting in January 2027, Georgia will also need to align its own program more closely with the new federal standard, adding yet another layer of complexity for enrollees already navigating a demanding system.

What the Numbers Cannot Tell Us

Data points can describe the scope of the problem, but they cannot capture what it feels like to live it. They cannot tell the story of a missed notice, a confusing requirement, a document that never arrives, or hours spent trying to upload paperwork or reach someone who can help. They cannot capture the challenge of meeting reporting requirements while balancing work, school, caregiving, transportation barriers, or unreliable internet access.

And they cannot measure the toll that navigating a complicated system can take on a person’s time, finances, and peace of mind.

That is where your story comes in.

Georgians for a Healthy Future is collecting stories from people who have navigated Georgia Pathways to Coverage. We want to hear what the work reporting requirements mean for your daily life, and what it has taken to hold onto the coverage you have earned. As other states prepare to follow Georgia’s lead, your experience can help shape how these programs are designed and implemented across the country.

Who Should Share Their Story?

We are looking for Georgians who:

• Are currently enrolled in Georgia Pathways to Coverage
  • If you are an adult who is working, in school, or participating in another qualifying activity and receive Medicaid coverage (sometimes called “medical assistance”), you may be enrolled in Pathways.
• Have tried to enroll in Pathways and faced barriers or denials such as missing paperwork, difficulty documenting qualifying activities, technical issues, or confusion about eligibility requirements
• Have lost Pathways coverage and are working to get it back after missing a deadline, renewal notice, or documentation request
• Have navigated the work reporting requirements while managing work, school, caregiving, transportation challenges, unreliable internet access, or other responsibilities

We especially encourage people in rural communities to share their experiences.

Your story matters, even if you think it doesn’t. If Pathways has been part of your life in any way, we want to hear about it.