ATLANTA, GA — Georgians for a Healthy Future (GHF) today responded to Thursday’s announcement from Georgia’s Department of Community Health (DCH) that the agency will ask the federal government for permission to change how it funds Pathways to Coverage, the state’s limited Medicaid program for Georgians earning up to 100% of the federal poverty level (FPL).
Because Georgia has not fully expanded Medicaid to cover Georgians earning up to 138% FPL, the federal government currently covers 66 percent of program costs (Georgia’s current Medicaid matching rate).
DCH is requesting an increase to 90 percent, the “enhanced” rate the federal government pays to states that have fully expanded Medicaid to low-income adults with incomes up to 138% FPL. DCH is asking for that funding boost without increasing Pathways’ income eligibility.
To make this request, DCH must formally amend the Georgia Pathways to Coverage Section 1115 waiver, the federal approval that allows Georgia to run Pathways with its own custom rules, including current work requirements, instead of following standard Medicaid rules.
“Every Georgian deserves access to health coverage, and every additional person who gains it is meaningful, even within a program as flawed as Pathways,” said Laura Colbert, Executive Director of Georgians for a Healthy Future. “While the federal requirements do not eliminate the inherent problems with work reporting requirements, the shift away from Pathways’ current structure to the federal version is an opportunity for more Georgians to gain coverage, including family caregivers, adults with serious chronic illnesses like cancer or mental illnesses, and veterans with major disabilities.”
Pathways currently requires enrollees to document at least 80 hours per month of work or another qualifying activity and covers fewer than 20,000 Georgians. Starting January 1, 2027, Georgia must align its work requirements with new nationwide standards under H.R. 1, the federal budget law passed last year that imposes Medicaid work requirements across the country. The new federal rules will include more exemptions than Georgia’s current program, and DCH estimates this could increase Pathways enrollment to 120,000 Georgians.