Budget bill includes changes to Medicaid similar to Georgia’s ‘Pathways’ program

Georgia could soon become the poster child for administering Medicaid with work requirements — for better or worse.

As Congressional Republicans seek to pass a budget bill enacting President Donald Trump’s agenda, they’re looking to require able-bodied Medicaid recipients to work in order to receive their health care coverage. Georgia is presently the only state in the nation with work requirements for its Medicaid population…

Laura Colbert, the executive director of Georgians for a Healthy Future, said frequent checks are difficult and expensive. There is more churn within the system because people are often falling in and out of care.

MORE THAN 7 MILLION PEOPLE will become uninsured if Medicaid cuts in Donald Trump’s “big, beautiful bill” become law, according to the Congressional Budget Office. And the single biggest reason for that would be new “work requirements” the legislation would impose on some Medicaid beneficiaries.

The Republicans say they are out to protect taxpayer resources, so that Medicaid isn’t subsidizing people who could be working but aren’t. They also say this is their way of “protecting Medicaid for the vulnerable”—that people who are engaged in productive activity will be able to stay on the program as long as they can prove it.

But one state is trying to do that now. It’s Georgia. And it hasn’t been going well.

DEANNA WILLIAMS, with Georgians for a Healthy Future who helps residents enroll in public health programs, told me she has seen this first-hand: “There are a lot of people who apply for the program who [worry] about meeting those hours because they have service jobs. If they are working at a restaurant, where their hours may fluctuate, or they are working in retail—during the holidays you may get more hours than normal, but during the regular season, you don’t get that many hours.”

As Congress continues to work to vote on a new budget, the Atlanta Community Food Bank said potential cuts could turn into a crisis with no answer.

The federal government is seeking public comment as it considers extending Georgia’s Pathways to Coverage program through 2030. Started by Gov. Brian Kemp in 2023, it offers Medicaid coverage to low-income adults but includes a work requirement. GPB’s Ellen Eldridge reports.

Since its launch in July 2023, less than 3% of those eligible for the state’s Pathways to Coverage — or 7,000 Georgians — have enrolled in health care coverage using a Medicaid waiver.

Whitney Griggs with Georgians for a Healthy Future said the administrative burden is preventing people from enrolling and is leaving more people without access to health care.

“Lots of folks who are eligible lose their coverage because they run into some sort of an administrative roadblock trying to submit their qualifying activity or prove their address or even just fill out the basic application,” she said.

Congress is considering similar changes as it looks to make cuts to Medicaid. The public comment period goes through June 1.

Peter Biello: The federal government is seeking public comment as it considers extending Georgia’s Pathways to Coverage program through 2030. Started by Gov. Brian Kemp in 2023, it offers Medicaid coverage to low-income adults but includes a work requirement. GPB’s Ellen Eldridge reports.

Ellen Eldridge: Since its launch in July 2023, less than 3% of those eligible, or 7,000 Georgians, have enrolled in health care coverage using a Medicaid waiver. Whitney Griggs is with Georgians for a Healthy Future. She says the administrative burden is preventing people from enrolling and is leaving more people without access to health care.

Whitney Griggs: Lots of folks who are eligible lose their coverage because they run into some sort of an administrative roadblock trying to submit their qualifying activity. Or, you know, move their address or even just, you know, fill out the basic applications.

Ellen Eldridge: Congress is considering similar changes as it looks to make cuts to Medicaid. The public comment period goes through June 1. For GPB News, I’m Ellen Eldridge

Congressional Republicans’ proposed cuts to health care, unveiled this week, lay the groundwork for thousands of Georgians on subsidized private insurance plans under the Affordable Care Act to lose their coverage and go uninsured.

Some of the cuts are made directly in the bill, such as revoking ACA insurance from about 21,000 Georgia DACA recipients, called “Dreamers”; or permanently shortening the open enrollment period.

Georgia mothers are facing a health care emergency — and Black women are disproportionately bearing the brunt of it…

Why is maternal mortality so high in Georgia?

There are many interconnected factors that contribute to Georgia’s crisis:

• Limited Medicaid coverage: Georgia has not adopted full Medicaid expansion. Instead, it launched a Pathways to Coverage program, intended to serve more people. According to Wilder, enrollment has fallen far short of its 100,000 goal after nearly two years, leaving critical federal dollars untapped.
• Medical deserts: Since 2010, nine rural hospitals have closed in Georgia, reports Georgians for a Healthy Future. This means many women have to drive hours for obstetric services.

CORDELE, GA – Today, Georgians had their last opportunity to speak out in a public hearing on the state’s Pathways to Coverage program, Georgia’s limited Medicaid expansion. The hearing, hosted by the Georgia Department of Community Health (DCH) in Cordele, drew testimony from community members, health advocates, and policy experts—many of whom voiced frustration with the program’s restrictive eligibility rules, as well as its administrative and accessibility burdens.

According to the Kemp administration, Pathways was designed to provide health coverage to tens of thousands of uninsured Georgians, but it has fallen far short of expectations. While the state originally projected between 30,000 – 100,000 enrollees in the program’s first year, only about 6,500 people have successfully signed up. The program’s work and activity requirements—including mandates for employment, student status, or volunteer work—have proven to be significant barriers to Georgians enrolling in the program and gaining health insurance. 

Sixty percent (60%) of uninsured, low-income Georgians live in a working household, and yet the vast majority have not been able to successfully enroll in health insurance through Pathways. The program covers only some full-time caregivers, and does not include flexibilities for people with serious medical conditions (like those who need cancer treatment and cannot work as a result),  and workers with inconsistent schedules.

Laura Colbert, Executive Director of Georgians for a Healthy Future, released the following statement after the hearing:

“Every Georgian–regardless of how little money may be in their bank account–deserves access to health care. Yet Pathways’ restrictive rules have blocked thousands of Georgians from getting the coverage they need. We’ve heard from parents and caregivers who can’t qualify, workers with inconsistent hours who are left out, and people with serious health conditions who still don’t meet the state’s rigid criteria. The message from today’s public hearing was clear: Pathways isn’t working, and Georgia must do better. Instead of maintaining an inefficient and costly program, state leaders should take the most effective path forward—fully expanding Medicaid to cover hard-working uninsured Georgians.”

State leaders celebrated three years ago when they passed a bipartisan measure designed to step up enforcement of a federal law that requires health insurers treat mental health and substance abuse services the same as physical care.

But more than two years after that law took effect, lawmakers and advocates are voicing frustration with the state of enforcement of behavioral health parity rules passed in 2022 that were intended to improve access to care in Georgia…

Laura Colbert, executive director of Georgians for a Healthy Future, which is a patient advocacy organization, described the implementation of the 2022 law as “uneven” at a parity day event in mid-February.

Colbert said the insurers’ reports to the state are not demonstrating compliance with the law, adding that the reports on private insurance coverage vary in quality. She said the reports on coverage through Medicaid are better, partly because the state Department of Community Health uses a standardized template for reporting.

“For parity to become so real, the onus is on insurance companies. The other portions of this law are very important for holding them accountable, because they certainly will not police themselves, but insurance companies should be doing the work of parity,” Colbert said.

Peter Biello: Welcome to the Georgia Today podcast from GPB News. Today is Thursday, Feb. 20. I’m Peter Biello. This podcast has the latest reports from the GPB newsroom. If there’s something you think we should cover, send us an email. The address is GeorgiaToday@GPB.org. On today’s episode, Georgia Democrats sound the alarm over possible cuts to Medicaid. Lawmakers advance a measure that may make child care slightly more affordable. And as Postmaster Louis DeJoy prepares to step down, Sen. Jon Ossoff looks towards the future of the post office.

Story 5: 

Ellen Eldridge: “The Legislature passed Georgia’s Mental Health Parity Act in 2022. Since then, the Carter Center and mental health care advocates have remembered the day by visiting lawmakers and also holding insurance companies accountable for keeping the state law. Laura Colbert is with Georgians for a Healthy Future. She says it’s not enough that the bill passed.”

Lauren Colbert: “Parity is about both policy and practice. So it’s not just what’s written down for an insurance company. It’s about how, then, when somebody calls and, you know, needs their coverage, that the practice meets that same policy.”

Ellen Eldridge: “Colbert says you can file a complaint if your behavioral health needs are not being met by your insurance provider. For GPB News, I’m Ellen Eldridge.”