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Georgia’s Pathways Program: What you need to know

Georgia is one of 10 states that has not yet expanded Medicaid. Our leaders’ in action leaves thousands of low-income Georgia adults without health insurance.

Instead of expanding Medicaid, Governor Kemp created a new program called Georgia Pathways to Coverage. This program will cover some low-income adults, but it has a lot of rules and requirements.

To qualify for Pathways, you must meet all of these four requirements:

  • Be a U.S. citizen or a qualified permanent resident
  • Be between the ages of 19 and 64
  • Have an income below the poverty line. (If you don’t know if your income is below the poverty line, use the chart below.)
  • Be working or doing other qualifying activities for at least 80 hours per month.
Chart with the title "Monthly Income Ranges". The chart lists the qualifying incomes for 2023 based on family size.

If you are uninsured and meet these requirements, you can apply for Pathways. You can apply online at gateway.ga.gov or by phone at 1-877-423-4746.

If you need assistance with your application, GHF’s enrollment assisters are here to help! Click here to ask for their assistance. 

What does this mean for Georgians?

Pathways is a complicated program with many rules and restrictions, so we expect only a fraction of eligible Georgians will get covered through the program. The Governor and his administration have estimated that between 31,000-100,000 Georgians will be able to enroll in Pathways. (Full Medicaid expansion would cover more than 400,000 Georgians.)  

Some people who are likely to be left out include:

  • Stay-at-home parents
  • Caregivers for aging family members or children with a disability
  • People in mental health or addiction recovery programs
  • Rural residents and people of color who live in areas where good jobs are hard to find
  • People who do not have reliable internet access or a car

These folks may not meet the requirements for Pathways or won’t be able to keep up with the tedious monthly reporting. They will likely be left behind. 

Medicaid expansion: an easier, better solution

Pathways is a broken bridge that lets too many Georgians and too much money fall through the cracks. Because of its complications and restrictions, thousands of Georgians will remain uninsured, and our state’s tax dollars–which are meant to help families access health care and keep hospitals open–will sit unused in Washington, D.C. 

Georgians deserve better. We deserve access to affordable, quality health care regardless of how little money is in our wallets. We deserve healthy hospitals whose doors are open to care for their communities. We deserve to visit the doctor when we’re sick and fill a prescription without worrying about whether to pay our rent or the medical bill.

Luckily Georgia leaders can replace Pathways with a program that is simpler, covers more people, costs less per person, and meets our state’s needs: Medicaid expansion! 

How you can help

Here are some things you can do to get Georgians covered and keep up the calls for Medicaid expansion:

By working together, we can make sure that all Georgians–regardless of how much or little money they have–have health coverage and the access to care that comes with an insurance card.


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GHF participates in visit from U.S. Department of Health and Human Services Secretary Becerra

By: Knetta Adkins

A group of adults standing together wearing masks in front of a sign at Southside Medical Center. They are a mix of Black, White, Latino, and other races.
HHS Secretary Xavier Becerra at Southside Medical Center, Atlanta, GA.

On August 2nd, I had the opportunity to meet with Secretary Xavier Becerra, the 25th Secretary of the Department of Health and Human Services. During his August trip to Georgia, Secretary Becerra hosted a roundtable with community leaders to hear about the health care concerns and challenges most affecting Georgians. Congresswomen Carolyn Bordeaux, Lucy McBath, and Nikema Williams, state Representative Matthew Wilson, and Mayor Keisha Lance Bottoms participated in the roundtable, as well as representatives from Community Catalyst, Protect Our Care Georgia, and others. It was an exciting moment to represent Georgians for a Healthy Future and share on behalf of the marginalized Georgians for whom we advocate. 

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New Georgia Medicaid Change Creates Opportunity to Invest in School Health Workforce

A white woman smiles as she uses a stethoscope & blood pressure cuff to measure a young Black student's blood pressure
Photo courtesy of Georgia State University

In June of this year, the Centers for Medicaid and Medicare Services (CMS) approved a change for Georgia’s Medicaid program that shifts how school nurses can bill for their services. Before June, Medicaid would only pay for school health services, including nursing services, if the student had a special education plan called an Individualized Education Program (IEP). IEPs are maps that lay out a program of tailored education instruction, supports, and services. These plans are required for all students receiving special education services like students with ADHD, autism, or a speech impairment. The approved change allows Medicaid to pay for more school health services provided to any student with Medicaid coverage.

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Medicaid & the disability community: One family’s journey

Stock photo of mother and child
Stock photo of mother and child

Georgia’s Medicaid health insurance system covers many different Georgians, including those with disabilities. The coverage provided to people with disabilities offers much-needed support to individuals and families that might otherwise fall short of addressing their health care needs.

While Medicaid has been a lifeline for some, a full expansion of Medicaid would bring additional funding to the state and strengthen existing programs. For every dollar Georgia would spend to close the coverage gap, Georgia would receive up to $9 in federal funding. The recently passed American Rescue Plan added to the financial incentives available under Medicaid expansion; under the new federal law, Georgia could attract $1.3-$2 Billion to cover the costs of expansion and offset state spending on other priorities.

This additional funding could benefit Georgians who need Home and Community-Based Services (HCBS) Medicaid waivers. HCBS waivers help people with disabilities get the health and support services they need so they can live independently in their communities, rather than in nursing homes or long-term care facilities. Currently, more than 6000 Georgians sit on a waiting list for one of these waivers.  The additional funding that Georgia could earn under Medicaid expansion could reduce or possibly eliminate the HCBS waiver waiting list altogether.

Below is a first-hand account from a Georgia mother, whose 9-year-old daughter is covered by Medicaid. Her daughter was diagnosed with Ataxic Cerebral Palsy at 18 months. Since her diagnosis, the two have navigated challenging care and coverage issues. Their experiences highlight a number of the policy and advocacy issues that consumers contact GHF about regularly: Medicaid, Medicaid expansion, difficulty finding health care providers, Georgia’s public health system.

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GHF submits comments on the Department of Community Health’s 2021- 2023 Quality Strategy

Population-based approach

We commend the Department of Community Health for taking a population-based approach to improving the health of Georgia’s Medicaid members. We are especially encouraged by the Department’s commitment to engaging with the care management organizations (CMOs) to monitor and improve racial health disparities among Medicaid members. This commitment is a strong first step, and we believe DCH could go even farther to address and improve health disparities in these three ways:

Planning for Healthy Babies

Planning for Healthy Babies (P4HB) is an important program to improve maternal and infant outcomes and address health disparities, but it serves only a small population of women in Georgia. One of the reasons P4HB is so successful is the targeted outreach efforts to women in areas with poor infant health outcomes. DCH should take a similar approach for all Medicaid eligible populations. By focusing CMO and DCH outreach efforts on areas of the state with poor health outcomes and high Medicaid-eligible populations, they may be able to make a similar impact on health disparities for a larger population.

Meaningful engagement with Medicaid members

To successfully reduce health disparities, we advise DCH and the CMOs to work closely and meaningfully with Medicaid members and community members from the populations experiencing the greatest health burdens to craft impactful strategies tailored to a specific group. There are great opportunities to close racial health gaps among Georgia’s Black & Hispanic communities especially. Georgia has the 2nd largest Black/African American population in the U.S.(The Office of Minority Health, 2021), and 15% of Black Georgians are uninsured (KFF, 2020). Georgia also has the 9th largest Hispanic/Latino population in the U.S., and 47% of Georgia Hispanics are uninsured (The Office of Minority Health, 2021). Black and Hispanic Georgians suffer from chronic and infectious diseases, including COVID-19, at rates higher than those of white Georgians CDC, 2021) and have shorter life expectancies ( The Office of Minority Health, 2021).

Unique barriers (including language, systemic inequities to build wealth, available pathways to coverage, immigration status, social discrimination, and more) block these groups from equitable health status and outcomes. These complex and long-standing barriers to health can only be overcome with meaningful, sustained engagement with members of these and similar groups. Based on GHF’s observations, the infrastructure that DCH and CMOs have for engaging members falls short of what is needed. (GHF humbly offers its assistance to all interested parties re-thinking engagement strategies and programs.)

Beyond language and cultural competency

The Quality Strategy points to translation and language services and cultural competency as strategies to reduce health disparities. These are important components, but they are not sufficient on their own. We encourage DCH to explore additional interventions that better address the root causes of disparities. These interventions could include maximizing the roles of the state’s community health workers (CHWs) and peer support coaches; and incentivizing CMOs to operate robust wrap-around service programs to address housing, food, transportation, and economic needs of members. Numerous studies have shown that CHWs and peer support coaches can play meaningful roles in improving health outcomes, lowering health spending, and reducing health disparities (Chan, 2021).

Another solution to reducing health disparities is to ensure every Georgian has a pathway to health coverage. Medicaid expansion would go farther than the proposed Pathways 1115 waiver towards accomplishing this. Several studies have shown that full expansion of

Medicaid (up to 138% FPL) narrowed disparities in health outcomes for Black and Hispanic individuals, particularly related to infant and maternal health (KFF, 2020). While this decision does not lay with the Department of Community Health, your leaders and staff are trusted and important messengers to state lawmakers about how such a move could improve the health of Georgians.

Behavioral health

We were encouraged to see the Quality Strategy call out behavioral health as an area of focus. Data before and during the pandemic supports that behavioral health needs are growing across the population, and there is no doubt that this holds true for Medicaid members.

However, the measures for Goal 1.5 predominantly address mental health (increase screening for depression among adults and adolescents), while largely ignoring substance use. We know that youth substance use is a risk factor for other issues, including school absenteeism, depression, and committing acts of violence. Data show that Georgia youth are experimenting with drugs and alcohol at younger ages (SAMSA, 2019). Therefore, DCH could significantly impact the behavioral health outcomes of young members by adding measures related to substance use screenings and referral to treatment services. To increase screening for substance-use disorders among youth, DCH could leverage CHIP funds for Health Service Initiatives. Utilizing these funds would provide sustainable funding for school-based or population-based services to address substance use.

Access to care via telemedicine

The increased utilization of telemedicine during COVID-19 has proven it is an important method of care for Georgia consumers, including Medicaid members. For that reason, we are pleased to see it identified in the Quality Strategy. However, telemedicine cannot overcome all access challenges because many Medicaid members live in areas with limited internet connectivity, especially those who live in communities of color and rural communities. We encourage DCH to look for additional methods to increase access to care, including addressing transportation gaps.

Notably, the Quality Strategy does not mention the Non-Emergency Medical Transportation benefit for Medicaid enrollees. In our experience, many enrollees do not know about the NEMT benefit and therefore do not make use of it. Additionally, at times NEMT is unreliable and unprepared to meet members’ transportation needs (i.e., sending a regular van to pick up a member who needs a wheelchair-ready van or sending transportation that cannot accommodate a child’s sibling). DCH could increase access to care by promoting the benefit to more beneficiaries and investing in improvements to the program.

Measurement, evaluation, and enforcement

GHF applauds the strong evaluation and enforcement measures included in the Quality Strategy. The inclusion of the value-based purchasing program in the GF 360º program and the intermediate sanctions policy offer strong accountability measures for Georgia’s CMOs.

We were further pleased to see multiple measures of network adequacy, including appointment availability, incorporated into the Quality Strategy. GHF views appointment availability and travel time/distance as perhaps the most accurate measures of network adequacy in terms of increasing access to care. We encourage DCH to hold these measures above other measures like provider member ratios. To meaningfully ensure network adequacy for Medicaid members, we encourage DCH to adopt more robust enforcement measures for these requirements. Specifically, DCH could leverage intermediate sanctions against CMOs with provider directories that are out-of-date or otherwise inaccurate. Requiring CMOs to maintain up-to-date and accurate provider directories will help ensure Medicaid enrollees can receive timely care and avoid costs associated with unknowingly utilizing out-of-network providers.


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Georgia’s health care transportation crisis: James and Lamar County

3 photos of James being active in his community

Having access to transportation is crucial to having access to health care. Each year millions of Americans miss or delay health care because they do not have a way to get there.

Medicaid’s non-emergency medical transportation (NEMT) program helps bridge the gap between home and the doctor’s office for individuals who are covered by Medicaid. In 2018, 396,000 Georgians got to their health visits using the free NEMT benefit.

In partnership with The Arc Georgia and the Georgians in the Driver’s Seat initiative, Georgians for a Healthy Future (GHF) staff have spoken with consumers around the state about their transportation needs and the NEMT program.

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Legislative Update: Sine Die brings Georgia’s 2021 legislative session to an end

Legislative update: Sine Die

Thank you for your continued readership and support during the 2021 legislative session! The GHF team is proud to deliver timely, accurate updates to you on health care happenings at the Capitol. We hope that they have helped you stay informed and connected. If you have enjoyed reading each week’s edition, please consider supporting our work with a donation today. Thank you very much!

In this week’s update:
Image of the Georgia capitol
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Legislative Update: Crossover Day recap, plus action alerts on Medicaid expansion & prior auth!

Legislative update: Week 9

The GHF team prides itself on delivering timely and accurate updates to you on health care happenings at the Capitol. We hope that you enjoy reading our weekly legislative updates and that they help you stay informed and connected. If you enjoy them, please consider supporting our work with a donation today. Thank you for your continued support!

In this week’s update:
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Legislative Update: Crossover day, big budget moves ahead, & action alerts!

Legislative update: Week 8

The GHF team prides itself on delivering timely and accurate updates to you on health care happenings at the Capitol. We hope that you enjoy reading our weekly legislative updates and that they help you stay informed and connected. If you enjoy them, please consider supporting our work with a donation today. Thank you for your continued support!

In this week’s update:
Image of the Georgia capitol
(more…)

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Legislative Update: Mental health & substance use updates, prior authorization, Medicaid expansion, telehealth, & more!

Legislative Update: Week 7

The GHF team prides itself on being able deliver timely and accurate updates on health care happenings at the Capitol. We hope that you enjoy reading our weekly legislative updates and that they help you stay informed and connected. If you enjoy them, please consider supporting our work with a donation today. Thank you for your continued support!


In this week’s update:
Image of the Georgia capitol

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