Narrow increase in Medicaid eligibility for low-income Georgians continues enrollment struggle

About 1,300 people have signed up for health care coverage through Georgia’s new Medicaid program for low-income adults, who must complete 80 hours of work or other activities every month to qualify and then keep their health care coverage. Jill Nolin/Georgia Recorder

Georgia’s new Medicaid program for low-income adults continues to enroll people at a slow rate, with just 1,300 people so far signing up.  

The state planned for about 100,000 people to enroll in the first year for the partial Medicaid expansion program called Georgia Pathways, which launched in July. As many as 370,000 may be eligible, according to the state’s projections.

As of Oct. 13, a total of 1,343 people had enrolled.  

The state Department of Community Health, which administers Georgia’s Medicaid program, released the enrollment data and posted it online Thursday morning. The numbers were first reported Thursday by the Atlanta Journal-Constitution, which says it was preparing to report an apparent violation of the Open Records Act.

State officials have previously said they expect enrollment to gradually ramp up. In August, an agency official said at a public meeting that 265 people had been approved for the program in the first month. 

“We will continue working to educate Georgians about Pathways’ innovative, first-of-its-kind opportunity and enroll more individuals in the months to come,” said Garrison Douglas, who is Gov. Brian Kemp’s press secretary.

The program is a key part of the Republican governor’s signature health care policy, which he unveiled during his first year in office in 2019. At the time, the governor’s office estimated that about 50,000 might enroll. 

Georgia Pathways slightly eases the state’s strict Medicaid eligibility requirements by opening the program up to adults without children who earn less than 100% of the federal poverty line, which is about $15,000 a year for a single person. But the newly eligible must also complete 80 hours of work or other activities every month to qualify and then keep their health care coverage.

The state’s plans were first approved under former President Donald Trump and then challenged by the Biden administration, which objected to the work requirement and a rule that some participants pay monthly premiums. Georgia officials were eventually able to move forward with the program after successfully suing the federal government. 

The program is being rolled out at a time when hundreds of thousands of people are expected to lose Medicaid coverage as part of a nationwide unwinding of a pandemic-era federal policy. 

Georgia is one of 10 states that have not fully expanded Medicaid under the Affordable Care Act, with North Carolina in the process of rolling out expansion next door. And Georgia is now the only state to partially expand Medicaid coverage while requiring the newly eligible people to satisfy a work requirement.

Supporters of Georgia’s new program say it’s too early to write it off just yet. They tout Georgia Pathways as a conservative alternative to full expansion that is designed to steer people toward private insurance options like employer-sponsored health care.

“It’s important to recognize that this is a new program with new requirements that is still in the infancy really of being established,” said Chris Denson, who is the director of policy and research at the Georgia Public Policy Foundation.

“And so, with that being said, we’re willing to give it the benefit of the doubt here in the first three months and at this point in time not reach any sweeping conclusions,” he said.

But proponents of full expansion continue to pan Georgia Pathways as a costly experiment that is failing the hundreds of thousands of people who could gain insurance if Medicaid were fully expanded here. Georgia has one of the highest uninsured rates in the country. 

“Georgians heard promises from state leaders about a new program that would expand access to care, cover between 31,000-345,000 uninsured adults, and lower costs for families. Pathways to Coverage is falling well short of these commitments to uninsured Georgians,” said Laura Colbert, executive director of Georgians for a Health Future, which is a patient advocacy group.

Colbert and others are contrasting Georgia Pathways with South Dakota’s full expansion, which launched at the same time and does not have a work requirement. About 11,000 people have signed up for Medicaid coverage in South Dakota, which represents its own kind of slow start.

Leah Chan, director of health justice with the left-leaning Georgia Budget and Policy Institute, has long criticized Georgia Pathways as being more expensive than full expansion while covering few people. So far, the state has spent $20 million to launch the program and has budgeted another $118 million for this year.

“These low initial enrollment numbers do not match the large-scale investment made thus far,” Chan said. “Further data and more transparency are needed to help us gain a deeper understanding of program gaps and how the state can pivot to ensure taxpayer dollars are being utilized as intended — to connect uninsured Georgians with the health care they deserve.”

The new enrollment numbers also sparked new calls from Georgia Democrats to fully expand Medicaid.  

“I, among many, have consistently said that Georgia needs to expand Medicaid, and that a costly half-measure pursued by Gov. Kemp and the GOP majority was a poor substitute,” state Sen. Elena Parent, an Atlanta Democrat, said on X, formerly known as Twitter. “The results speak volumes. Expand Medicaid now! We are years behind other states but it’s not too late.”

But supporters of the program argue other data points beyond the number of people enrolled will signal the success of Georgia Pathways.

“I think if we are to assess the program two, three, four years from now, it will not so much be the number of beneficiaries who are enrolled but those that have successfully graduated from the program,” said Denson with the conservative-leaning Georgia Public Policy Foundation.

“And I do hope the state will track that number, because to us the biggest incentive for supporting this program is that, ultimately, we’re providing a pathway for able-bodied, low-income individuals to gain access to health care, but we just don’t feel that Medicaid is the best long-term solution for providing health care access.” 

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