Georgia: Medicaid work requirements working out pretty much as well as you might expect. Yes, that's sarcasm.

Over at Inside Health Policy, Dorothy Mills-Gregg has decided to check in on "Georgia Pathways," the Peach State's new program which partially expands Medicaid to residents earning up to 100% of the Federal Poverty Level (FPL), but with a rather significant string attached: Work reporting requirements:

As noted by Madeline Guth of the Kaiser Family Foundation last year: spite of nearly every state which tried to (or succeeded in) implement Medicaid work requirements having their programs shut down by the courts, one state's work/reporting managed to survive: Georgia. As explained in the Kaiser article:

In August 2022, a Federal District Court judge issued a decision in favor of the state, vacating CMS’s rescission thus reinstating these provisions. Although CMS generally reserves the right to withdraw waiver authorities at any time, the judge found that its rescission of Georgia’s waiver provisions was arbitrary and capricious due to agency errors, including that it failed to weigh that the waiver would have increased Medicaid coverage. CMS did not appeal this decision. Georgia Governor Brian Kemp allocated $52 million in his proposed state fiscal year (FY) 2024 budget to implement the Georgia Pathways program beginning July 1, 2023.

The key distinction between Georgia's waiver and every other state is that the other states were trying to impose work requirements on populations which they had already expanded Medicaid eligibility to. This would amount to something of a bait & switch. In addition, the court seems to reason that seeing how over 250,000 low-income Georgians caught in the Medicaid Gap don't have any viable healthcare coverage options at the moment (due, of course, to Georgia refusing to fully expand the program to them under the ACA), allowing some of them to gain Medicaid coverage, even with pointless/stupid work & reporting requirements attached, is better than not allowing them to enroll at all.

Georgia GOP Governor Brian Kemp originally claimed that as many as 345,000 residents would be eligible for the new program, but state Medicaid officials later estimated that the actual number would likely be closer to 64,000 or so.

Still, 64,000 more low-income, uninsured people receiving healthcare coverage is a good thing, right?

Well, yes. So, how's that actually working out for Georgia so far now that the program has been open for people to enroll for two months? According to Inside Health Policy:

Georgia’s partial Medicaid expansion program has enrolled 265 people since it began July 1, doing little to counter advocates’ complaints that work requirements are barriers to coverage and, as a Center for Budget and Policy Priorities report found last month, create a confusing, onerous system that’s only effective at kicking people off Medicaid. The CBPP report specifically calls out House Republicans for proposing to add a national Medicaid work requirement during the debt ceiling negotiations.

...just 265 Georgians were enrolled in the new program as of Aug. 17, Georgia’s Department of Community Health told Inside Health Policy.

Imagine that. And why is this the case? The article offers up several possibilities:

Beneficiary advocates say the surprisingly low number of enrollees is due to a combination of factors: poor advertising for the program mixed with proof of work that must be provided at signup while applications are submitted through an often-counterintuitive online portal and processed by staff who are also preoccupied with redetermining hundreds of post-pandemic renewals.

But wait, there's more!

But advocates note the number of enrollees could also decrease as beneficiaries must re-attest each month that they’re meeting Georgia Pathways’ work requirements. Enrollment might also take a hit when the state begins charging Pathway enrollees a premium in 2024.

Oh yeah...and just like what's been happening in Wisconsin for the past 9 years and what almost happened in Utah back in 2019, this pitiful partial expansion is actually costing Georgia taxpayers more per enrollee than it would if they just, you know, fully expanded Medicaid under the ACA:

CMS estimated in 2021 that Georgia would receive about $1.07 billion under the American Rescue Plan Act if it fully expanded Medicaid to 647,300 likely eligible residents. But the state’s decision to only partially expand Medicaid means the state will receive far less in federal assistance -- a federal matching rate per beneficiary of about 66% versus the 90% match promised to states that fully expand Medicaid.

“The lower matching rate for the Pathways program and forfeiting the ARPA dollars means that the state will be paying significantly more per person covered that it would under a full expansion. In fact, the cost to the state on a per capita basis in the first year of Pathways will be five times higher than the first year of full Medicaid expansion ($2,490 per person versus $496 per person, respectively),” says a June 2023 analysis from Georgetown University’s Center for Children and Families.

Amazing, isn't it? So much for "budgetary concern" opposition to ACA Medicaid expansion.