Georgia: How's that partial Medicaid expansion program with work requirements doing these days anyway? Ummmm...

Mon, 01/22/2024 - 10:57pm

Back in September, Inside Health Policy reporter Dorothy Mills-Gregg checked 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:

...in 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, as of mid-August 2023, two months in, a whopping 265 Georgians had actually enrolled in the program.

Huh.

The good news is that a couple of months later, in early November, the enrollment tally had climbed significantly. The bad news is that it had still only reached around 1,800 people, according to the Georgetown University McCourt School of Public Policy.

As Leonardo Cuello of Georgetown noted:

So, first, individuals who fail to report and document sufficient hours in any month (even, for example, someone with variable job hours) are suspended the next month – their health coverage completely stops. This means that many individuals will cycle on and off coverage, based on whether they are able to report and document enough hours every month. This isn’t a three-strikes policy such as Arkansas had – it’s one strike and you’re out. This policy will be devastating to enrollment and continuity of care in Georgia Pathways and will create an incredible amount of administrative hassle for individuals, providers, and state staff. Georgians won’t get far on this “Pathway” lined with red tape.

Second, of course, the strict requirements on documentation will lead to many reporting failures. Consider, for example, individuals who have informal employment arrangements or are self-employed. While the state does offer some good cause exceptions, they are time-limited and also almost always require submitting documentation. So this too will be a failure point.

Finally, as we have discussed from the outset, one of the most harmful and anti-family features of the Pathways model is that, unlike every work requirement proposal before it, there is no exemption of any kind for parents or caregivers. Parents will have to choose between taking care of their children or having health insurance – a terrible situation for parents and children alike.

Anyway, I just posted an entry about North Carolina, which fully expanded Medicaid starting December 1st, newly enrolling over 314,000 people into the program in just the first 43 days, and since North Carolina and Georgia both have roughly the same total population (around 10.5 million each), I decided to take a look at Georgia's latest "Pathways" numbers to see how they're doing by comparison: