Georgia’s Experience Raises Red Flags for Medicaid Work Requirement

Introduction to Medicaid Work Requirements

ATLANTA (AP) — Georgia’s experiment with a work requirement for Medicaid offers a test of a similar mandate Republicans in Congress want to implement nationally, and advocates say the results so far should serve as a warning.

Georgia’s Medicaid Program

Just days shy of its two-year anniversary, the Georgia Medicaid program is providing health coverage to about 7,500 low-income residents, up from 4,300 in the first year, but far fewer than the estimated 240,000 people who could qualify. The state had predicted at least 25,000 enrollees in the first year and nearly 50,000 in the second year.

Applicants and beneficiaries have faced technical glitches and found it nearly impossible at times to reach staff for help, despite more than $50 million in federal and state spending on computer software and administration. The program, dubbed Georgia Pathways, had a backlog of more than 16,000 applications 14 months after its July 2023 launch, according to a renewal application Georgia submitted to the Trump administration in April.

Challenges in the Program

“The data on the Pathways program speaks for itself,” said Laura Colbert, executive director of Georgians for a Healthy Future, an advocacy group that has called for a broader expansion of Medicaid without work requirements. “There are just so many hurdles at every step of the way that it’s just a really difficult program for people to enroll in and then to stay enrolled in too.”

Georgia’s Rules

A tax and spending bill backed by President Donald Trump and Republican lawmakers that passed the U.S. House in May would require many able-bodied Medicaid enrollees under 65 to show that they work, volunteer or go to school. The bill is now in the Senate, where Republicans want significant changes.
Pathways requires beneficiaries to perform 80 hours a month of work, volunteer activity, schooling or vocational rehabilitation. It’s the only Medicaid program in the nation with a work requirement.
But Georgia recently stopped checking each month whether beneficiaries were meeting the mandate.
Colbert and other advocates view that as evidence that state staff was overburdened with reviewing proof-of-work documents.

Georgia’s Governor Defends Pathways

The governor’s office defended the enrollment numbers. Kemp spokesman Garrison Douglas said the early projections for Pathways were made in 2019, when the state had a much larger pool of uninsured residents who could qualify for the program.
In a statement, Douglas credited the Republican governor with bringing that number down significantly through “historic job growth,” and said the decline in uninsured residents proved “the governor’s plan to address our healthcare needs is working.”
FILE – Georgia Gov. Brian Kemp delivers the State of the State speech, Jan. 11, 2024, in Atlanta. (AP Photo/Brynn Anderson, File)

The Human Impact

For BeShea Terry, Pathways was a “godsend.” After going without insurance for more than a year, Terry, 51, said Pathways allowed her to get a mammogram and other screening tests. Terry touts Pathways in a video on the program’s website.
But in a phone interview with The Associated Press, she said she also experienced problems. Numerous times, she received erroneous messages that she hadn’t uploaded proof of her work hours. Then in December, her coverage was abruptly canceled — a mistake that took months of calls to a caseworker and visits to a state office to resolve, she said.
This undated photo provided by BeShea Terry shows a selfie of BeShea Terry in Americus, Ga. (BeShea Terry via AP)

Concerns and Criticisms

Health advocates say many low-income Americans may not have the time or resources. They are often struggling with food and housing needs. They are also more likely to have limited access to the internet and work informal jobs that don’t produce pay stubs.
Republican lawmakers have promoted work requirements as a way to boost employment, but most Medicaid recipients already work, and the vast majority who don’t are in school, caring for someone, or sick or disabled.

The Arkansas Experiment

That’s a contrast with Arkansas, where 18,000 people were pushed off Medicaid within the first seven months of a 2018 work mandate that applied to some existing beneficiaries. A federal judge later blocked the requirement.
The bill that passed the U.S. House would likely cause an estimated 5.2 million people to lose health coverage, according to an analysis from the nonpartisan Congressional Budget Office released Wednesday.

Conclusion

Georgia’s experience with Medicaid work requirements raises significant red flags. The program’s low enrollment numbers, technical glitches, and administrative burdens all point to a flawed approach that prioritizes bureaucracy over patient care. As Congress considers a national Medicaid work requirement, lawmakers would do well to heed the warnings from Georgia’s experiment and prioritize a more comprehensive and compassionate approach to healthcare.

FAQs

Q: What is the Georgia Pathways program?
A: Georgia Pathways is a Medicaid program that requires beneficiaries to perform 80 hours a month of work, volunteer activity, schooling or vocational rehabilitation in order to receive health coverage.
Q: How many people are currently enrolled in the Georgia Pathways program?
A: Approximately 7,500 low-income residents are currently enrolled in the program.
Q: What are some of the challenges faced by applicants and beneficiaries of the program?
A: Technical glitches, difficulty reaching staff for help, and a backlog of applications are some of the challenges faced by applicants and beneficiaries.
Q: How does the Georgia Pathways program compare to other Medicaid work requirement programs?
A: Georgia’s program is the only Medicaid program in the nation with a work requirement, and its low enrollment numbers and administrative burdens have raised concerns about the effectiveness of such programs.
Q: What is the potential impact of a national Medicaid work requirement on healthcare coverage?
A: According to an analysis from the nonpartisan Congressional Budget Office, a national Medicaid work requirement could cause an estimated 5.2 million people to lose health coverage.