In the state of Georgia, an experimental Medicaid program is serving as a real-world trial for a similar work requirement that Republicans in Congress aim to expand on a national level. However, consumer advocates are raising alarms over its current performance and suggesting that it should act as a cautionary lesson.
Currently, as it approaches its second anniversary, Georgia’s Medicaid initiative covers about 7,500 residents from low-income brackets, an increase from the 4,300 it served in its initial year. Yet, this is a far cry from the estimated 240,000 who could be eligible. Initial predictions estimated that 25,000 individuals would be enrolled by the end of year one, with this number expected to reach 50,000 by the second year.
Enrollees and applicants have encountered numerous technological problems, ranging from system glitches to extended wait times when trying to get assistance from staff. Despite significant investment—more than $50 million—from both federal and state budgets on computer systems and administration, the Georgia Pathways program still struggled with a backlog of over 16,000 applications a full 14 months after its launch in July 2023.
Laura Colbert, who heads the advocacy group Georgians for a Healthy Future, argues that the challenges encountered in the program are numerous. She remarks, “The data on the Pathways program speaks for itself. There are just so many hurdles at every step that it’s just a really difficult program for people to enroll in and then to stay enrolled in too.”
In terms of state regulations, Georgia’s Medicaid initiative includes a mandate requiring beneficiaries to commit to 80 hours per month of work, education, volunteering, or vocational training. This makes it the only Medicaid program across the United States to implement such a requirement. However, recent changes mean the state is no longer checking monthly compliance with this mandate.
Colbert and other proponents interpret this shift as an indication that the state’s resources were overextended, struggling to manage the review workload of verifying proof-of-work documents. Nevertheless, Fiona Roberts, speaking for Georgia’s Department of Community Health, mentioned that Governor Brian Kemp has required state bodies to relentlessly pursue enhanced efficiency and accessibility in government services.
In defense of the program, Garrison Douglas, a spokesperson for Governor Kemp, said the projections for the Pathways initiative were initially made in the year 2019, a period when more residents were uninsured. He credited the governor for significantly reducing this number through what he described as “historic job growth.”
For program participant BeShea Terry, Georgia Pathways was a “godsend” after a year without health insurance. She was able to obtain important screening tests thanks to the program. Nevertheless, Terry faced issues such as receiving incorrect notifications about incomplete work documentation and suffering an abrupt cancellation of coverage, which took months to redress.
Many health advocates argue that people living in low-income scenarios often face pressing concerns such as food and shelter insecurity. They also might have limited internet access and work in informal or unsteady jobs that do not provide traditional pay stubs, presenting additional difficulties in navigating such programs.
Republican legislators have promoted work requirements as a measure to enhance employment rates, despite analysis showing most Medicaid recipients are already employed, or otherwise occupied by education, caregiving, sickness, or disability.
Advocating for Pathways, Kemp’s administration purports that the initiative serves as a transition for individuals to move toward private healthcare options. Reportedly, over 1,000 enrollees have left the scheme because they have shifted to private insurance owing to increased income levels.
Following a slow start, promotional efforts and outreach for the Pathways initiative have intensified throughout the past year. For example, at a job fair in Atlanta, stakeholders provided information and promotional materials about the program, garnering interest from attendees.
Unlike a similar scheme in Arkansas, Georgia implemented the work requirement solely on new beneficiaries. This means no one has lost coverage under Georgia’s rules due to the mandate. Previously, in Arkansas, the introduction of a work mandate in 2018 resulted in 18,000 people losing Medicaid coverage within a mere seven months, although a federal judge later overruled this requirement.
An analysis conducted by the nonpartisan Congressional Budget Office proposes that a nationwide rollout of such work mandates could lead to approximately 5.2 million people losing healthcare coverage.
In Arkansas, efforts are being made to revive work mandates, yet lawmakers propose more lenient reporting measures. They aim to utilize current data to identify individuals not meeting employment or community engagement goals and to connect them with coaching resources before deciding on coverage suspension.
At least 10 states are considering work requirements for their Medicaid programs, separate from the federal legislative initiative. Arkansas state leadership wants to engage more deeply with beneficiaries, exploring their unique challenges and goals to promote a healthier, self-sufficient population.