U.S. Senators Jon Ossoff and Raphael Warnock and Senate Finance Committee Chair Ron Wyden are demanding a federal probe of what they called “waste and mismanagement” in Georgia Pathways to Coverage, the state’s limited Medicaid expansion for state residents.
The senators cite the program’s high cost to launch and its low enrollment numbers so far. In a letter requesting the probe, they add that the program has created “barriers to health care coverage ... either because of inherent design failure or mismanagement by state administrators.”
Medicaid is the state-federal health insurance for the poor children in Georgia, and some poor adults including elderly nursing home residents. Pathways added eligibility for poor adults who work at least 80 hours a month or perform some other state-approved activity, like volunteering at a nonprofit.
At the end of its first full year of operation in June 2024, Pathways was insuring 4,231 Georgians with Medicaid, out of about 240,000 that may be eligible, according to state figures. A spokeswoman for the Department of Community Health said Pathways enrollment is currently 5,903 and overall in the course of the program more than 2,000 additional people were enrolled but left: a sign they had successfully progressed to private sector insurance.
Reported enrollment has been far lower than Governor Brian Kemp’s office had predicted before the program launched.
The program is currently the only one in the nation that includes work requirements in exchange for Medicaid, and with the incoming second Trump administration, Pathways is now being watched by other states interested in work requirements under a White House that views such requirements more favorably.
“While hundreds of thousands of Georgians are left without the health coverage they need, taxpayer dollars are being routed into the pockets of eligibility system vendors and consultants,” the senators wrote, in a letter requesting that the Government Accountability Office probe both state and federal burdens posed by Pathways.
“This analysis is crucial to understand the impact administering Pathways has on federal and state spending, as well as the barriers to health care coverage Pathways has created either because of inherent design failure or mismanagement by state administrators,” the letter said.
The program cost more than $40 million in state and federal tax dollars, with nearly 80% of that going toward administration and consulting fees rather than paying for medical care, according to KFF Health News. In addition, the state has recently put another $10.7 million into advertising it to boost awareness.
A spokesman for Kemp, Garrison Douglas, said the state is working on ways to streamline and improve Pathways.
But he said the senators should pay attention to failures in the federal government instead, pointing to problems with the post office and long delays for people to get federally declared disabled, which also delays their ability to claim Georgia Medicaid.
“The Senators should be more focused on examining the failures of the federal government to adequately provide the services they’re required to administer than looking for every opportunity to criticize states that are taking innovative approaches to providing health care to their people,” Douglas said.
Douglas also noted that by refusing to expand Medicaid to the broad population as other states have, there is a slice of Georgians just above the federal poverty level who are allowed to seek private health plans on the federal Affordable Care Act exchange. With temporary “enhanced subsidies” enacted under the Biden administration making many of those plans virtually free, those ACA enrollees have jumped by about 700,000.
Douglas pointed out that Georgia’s goal is fundamentally different than the goal of simply putting people on Medicaid. He said the goal in Georgia is to help get people into a situation where they can start to work and grow a path to a better life, which would get them off Medicaid and into a job with private insurance.
“Our goal is not to have 30,000, 50,000, 100,000 people just sitting on Pathways for years,” Douglas said. “The goal is for people to be able to get access to Pathways, apply, receive that coverage, and be able to eventually take that next step” of receiving employer-sponsored insurance or buying a private plan on the ACA exchange.
Kemp and his aides have also said that during Pathways’ first year they were hamstrung by other pandemic-related Medicaid work that overwhelmed their staff. They have since launched a $10.7 million advertising campaign to try to send a clear message to the public that Pathways is an option.
The Department of Community Health estimates that 240,000 Georgians could be eligible for Pathways. Those are people who are adults below 65 who earn under the federal poverty level.
Trump aides worked with Kemp’s office as they developed Pathways, and Trump’s director of the Centers for Medicare and Medicaid Services announced its approval in a celebratory visit to Georgia. Trump’s first administration helped guide and approved the program, whereas the Biden administration delayed it.
Pathways was meant to address Georgia’s lack of coverage among poor adults, which helps keep Georgia’s overall uninsured rate among the three worst in the country. Forty other states have expanded Medicaid to all their poor adults under the Affordable Care Act, with the federal government paying 90% of those costs.
Instead of doing that, Georgia offered it to all those who perform at least 80 hours a month of work or other specified activities including volunteering for a registered nonprofit, or certain types of education. Activities that don’t qualify include caretaking for one’s own children or elderly relatives. Patient advocates have said that a major barrier is simply the paperwork itself, as well as the changeability of income and employment status among people who make very little money, that may put them back and forth over eligibility lines.
Credit: TNS
Credit: TNS
EDITOR’S NOTE: A sub-headline in this story has been corrected to note that fewer than 6,000 people are currently enrolled in the Pathways program.
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