Gov. Brian Kemp is open to considering changes to his Medicaid waiver program — Georgia Pathways to Coverage — as his administration prepares to request its renewal to the federal government upon its planned expiration in 2025, his office said.
State legislators weighed in on the program this week during the Biennial Institute, a training seminar for new and returning lawmakers held at the University of Georgia in Athens. Both Democrats and Republicans said they would like to broaden the eligibility for Georgians to enroll.
Under the current Pathways requirements, adults making below the federal poverty line can qualify to receive Medicaid if they work at least 80 hours per month, attend a technical college or perform another state-approved activity.
State Sen. Sally Harrell, D-Atlanta, said that Pathways’ work requirement hinders caregivers whose work does not qualify as employment under the current rules of the program, which provides health care coverage for low-income children and some adults.
“We have caretakers throughout the state who do a lot of uncompensated work,” she said. “The person who’s staying at home and taking care of her mother with dementia and maybe even having small children — how does that work fit into the work requirements?”
State Rep. Mark Newton of Augusta and state Sen. Chuck Hufstetler of Rome, both Republicans, said they were open to discussing the idea of including caregiving as recognized work under the Pathways program.
Garrison Douglas, a spokesperson for Kemp, said the governor’s office is “continually looking at the program to see where we can streamline it and make it more accessible to people.”
Because the program is administered under a federal waiver, the state has to get special permission for its exceptions. Official changes can only be made by the governor’s office in partnership with the state’s Department of Community Health, Douglas said. The Centers for Medicare & Medicaid Services have to approve the requested changes and allow a comment period for the public.
The Legislature has limited authority to formally change the program, but members could propose a resolution to signal their support. A commission appointed by Kemp and leaders in the Legislature is also studying how Medicaid is accessed in Georgia.
“It’s unfortunate that caretakers were forgotten in the first place,” Harrell said, and she would be interested in leading a bipartisan effort.
Pathways’ work requirements have been criticized by President Joe Biden’s administration as not aligning with the mission of the federal benefit and are more cumbersome to enforce. And for some, medical conditions prevent them from being able to work traditional jobs.
In theory, disabled poor people should be able to get Medicaid, but patient advocates say the approval process for disability benefits is deeply flawed, leaves many patients out and can take years for approval.
However, state officials believe the requirement that recipients find work will be more welcome in President-elect Donald Trump’s administration.
“Work requirements are considered to be the most politically palatable of most of these Medicaid changes,” said Caylee Noggle, the president and CEO of the Georgia Hospital Association. In fact, she said Georgia’s plan could be a national model, which would have a greater impact on the 40 states that have already expanded Medicaid. Georgia is one of 10 that has not.
Pathways has faced challenges, attracting just 4,500 uninsured applicants out of an estimated 240,000 eligible Georgians. More than 90% of the program’s $26 million cost has gone toward administrative and consulting fees.
Republicans have been critical of expanding Medicaid for multiple reasons, including that the rates physicians are paid are low compared with commercial insurance rates.
They’ve signaled more interest about another plan, piloted in Arkansas, where the state used federal expansion dollars to buy plans for people with lower incomes on the health insurance marketplace.
Democrats had hoped to tie Medicaid expansion to a bill the Legislature passed loosening restrictions on establishing new hospitals. Instead, lawmakers pushed the conversation to a study commission, which began meeting earlier this year.
The Comprehensive Health Coverage Commission, which will meet over the course of the next two years, released its first report Dec. 1. In it, commission members suggested several topics to continue exploring, including making sure children have uninterrupted coverage until age 6 and providing coverage to Georgians with HIV before the virus progresses to AIDS.
Noggle, who chairs the commission, also said that she expects to see changes to the federal medical assistance percentage. Currently the federal government pays about 65% and states pay about 35% for the expansion population. Noggle said she thinks Trump may look to cut federal payments to states, allowing him to renew tax cuts delivered under his first administration. He needs $4.6 trillion to do that.
“There is a lot of conversation about that changing and coming way back down,” she said.
Given the politics, Noggle expects the discussion to continue.
“There are too many states that supported President-elect Trump that have also expanded Medicaid for there not to be a healthy debate around this,” Noggle said.
Natalie Crawford, executive director of Georgia First, which supports Medicaid expansion, said she is encouraged by the commission’s report.
“But we continue to believe it’s time for Georgia to close the coverage gap and maximize our federal tax dollars available by expanding Medicaid coverage,” she said. “This is a missed opportunity to enhance access to affordable coverage that will yield a positive economic impact for our state.”
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