Georgia launches Medicaid expansion in closely monitored test of job requirements

ATLANTA (AP) Georgia is offering a new deal to some uninsured adults starting Saturday: Go to work or school and the state will cover you.

But advocates denounce the plan, which will insure far fewer people than a full-blown state Medicaid program, as unnecessarily restrictive and expensive.

The program is likely to be followed as closely as Republicans in Congress push to let states request work by some current Medicaid enrollees. Georgia would be the only state requiring Medicaid beneficiaries to meet a work requirement.

Democratic President Joe Biden’s administration is unlikely to approve the job requirements, but a future Republican president could, said Madeline Guth, a senior policy analyst at KFF, a nonprofit that studies health issues.

I think there will be a lot of eyes on Georgia, Guth said.

Georgia is one of the 10 remaining states which did not expand Medicaid eligibility to include individuals and families earning up to 138 percent of the federal poverty line, or $20,120 a year for a single person and $41,400 for a family of four.

Expanding Medicaid was a key part of President Barack Obama’s health care overhaul in 2010, but many Republicans fought it, including Georgia Governor Brian Kemp, a Republican.

Instead, Kemp is limiting expanded coverage to adults earning up to 100 percent of the poverty line $14,580 for a single person or $30,000 for a family of four. And coverage is only available if able-bodied adults document that they are working, volunteering, studying or in vocational rehabilitation for 80 hours a month.

It fits Kemp’s argument, as he seeks to distance his party from former President Donald Trump, that the GOP must show tangible conservative results for ordinary people.

In our state, we want more people covered at a lower cost with more options for patients, Kemp said in his state of the state address in January.

Those who earn the most will remain eligible for subsidized coverage, often at no extra cost, on the federal market. Kemp’s administration argues that commercial coverage is better because it pays providers more than the state-set Medicaid rates.

The Trump administration finally gave permission for 13 states to impose work requirements on some Medicaid beneficiaries. The Biden administration revoked all those exceptions in 2021, government work is not a primary purpose of Medicaid. But the Kemps administration won a federal court battle last year to preserve Georgia’s plan, in part because it applies to new enrollees and not current Medicaid recipients.

Caylee Noggle, commissioner of the Department of Community Health, told the Associated Press this week that Pathways to Coverage is a Georgia-specific approach that could insure up to 100,000 people in its first year.

But 100,000 is far fewer than the nearly 450,000 uninsured Georgians the Urban Institute estimates could get coverage with a full expansion of Medicaid.

Others say the nearly $118 million in state money, combined with another $229 million in federal money, isn’t enough to cover 100,000 people. The liberal-leaning Georgia Budget & Policy Institute estimates the funds will cover fewer than 50,000 people.

And state taxpayers will pay much more per person. Partly at the behest of Democratic Georgia Senator Raphael Warnock, the federal government is offering to pay 95% for a full Medicaid expansion for two years and 90% thereafter. Instead, by rejecting the federal largesse, Georgia will continue to pay the same 34.2 percent share of state funding for its existing Medicaid program and reject additional federal funding that has been promised.

The inappropriately named Pathways to Coverage will cost Georgia more money and cover fewer people than if the state simply joined 40 other states in expanding Medicaid, Warnock said in a statement to the AP.

While state politicians continue to play with people’s lives, Georgians are dying because they can’t afford the healthcare they need, he said.

Noggle and other Georgia officials say working, studying or volunteering leads to improved health, a key argument as to why such requirements should be part of a health insurance program.

But those who treat uninsured people say many are unable to work because they are in poor health.

The reason they have their challenges, that they can’t work, is because they have a mental illness or have a medical illness that is affecting their ability to do so, said Dr. Reed Pitre, an addictions psychiatrist and acting medical director. at the Mercy. Care, a federally funded non-profit organization in Atlanta.

Enrolling people in the new program is a priority for Mercy Care, Pitre said, noting that no one will qualify until one month after compliance with job requirements is established.

The Kemp administration expects the program to serve people in low-wage jobs who can’t afford employer insurance, as well as students. The state is also redefining eligibility for 2.4 million adults and children now covered by Medicaid.

Georgia has been delaying decisions about people it deems ineligible for regular Medicaid but who could transfer to the Pathways program, Noggle said.

Either way, once people join the new program, they’ll need to meet activity requirements or lose coverage starting the next month, which could impact thousands of people. When Arkansas imposed work requirements in 2018 for some adults, more than 18,000 people lost coverage in less than a year.

Georgia will be different, Noggle argued. Recipients will only need to certify that they meet the activity requirements for the first six months of the year.

I think we will make it as easy as possible for our members to verify their eligibility, he said.

But only time will tell. Kemp’s expansion plan in Georgia could provide a model for other states and other Republicans looking to demand more from those on Medicaid.

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This story was updated to correct that Medicaid recipients must certify the work requirement for six months, not three, and to reflect that the name of the healthcare nonprofit is KFF, not the Kaiser Family Foundation.