by Staff Writer | Dec 23, 2022 | Capitol Beat News Service
ATLANTA – After years of legal wrangling, the countdown to the July 1, 2023, launch date of Georgia’s Medicaid work requirements program is underway.
The new plan – officially called Pathways to Coverage – will require enrollees to complete 80 hours of work, education, job training, or community service per month to get Medicaid health insurance. Many will also have to pay a monthly premium.
Once the program begins, Georgia will be the sole state with work requirements for Medicaid. Adults between ages 18 and 64 who earn less than 100% of the federal poverty level – and who are not otherwise eligible for Medicaid – are the targeted group. For 2022, the federal poverty level was $13,590 for a single person and $27,750 for a family of four.
Though exact numbers are difficult to calculate, it’s expected that the Pathways program will provide insurance to only a small percentage of the 1.3 million Georgians without health insurance.
State officials estimate around 345,000 Georgians would be eligible for the new program. Back in 2020, they said they expected only about 64,000 people to actually enroll in the program.
Now that the program is becoming a reality, the Georgia Department of Community Health (DCH), the state Medicaid agency, has requested funds to cover up to 100,000 people in the upcoming budget, said spokesman David Graves. That’s 29% of those who will be eligible.
“Georgia leadership has put in place barriers that they know, that they have calculated, will prevent … people from enrolling,” said Leonardo Cuello, research professor at Georgetown University’s Center for Children and Families, about the discrepancy between the number of eligible people and the number expected to enroll.
Critics of Pathways contend the program will cover far fewer Georgians and cost more than a full expansion of Medicaid, as 39 states have done.
Leah Chan, senior health analyst at the Georgia Budget and Policy Institute, a left-leaning think tank in Atlanta, said the new program will cost around $2,420 per enrollee while it would cost only $496 per enrollee if the state fully expanded Medicaid.
“New financial incentives under the American Rescue Plan sweeten the deal [for full Medicaid expansion] and more than offset the state cost of expansion for at least the first two years,” Chan said.
Enrollees in Georgia Pathways will need to certify their employment each month. Those who earn more than 50% of the federal poverty level will also be required to pay a monthly premium ranging from $7 to $11, with an additional surcharge for people who use tobacco products.
The program will provide a two-month grace period for people who do not pay their premiums. But after three months of non-payment, they will lose the insurance. They can be reinstated if they make at least one monthly payment within 90 days.
The state plans to use the existing benefits portal, Georgia Gateway, for program applicants to manage their work-requirement reporting, said Graves, the DCH spokesperson. He said Georgians can expect to learn more about the details of the program over the coming months.
Critics say the machinery necessary to track enrollee work records and payments will dramatically increase bureaucratic burdens both for Medicaid recipients and the state.
“When you think about working families in Georgia, they are busy with their jobs, getting kids to school and the doctor, paying the stack of bills that come in every month, and the last thing they need is additional red tape … every month just to keep their health insurance from getting terminated,” Cuello said.
Cuello said the state will have to develop “expensive administrative processes” to ensure compliance with the work requirements. The [congressional Government Accountability Office] and states have estimated costs ranging from $70 million to $270 million a year to implement and run this type of program, he said.
DCH has not yet decided whether it will need to hire additional staff to help run the program, Graves said.
The Pathways program allows some exceptions to the work-requirement rules. Enrollees will be allowed 120 hours of “non-compliance,” that is of not meeting the work requirements, in every 12-month period.
But routine child care is not on the list of exceptions. Other states that previously attempted work requirements ensured that caring for young children was a valid reason for not meeting the requirements and would not result in losing insurance.
“A stay-at-home parent taking care of two young kids in a family that lives at half of the poverty level … can’t afford child care, and they can’t just leave two young kids at home alone,” Cuello said. “Georgia’s plan makes no exceptions for these parents, and they will be denied health insurance.”
The plan has federal approval to operate until Sept. 30, 2025.
This story is available through a news partnership with Capitol Beat News Service, a project of the Georgia Press Educational Foundation.
by Ty Tagami | Sep 25, 2025 | Capitol Beat News Service
ATLANTA — Georgia’s unique approach to Medicaid was set to expire this month, but the state just got a one-year extension from the federal government.
The Pathways to Coverage program, which requires recipients to prove that they work, volunteer or take classes 80 hours a month, will now run through 2026, with modifications intended to increase the number of people who are covered.
As of May, 23 months into the program, there were 7,463 enrolled, well short of the state’s initial projections of 47,000, the Center for Medicare & Medicaid Services observed in its extension notice to the Georgia Department of Community Health Tuesday.
To “streamline” compliance and expand coverage, Gov. Brian Kemp’s administration asked for and received permission to amend the program. Rather than requiring recipients to report monthly about their work and other qualifying activities, they will report annually.
And two new qualifying categories were added: parents of children under age 6 do not have to work or engage in other activities if the child is enrolled in Medicaid; and childless, able-bodied adults can meet the requirements by complying with other programs, including the Supplemental Nutrition Assistance Program.
Kemp’s office said the extension “further validates” Georgia’s approach to Medicaid, which will soon be a requirement in every state under new federal law.
A recent report by the U.S. Government Accountability Office found that Georgia spent two-thirds of implementation costs on administration rather than on medical assistance, with more than half of the $80 million going to contractors.
Kemp blamed the administration of then-President Joe Biden for driving up costs by obstructing implementation. Kemp praised President Donald Trump.
“Unlike the previous administration which chose to sue, obstruct, and delay, President Trump and his team have worked alongside us to improve Georgia Pathways and ultimately deliver a better program to Georgians who need it most,” Kemp said in a statement Thursday. “We look forward to continuing that partnership in the months ahead.”
by Ty Tagami | Sep 18, 2025 | Capitol Beat News Service
ATLANTA — A federal review of Georgia’s unique implementation of Medicaid found that two-thirds of the money went to administrative overhead rather than to medical assistance.
The report from the U.S. Government Accountability Office also found that more than half of the $80 million spent on the program since 2021 went to contractors who helped the state overhaul its eligibility and enrollment system.
Georgia’s Pathways to Coverage demonstration project needed the overhaul because of the state’s work requirement. All applicants must prove they spent 80 hours working, attending college or doing community service during the month before applying.
They must continue those activities to stay insured.
A law passed by Congress this year makes other states impose similar work requirements.
The new GAO review was requested by four Democrats in the U.S. Senate, including Georgia Sens. Raphael Warnock and Jon Ossoff. They oppose the work requirements.
Warnock’s office released the report Thursday.
In a briefing with reporters, a Warnock staffer criticized the lower-than-advertised program enrollment. There were about 7,500 Georgians insured by Pathways in May, the review said, far below the 25,000 Georgia had projected for the first year.
“This program is here to kick people off their health insurance,” said the Warnock staffer, who asked not to be identified.
The Pathways program technically started in 2021, but it did not get off the ground until 2023.
That pause likely drove up administrative costs, said the review.
Georgia’s Republican governor, Brian Kemp, blames the administration of former President Joe Biden, a Democrat, for that pause. Kemp’s office said the Biden administration “put up roadblocks at every turn” to stop Pathways.
“Democrats like Senators Ossoff and Warnock are trying to rewrite history after four years of inaction and blame the State for costs associated with their own stonewalling,” Kemp’s office said in an emailed statement.
Georgia is applying to extend the program another five years. The state estimates it can enroll at least 18,000 in the first year of extension, increasing that to more than 30,000 by year five.
The federal government has budgeted $400 million for administrative costs to implement the same kind of work requirements in states across the country.
by Dave Williams | Jul 11, 2025 | Capitol Beat News Service
ATLANTA – When Congress passed President Donald Trump’s controversial budget bill July 3, Republicans and Democrats went to their corners to portray it either as the largest tax cut in U.S. history or a devastating gutting of the nation’s safety net.
But beyond the politics, Georgia health-care and clean-energy advocates warned that cuts to Medicaid, the Affordable Care Act (ACA), and food stamps, as well as the phasing out of clean-energy tax credits will hurt low- and middle-income Georgians in exchange for easing the tax burden on the wealthy who don’t need such government largesse.
“It’s the largest cut ever, and it moves us in the wrong direction,” said Monte Veazey, president and CEO of the Georgia Alliance of Community Hospitals. “It’s a moral failure that hurts everyone who depends on our health-care system.”
The bill’s cuts to health care will kick about 93,000 Georgians off of Medicaid and raise health-insurance premiums for more than 1.2 million Georgians, according to numbers released by U.S. Sen. Raphael Warnock, D-Ga. More than 120,000 Georgia children will lose some or all food assistance, according to Warnock.
Veazey said rural Georgia will be hit particularly hard, with 16 cash-strapped rural hospitals facing potential closure and others being forced to reduce services they offer that lose money.
“For every Medicaid patient we serve, we lose about 17 cents on the dollar,” he said. “This is going to grow that number. It’s going to be difficult for people to access the health-care system.”
Advocates for low-income Georgians and children said the federal cuts will shift the cost of paying for health insurance and food to states.
Georgia will have a couple of choices, they said: dig into its own treasury to fill the void or cut services.
State cutbacks to the ACA, Medicaid, and SNAP (the food stamps program) could be achieved by introducing more administrative requirements, they said, something the federal government is already imposing.
Identity “proofing” challenges with ACA “mean that many folks just won’t enroll because of administrative burdens,” said Whitney Griggs, director of health policy for Georgians for a Healthy Future.
Work requirements and direct cuts will cost Georgia $10 billion in Medicaid funding over the next decade, said Leah Chan, director of health justice for the Georgia Budget & Policy Institute.
SNAP cuts will also hit the state, said Ife Finch Floyd, the Georgia Budget & Policy Institute’s director of economic justice.
The federal government historically has covered the full cost of SNAP, but the new budget bill changed that by requiring states to pay a percentage of their cost if they have an unacceptable payment “error rate,” meaning inaccurate eligibility roles, Chan said.
“This is unprecedented, and this is a fundamental change in the structure of the SNAP program,” she said.
In a few years, states with an error rate of 6% or more will have to pay 5% to 15% of their program benefit costs, Chan said, noting that in Georgia, 5% is equal to $162 million.
It also will become harder for Georgians to qualify for SNAP with the new federal work requirements. Currently, people ages 18-54 without children or a qualifying disability must prove they are working 80 hours a month to receive benefits. The federal cuts extend that to age 64 and will require parents of kids ages 14-17 to hold a job.
The phasing out of clean-energy tax credits will do tremendous damage to fast-growing renewable energy and electric vehicle operations across Georgia, said Sen. Jon Ossoff, D-Ga. The massive EV plant Hyundai opened in March west of Savannah in Bryan County is the largest economic development project in the state’s history.
“The renewable sector, solar manufacturing, battery production, electric vehicle manufacturing will all be hurt,” Ossoff said. “This bill is a direct attack on the industry that is driving Georgia’s economic development, job creation, and wealth creation.”
The same goes for the state’s solar energy industry, added Hannah Shultz, program director at the nonprofit Georgia Interfaith Power and Light.
“Solar tax incentives have allowed over a dozen faith communities in the last several years to build resilience, reduce their electric costs, and reinvest savings into vital mission and ministry initiatives in service to their communities,” she said. “It is incredibly disheartening to see partisan politics take precedence over real impacts to people and our planet.”
While most of the reaction to the budget bill has come from critics decrying the various spending cuts, one group that stands to benefit from the legislation is farmers.
Georgia Commissioner of Agriculture Tyler Harper said prices of farm inputs have increased by 30% in the last half dozen years. Nationally, the bill invests an additional $60 billion in farm programs.
“It helps agriculture across the board,” Harper said. “Investment in farm programs … is a success for all farms regardless of size.”
Even taxpayer advocates are criticizing the bill because of its impact on the nation’s growing debt. Nearly $4.5 trillion in tax cuts nationwide are projected to add a net $3.24 trillion to the red ink.
“Congress has officially lost its mind when it comes to fiscal responsibility,” said Steve Ellis, president of Taxpayers for Common Sense. “The One Big Beautiful Bill Act is a really ugly, scary, ticking debt bomb.”
But Kyle Wingfield, president and CEO of the Georgia Public Policy Foundation, said the bill’s tax cuts simply make permanent the lower tax rates Congress enacted early in Trump’s first term in the White House. Without the bill, those 2017 tax cuts would have expired, leading to a major tax increase, Wingfield said.
Wingfield disputed claims by opponents that the measure only benefits the wealthy.
“It’s all the brackets all the way up and down,” he said. “The bulk of the tax money that gets cut goes to the middle class because there are so many middle-class taxpayers.”
The work requirement in the bill for Medicaid recipients has been widely criticized since many face significant barriers to employment including health problems and child-care duties.
But Wingfield said the legislation could give able-bodied recipients the incentive they need to find a job.
“Far from being a punitive or harmful policy, this could end up helping people be in a better position,” he said.
Staff writer Ty Tagami contributed to this report.
by Ty Tagami | May 2, 2025 | Capitol Beat News Service
ATLANTA – The future oversight over Georgia’s multi-billion-dollar Medicaid program is in limbo as companies battle over new management contracts after a lengthy bidding process.
The medical safety net covered 2.5 million children, pregnant woman, low-income adults, seniors and people with disabilities in Georgia last year.
The program totals $17 billion, with $5 billion from the state and the rest mostly from the federal government. The total is slated to rise to nearly $18 billion next year in the budget that lawmakers sent to Gov. Brian Kemp last month.
Georgia used to manage the Medicaid program directly, but about two decades ago the state decided to contract out the work. There have been tweaks along the way, with more companies added through competitive bidding. Then, more than two years ago, the Kemp administration initiated another competitive bid, and it could result in a major overhaul.
Two of the three incumbents — Amerigroup and Peach State Health Plan — lost.
Incumbent CareSource won a new contract, along with three newcomers: Humana Employers Health Plan of Georgia, Molina Health Care of Georgia and UnitedHealthcare of Georgia.
The change is prompting concern among doctors and other medical providers, who worry about service disruptions when their patients must enroll with one of the new management companies.
They remember what happened last year when Medicaid recipients had to undergo eligibility redeterminations after the requirement was waived during the COVID-19 pandemic. Nearly 300,000 lost coverage after enrollment peaked at more than 2.8 million in 2023.
Steven Miracle, CEO of Georgia Mountains Health Services, a non-profit in Blue Ridge with a large Medicaid clientele, thinks the new contracts will have a similar effect as his patients are forced to enroll with a different company.
“If they don’t have the information or if they aren’t able to access the technology that will allow them to sign up or if somehow, some way they miss the deadline, then there will be people who believe that they have insurance coverage that in fact don’t,” Miracle said. “People don’t pay attention, so they’re not going to be aware that that they have to re-enroll.”
Miracle’s organization is among three dozen represented by the Georgia Primary Care Association. Albert Grandy, Jr., the association’s president, drafted an open letter to Georgians in March on behalf of those organizations.
“This shift introduces a heightened risk of disruption to critical health-care services, particularly for those who depend on continuity of care to manage chronic conditions, access mental health services, or receive specialized treatments,” Grandy wrote, adding that colleagues across the state were finding it difficult to negotiate contracts with the new insurers, leaving thousands of patients unclear about whether they could continue with their current medical providers.
“These changes could have devastating consequences for patients. Delays in care, denied claims, and lapses in coverage are not just administrative headaches — they are life-threatening issues for many. Our most vulnerable populations — children in foster care, individuals with disabilities, pregnant women and seniors — cannot afford to fall through the cracks of an uncertain system,” wrote Grandy, CEO of Curtis V. Cooper Primary Health Care in Savannah.
In an interview this week, Grandy said the state might automatically assign existing Medicaid patients to one of the new insurers if they fail to enroll themselves.
So, they would still be insured, but they might find that their current doctors are out of network, he said, adding that labs, radiologists and other specialists might also be out of network and thus inaccessible.
Dr. Samantha D. Manderson, an obstetrician-gynecologist in Cordele, said patients in rural areas could find it particularly difficult to locate new providers.
“I’m especially concerned about expectant mothers who will be forced to change doctors mid-pregnancy,” she said through a spokeswoman. “Many of my rural patients would not have other options close by and would have to travel just to get the care they need, potentially delaying life-saving care.”
After the winning bids were selected, the Georgia Department of Administrative Services initiated what’s known as a protest period, during which the public can raise concerns about the pending contracts.
Kimberly Oviedo, an audiologist in Acworth, sent an email to the agency on March 10 that is among the hundreds of protest-related documents on file. She was concerned about the lengthy process that medical offices must go through to ensure their staff can be reimbursed for service.
UnitedHealthcare was non-responsive, she wrote.
“We were able to start credentialing with Molina Health, Humana, and CareSource. However, UHC says they have no idea of what the contract is that they won in GA,” Oviedo wrote. “We can’t get through to anyone with UHC to start the process. This is alarming as this is one of the largest bids won in GA.”
In an interview this week, nearly two months after she sent that email, Oviedo said she still hadn’t gotten through to UnitedHealthcare.
She said she had an initial email exchange with the company wherein an employee said UnitedHealthcare had no contract to manage Medicaid in Georgia. Although technically true — the contracts are on hold until the protests are resolved — she said the other three bid winners had contacted her to initiate the credentialing process, which she said can take six months.
Oviedo said she sent her correspondent at UnitedHealthcare links to articles about the company’s winning bid but said she never heard back. She said a large portion of her practice serves children in foster care, adding that UnitedHealthcare won that portion of the bid. She worries that her patients won’t have access to insurance and that it will affect her business.
“You can’t call anybody there. You have to go through their chat system. And then their chat person says, ‘Sorry, we don’t offer that contract,’ ” Oviedo said. “So that’s very frustrating.”
She said she made a lucky guess at an email address that worked, until the company stopped responding.
“You can sometimes reach somebody that way, but they don’t make it easy, where like Molina, you can call the rep — her phone number’s right on the email she sent saying, ‘Hey, we’re reaching out to credential you.’ “
As of late Friday afternoon, UnitedHealthcare had not responded to emails sent by Capitol Beat a week earlier seeking a response.
Among the protest documents are more serious allegations from the losing bidders, for instance that a state evaluator lowered her scores for one company after meeting with her boss, suggesting that the boss influenced the outcome; or that state employees and their consultant working on the procurement didn’t all fill out the required conflict of interest disclosures.
Both losing incumbents leveled what is possibly the most serious charge: a direct conflict of interest for CareSource.
They assert that the company hired away a Georgia Department of Community Health official during the bidding process, a woman they said had helped to write the state’s procurement competition, formally known as an “electronic Request for Proposals,” or eRFP.
That department is the agency responsible for the state’s Medicaid program and the management contracts.
She “undoubtedly would have been privy to confidential information about the development of the eRFP that would have been helpful to CareSource in preparing its proposal,” a lawyer for Peach State wrote in a protest document filed last month. At best, this creates an appearance of impropriety, the protest says, and at worst reflects “an improper effort by CareSource to gain an unfair competitive advantage.”
The protest says CareSource should be disqualified.
A spokeswoman for CareSource said the company had no comment “at this time per the RFP requirements.”
The protests have apparently delayed the new contracts. Peach State’s contract was set to expire June 30, which would have required the new contracts to be in place July 1.
But Grandy, the president of the Georgia Primary Care Association, said he heard the contract date was pushed back, initially to next summer and then to the start of 2027.
That’s fine by Miracle and his medical office in Blue Ridge.
“A longer lead time is better,” he said. “Because we’ve got to get providers credentialed with the new insurance companies. We’ve got to get the organizational relationships set up so that we can do billing collections. I mean there’s a lot that has to happen. You can’t just say, ‘Okay we’ve got a new company.’ Health care is much more complex than that.”
