LISTEN: Gov. Brian Kemp’s Pathways to Coverage program planned to extend Medicaid coverage to an estimated 100,000 Georgians in its first year. But, four months in, only 1,300 people have signed up. GPB’s Ellen Eldridge reports.

Gov. Brian Kemp signs a law

Gov. Brian Kemp

Credit: Grant Blankenship/GPB News

A policy expert with the Georgia Budget and Policy Institute says low enrollment numbers do not match the state’s $20 million dollar investment in Gov. Brian Kemp's program to expand health care coverage in Georgia.

The governor's plan, called Pathways to Coverage, is meant to help more lower income Georgians receive Medicaid health insurance, but includes a work requirement.

Georgia is the only state in the nation requiring enrollees to work 80 hours per month or participate in education, job training, or other approved activities such as community service.

Qualifying adults are those between ages 18 and 64 who earn less than 100% of the federal poverty level — and who are not otherwise eligible for Medicaid. For 2022, the federal poverty level was $13,590 for a single person and $27,750 for a family of four. 

The Department of Community Health reports 1,300 people have enrolled since the program began in July, which is only about 1% of the 100,000 Georgians estimated to enroll in the first year.

Garrison Douglas, a spokesperson for Gov. Brian Kemp's office, said the office has not provided any quarterly or monthly projections for Pathways and always anticipated a slow rollout.

The state launched Pathways just as it began a review of Medicaid eligibility following the end of the COVID-19 public health emergency. Federal law prohibited states from removing people from Medicaid during the three-year emergency.

Georgia has since cut more than 170,000 adults and kids from Medicaid and is expected to remove thousands more as the yearlong review of all 2.7 million Medicaid recipients in the state continues.

In 2021, President Joe Biden’s Centers for Medicare and Medicaid Services balked at the state's proposed work requirement, withdrawing approval for two key components — the work requirement and a small monthly premium. In January 2022, the state sued the CMS, the United States Department of Health and Human Services (HHS), and related parties within the Biden administration.

“After two years of delays by the Biden administration, Georgia Pathways is now providing a sustainable and Georgia-centric option for health coverage for low-income adults," Douglas said Oct. 23. "This is being achieved without full Medicaid expansion, which would kick hundreds of thousands of Georgians off their private insurance. We will continue working to educate Georgians about Pathways’ innovative, first-of-its-kind opportunity and enroll more individuals in the months to come.”

Leonardo Cuello, research professor at Georgetown University’s Center for Children and Families told the Capitol Beat News Service that 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.   

That is not the case with Kemp's plan.

“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.”  

Taxpayers have made a $20 million investment in Georgia Pathways, and, so far, it's unclear if they are getting the return on that investment, Leah Chan with the Georgia Budget and Policy Institute said.

"People are essentially getting caught in the application process," Chan said. "And so we could be missing a lot of people who are eligible but just don't understand how to make it through the many steps that it takes to apply."

Chan said the GBPI has known for a while that Medicaid expansion is a better deal for Georgia's bottom line.

"We know that Pathways to Coverage costs five times more per person than full Medicaid expansion," she said. "We also know that with full Medicaid expansion, Georgia would get a sign on bonus of up to $1.2 billion that would basically cover the state cost of full Medicaid expansion for the first two years. So it's the so from an economic standpoint, you know, full Medicaid expansion is a better deal for Georgia."

More data and transparency around this program are needed to better understand barriers to coverage so that as many people as possible are getting access to health care and state dollars are being used effectively, she said.