Nonpartisan report outlines overspending in Georgia's Pathways to Coverage Program

The congressional watchdog for government spending says administrative costs to implement Georgia’s Pathways to Coverage program has surpassed the amount spent on health care coverage.  

A report from the U.S. Government Accountability Office (GAO) notes weaknesses in the federal government's oversight of programs like Pathways, called Medicaid Section 115 Demonstration Waivers.  

The report was requested by Senate Democrats including Georgia's U.S. Sens. Jon Ossoff and Raphael Warnock. 

Most money spent on the Pathways program has gone to a single contractor overseeing changes to eligibility and enrollment processes, the report said.  

The federal government covered almost 90% of those costs, or about $40 million. Data from the state, and compiled by a coalition which includes the Georgia Budget and Policy Institute, suggests about $15 million less was spent on people’s health care. 

A federal funding match rate of 90% was also approved for a marketing and outreach campaign, the report said, when usually, those activities would be funded at 50%.  

• RELATED: Firm running Georgia’s struggling Medicaid experiment was also paid millions to sell it to public 

Total administrative expenditures on Pathways from 2021 to the first and second quarter of 2025 is $54 million, according to the GAO report. 

A delay in the program’s start is credited as one reason for the increased spending.  

In a statement from Gov.Brian Kemp’s office, a spokesperson said President Joe Biden should be blamed for that delay. Pathways to Coverage was approved for state implementation in 2019 under the first Trump administration, but approval was rolled back under Biden.  

Kemp remains “committed” to Pathways, reads the statement.  

“This report was requested by the same individuals who have no new or good ideas for addressing health care needs in Georgia,” Kemp’s spokesperson said in an email. “Meanwhile, our approach — through Georgia Access and Pathways — has now covered more Georgians than traditional Medicaid expansion would have, and provided better coverage at that.” 

Pathways, a form of Medicaid for working adults under 100% of the federal poverty level, has reached only a fraction of its early estimates. Georgia’s Department of Community Health (DCH) says 9,656 Georgians are actively enrolled today.   

The state has requested an extension on the Pathways program with some eligibility changes that would benefit parents of young children. The report from the GAO notes that state officials hope to see enrollment double compared to current numbers within a year of the program being extended.  

“Administrative expenses are a fundamental and expected component of any public program, including Georgia Pathways to Coverage,” said Fiona Roberts, spokesperson for DCH, in an email. “As we move forward with the renewal application, our plan is to ensure that administrative costs are managed in support of our members.” 

Since the start of Pathways in 2023, 15,427 people have enrolled in the program.  

Concerns over program expenditures were raised in a 2019 report from the GAO that advised the Centers for Medicare and Medicaid to require states provide projection for 1115 demonstration waivers, and “consider risks related to costs for information systems, beneficiary supports, and managed care.” 

Georgia is the only state with active Medicaid work requirements.