Georgia Medicaid Debacle Bolsters Progressive Case Against Work Requirements

An effort by the Republican-led Georgia government to partially expand Medicaid is falling well short of enrollment expectations, a failure that could stem from the program's burdensome work requirements and other administrative barriers that are abundant in a for-profit system that doesn't guarantee healthcare to all as a right.

Politico reported Tuesday that just 1,800 people enrolled during the program's first four months—leaving the state on pace to miss Republican Gov. Brian Kemp's target of 31,000 enrollees within the first year.

"Critics blame the paltry expansion on an overly complex program with too many hurdles for people to clear," the outlet noted.

Brendan Duke, senior director for economic policy at the Center for American Progress, wrote in response to Politico's reporting that "a large part of progressive opposition to work requirements in safety net programs isn’t principle—it's about the paperwork that prevents working people from enrolling in programs they qualify for."

"Great example with Georgia and Medicaid here," Duke added. "Work requirement supporters will ask, 'Why do you oppose work reqs if the vast majority of people would still qualify?' Some of the problem is you're denying support to people who can't find a job. But some of it is you're functionally denying support to people with a job!"

As Georgia began rolling out its Pathways to Coverage program earlier this year following a legal fight with the Biden administration, researchers at Georgetown University's Center for Children and Families (CCF) argued that the state's insistence on a work requirement would likely box many people out, including workers with irregular hours and parents who lack access to childcare.

The work requirements in Georgia's program do not include an exemption for caregiving or high childcare costs, the CCF experts noted. As such, they warned, "many parents will likely remain uninsured under the Pathways program especially parents of babies and toddlers who are preschool age."

Georgia, which has one of the highest uninsured rates in the U.S., is currently the only state with a Medicaid work requirement in effect—though it's not the first to ever implement one.

In 2018, with the approval of the Trump administration, Arkansas put in place work mandates for Medicaid with disastrous results. Before the policy was blocked in federal court, more than 18,000 people in the state were thrown off Medicaid in just seven months for failing to adhere to the requirements.

The Arkansas policy did not boost employment, an outcome consistent with research showing that work requirements are only effective at stripping people of benefits.

"Pathways to Coverage has cost Georgia more money and covers far fewer people than if the state simply joined 40 other states in expanding Medicaid."

In 2021, the Biden administration rescinded Trump-approved waivers that had allowed Georgia and other states to add work requirements to their Medicaid programs. Georgia challenged the decision in court and prevailed last year, thanks to its argument that the experiment would lead to more people receiving coverage than if the program were blocked.

Kemp has suggested that around 345,000 Georgians could be eligible for the expanded Medicaid program, but the state expects that just around 64,000 will eventually enroll in the program.

That's just 14% of the people who would be covered if Georgia joined nearly every other U.S. state in fully expanding Medicaid under the Affordable Care Act, CCF researchers estimated earlier this year.

In addition to covering fewer people than full Medicaid expansion, Georgia's experiment is also expected to cost the state far more.

Leah Chan, senior health analyst at the Georgia Budget and Policy Institute, told a local Georgia newspaper earlier this year that Pathways to Coverage will cost roughly $2,420 per enrollee. Full Medicaid expansion, by contrast, would run the state just $496 per enrollee, as the federal government pays much of the cost.

Sen. Raphael Warnock (D-Ga.) told Politico that "Pathways to Coverage has cost Georgia more money and covers far fewer people than if the state simply joined 40 other states in expanding Medicaid."

"While state politicians continue playing games with people's lives," he added, "Georgians are dying because they can't afford the healthcare they need."

Heightened scrutiny of Georgia's Medicaid experiment comes as states across the U.S. are rapidly conducting eligibility checks and kicking people off Medicaid en masse following the end of pandemic-era protections. Georgia is one of nine Republican-led states that collectively account for 60% of Medicaid and Children's Health Insurance Program disenrollments this year.

An overwhelming majority of the disenrollments nationwide have been for procedural reasons, such as a paperwork error.