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Medicaid Work Requirements Again Driving High Costs, Low Enrollment

As of today, 41 states and the District of Columbia have expanded Medicaid coverage to adults between the ages of 19 and 64. Georgia is one of the holdouts. Though the state has taken steps to adopt a modified expansion, that approach has been unsuccessful, rife with significant eligibility and enrollment barriers, burgeoning costs, and few enrollees.

This effort began in July 2023, when Georgia launched Georgia Pathways to Coverage, a program to extend Medicaid only to applicants able to meet and document onerous work, school, or other administrative requirements. So far, the state reports that only 3,500 people have enrolled in the program, far below their projection of 25,000 enrollees in the first year and 50,000 within the first two years.

Despite its tiny enrollment, the Pathways program has been racking up extensive bills. Georgia reported spending $26.6 million from July through December, with only $2 million going to medical care. Over 90% of the spending was on administrative and consultant costs.

By comparison, KFF research in 2021 suggested that Georgia would save $640 million in the first year alone by doing a full expansion of Medicaid as envisioned under the Affordable Care Act. KFF also notes that a “comprehensive literature review of Medicaid expansion studies shows that expansion helps to expand coverage and reduce the uninsured, improve access to and utilization of care, reduce uncompensated care costs, improve affordability of care and reduce racial and ethnic disparities in coverage.” The Urban Institute projected in 2022 that true Medicaid expansion would decrease Georgia’s uninsured population by 448,000, a major improvement in access to quality care.

The failure of Georgia’s Medicaid work requirements can come as no surprise. In 2018, Arkansas briefly implemented similar rules that led to 18,000 people losing coverage before a federal court halted the program. These coverage losses occurred despite research showing 95% of those subject to the requirements satisfied or were exempted from them, underscoring the burdensome impact of compliance reporting.

This new information about Georgia’s experience with the expensive and ineffective use of work and documentation rules comes as efforts are again underway to apply such requirements, as well as other Medicaid cuts like block grants, nationwide.

At Medicare Rights, we are staunchly opposed to barriers to coverage, especially barriers like work requirements that disproportionately affect older adults who are approaching Medicare eligibility. Instead of making coverage and care harder to access, we urge states to embrace methods to reduce these burdens and their un- or underinsurance rates, such as through full Medicaid expansion; streamlined enrollment for Aged, Blind, and Disabled Medicaid and Medicare Savings Programs (MSP); and expanded eligibility for assistance programs.

Read more about Pathways spending and enrollment.

Read more about issues with the Pathways program.

Read more about Medicaid work requirements.

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