ATLANTA, Ga. — Full Medicaid expansion will lead the agenda when Keisha Lance Bottoms takes over as Georgia governor in January, and the Democrat has said she is ready to scrap the state’s current work-based coverage program to get there.
At her first news conference since winning the race, held at the state Capitol with members of her transition team, Bottoms tied her plans to cost of living, health care and school funding, the pocketbook issues she said carried her to victory. She said hundreds of thousands of Georgians are uninsured because of how the state handles Medicaid and because coverage bought under the Affordable Care Act keeps getting more expensive.
Her target is Georgia Pathways to Coverage, the partial expansion built under Gov. Brian Kemp. Enrollees must log 80 hours a month of work, volunteering or classes to qualify, and a federal Government Accountability Office review found the program costly to run and slow to enroll people. Bottoms has said she wants it gone entirely.
Under full expansion, a single adult with income as high as $22,024 a year, or 138% of the poverty level, could qualify, compared with the current cutoff of $15,960. Washington covers 90% of the cost for newly eligible enrollees. Forty states have taken that deal, and Georgia is among the 10 that have not.
Expansion would not erase work rules. A federal law passed last year requires many nonpregnant adult Medicaid enrollees to work, study or volunteer, and that mandate takes effect in January 2027 whether Georgia expands fully or keeps Pathways.
Paying the state share is the harder part. Georgia has drawn down much of its once-large surplus through income tax rebates, rate cuts and pauses in the gas tax, and Kemp has floated a special session on the budget. Bottoms has said she will comb through the budget for money, and that tax breaks for data centers are open for review.
Any change still needs lawmakers. Democrats are on track to hold the state House for the first time in more than 20 years, while Republicans kept the state Senate. A 2024 expansion bill drew some Republican support but died in committee without the governor’s backing.
Bottoms will also be the first Black woman elected governor of any U.S. state.
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