Georgia’s Medicaid Pathways Program Struggles with Enrollment

ATLANTA

Georgia’s “Pathways” Medicaid program, which incorporates work requirements, is falling short of its enrollment goals two years after its launch. Currently, the program covers approximately 7,500 low-income residents, a notable increase from 4,300 in its first year, but this number is significantly lower than the anticipated 240,000 individuals who qualify. Initial projections from state officials expected a minimum of 25,000 enrollees in the first year, aiming for nearly 50,000 by the second year.

The Pathways program, aimed at incentivizing beneficiaries to engage in work, community service, or vocational training, requires participants to complete 80 hours of such activities each month. However, the state has recently ceased regular checks on compliance due to employee workload challenges, leading to operational issues since the program’s launch in July 2023.

By the end of 2023, the program had a backlog of over 16,000 applications. Many applicants faced hurdles in reaching staff for assistance, even after the state invested more than $50 million to bolster its software and administrative capabilities. Critics argue that the design and execution of the program have created significant barriers to enrollment and retention for low-income individuals.

Program Impact and Challenges

Although some participants, such as BeShea Terry, have reported improvements in health outcomes due to access to the program, they also encountered difficulties, including erroneous cancellations of their coverage and the complex documentation required for enrollment. Many individuals attempting to enroll in the program may lack adequate time or resources to navigate the complicated process effectively.

Critics assert that work requirements do not take into account the realities faced by most Medicaid recipients, who are often already employed, engaged in education, responsible for caregiving, or unable to work due to illness or disability. Reports indicate that at least 1,000 individuals transitioned from Medicaid to private insurance due to increased income, highlighting the program’s limited reach.

Comparison With Other States

Unlike Arkansas, which removed thousands from Medicaid under a similar initiative, Georgia’s work requirements only apply to newly eligible residents, protecting existing beneficiaries from coverage loss. This distinction may offer some stability to those enrolled in the program, yet the overall effectiveness remains under scrutiny.

The House of Representatives recently passed a separate bill proposing national work requirements that could potentially impact around 5.2 million people’s health coverage. This proposed legislation would impose similar obligations on adult Medicaid beneficiaries across the country, mandating them to work, volunteer, or study for at least 80 hours per month.

Expert Opinions

Public health experts have expressed concerns that such work requirements primarily serve to disenfranchise eligible individuals. They emphasize that the administrative costs associated with monitoring and verifying compliance are likely to increase, diverting resources away from actual healthcare services. While some states, including Iowa and Ohio, are exploring similar work requirement measures, the recent challenges faced by the Pathways program have raised alarms about its viability as a model for nationwide implementation.

In comparison to expanding Medicaid under the Affordable Care Act, which could accommodate higher income thresholds, Georgia’s Pathways program has been described as more costly and less effective. Critics, including public health scholars, argue that the state’s experience underscores the negative consequences associated with imposing work requirements on Medicaid enrollment and access to vital healthcare resources.

Due to ongoing concerns about the Pathways program’s effectiveness and the significant enrollment issues it has faced, the Government Accountability Office is currently investigating its administration. The outcomes of this investigation may raise further questions about the model’s applicability for future national mandates and the broader implications for low-income health coverage nationwide.