Georgetown CCF Analysis Finds Georgia’s Pathways to Coverage Program Would Cost More to Cover Fewer People

This week, we released a new analysis, written by Allexa Gardner, Joan Alker and Leo Cuello, that finds Georgia’s limited Medicaid expansion program, known as “Pathways,” is fiscally foolish and sets up a structure that discriminates against parents. Enrollment for Pathways begins on July 1st with coverage being at a later date likely September 1. The new program caps eligibility for working adults at 100 percent of the federal poverty level (FPL) (i.e., $30,000 for a family of four in 2023) and imposes onerous work reporting requirements and premiums to access health coverage. The terms of the federal Section 1115 approval assume coverage will be extended to roughly 64,000 low-income Georgians; less than 15 percent of the population that could be eligible if the state were to adopt a full Medicaid expansion.

Our analysis also finds implementation of the program would be costly. By enacting a partial expansion through Pathways, the state will forego an additional $1.1 billion dollars in federal incentives it could receive by fully expanding the federal Medicaid program. Congress made these funds available in 2021 after Governor Kemp agreed to “Pathways to Coverage” terms set out by the Trump Administration in 2020. This loss of federal funds in addition to the lower Medicaid matching rate the state will receive under the terms of the waiver agreement for Pathways means the state will pay more to cover fewer people. The cost to the state on a per capita basis in the first year of Pathways is expected to be five times higher than the first year of full Medicaid expansion.

We found that “Pathways” includes the most restrictive work reporting requirement to date, with no exceptions for caregiving or high child care costs. Enrollees are expected to complete 80 hours of work each month and provide documentation to keep their coverage. These restrictions would disproportionately impact health care access for parents as well as low-wage workers. Low-wage workers in Georgia most commonly work in sectors like retail or hospitality with fluctuating work hours that may make it more difficult for them to consistently meet the monthly work requirement.

“As the failed experiment in Arkansas found, work reporting requirements don’t work to promote employment, but they are very good at establishing barriers to needed coverage,” said Joan Alker, Executive Director of the Georgetown University McCourt School of Public Policy Center for Children and Families. “Georgia’s design is notable for its anti-family provisions since there is no caregiving exception or child care support for parents of young children. As a consequence, coverage is likely to be largely off limit to parents – especially new mothers.”

Implementation of Pathways comes on the heels of Georgia resuming eligibility checks for Medicaid and PeachCare for Kids, following the end of the Medicaid continuous coverage provision that was in place during the COVID-19 pandemic. The process is expected to lead to many families and children losing health coverage due primarily to administrative hurdles instead of confirmed ineligibility.