Last week we updated our scan of Medicaid renewal tutorials and self-help tools in advance of implementation of semi-annual renewals for the Medicaid expansion group starting in 2027. For all enrollees, not just expansion adults, it’s important to states to keep these resources updated and relevant. And it’s not too early to start thinking about creating similar content for expansion adults who will be required to report work or qualifying activities beginning in 2027. Self-help resources remain an essential source of consumer assistance to enrollees that reduces administrative burden on state agencies and individuals.
But unlike the variety of renewal resources available across states, we only have one example of a state with an active work/community engagement requirement – Georgia Pathways to Coverage, a Section 1115 demonstration project, implemented in 2023. However, Nebraska, which plans to implement work reporting requirements early in May 2026, has recently posted some content on its website, which is described below.
In Georgia, one of the ten states that has not expanded Medicaid to low-income adults without dependent children, Pathways was touted as a way for working adults with income at or below the poverty level ($1,304 monthly for an individual) to gain access to Medicaid coverage. As the only state currently requiring certain Medicaid adults to work or engage in qualifying activities, we took a look at what information and resources we could find about Pathways.
Pathways applicants and enrollees use the state’s benefits portal, Georgia Gateway, to apply, renew coverage, and report changes. The site features a number of tutorial videos, ranging from a step-by-step portal overview video to specific videos on how to get the latest updates, verify employment or self-employment, navigate dashboard functions, reset your password, and renew coverage. While those videos are generic to the Gateway portal with a few references to Pathways, one video focuses on applying for Pathways which also explains the eligibility requirements. It links to a table of qualifying activities and how each can be verified, including self-employment or employment income. While the application requires the user to upload documents to verify qualifying activities, the Gateway offers two automatic ways to verify income – the state contracts with Truv, a consent-based income verification tool that automatically verifies employment with major employers, and Steady IQ to verify self-employment.
The site includes a set of FAQs and information on good cause exceptions, such as a family emergency that temporarily exempts enrollees from meeting the 80 hour requirement. But there doesn’t appear to be a way to request a good cause exception online; enrollees must contact the agency by phone or mail, or in person at a local office, which can be a barrier when distances to local offices or call wait times are long. Notably, by early 2025, the state had spent $80 million with less than one third spent on health services, with almost 90% funded by the federal government.
Just before the New Year, Nebraska was the first state to announce that it was implementing work reporting requirements early, as of May 2026. The state has begun to post information about the new policy including a new webpage dedicated to work requirements (no, they don’t call it community engagement!). The outreach notice that expansion adults will receive indicates that if the state is unable to automatically verify work, the individual will receive a form indicating what information the state needs. FAQs largely repeat the content on the web and in the outreach notice. As yet, no content explains step-by-step instructions or includes video tutorials.
Information available on state websites may be the only source of information about how each state is approaching implementation of work reporting requirements. Unlike the unwinding, states are not required to develop a written plan on implementation of work/community engagement requirements, so it’s up to the state to share details of how this new policy will work in their state. For example, it’s clear that Nebraska plans to use the proxy of ~$580 per month in income as verification of work, which is likely the strategy that can automatically determine compliance for the largest number of individuals.
We know that the timeline for implementing work/community engagement requirements is clearly insufficient for states to adequately plan, acquire new systems capability, and develop new processes. Developing self-help tools will be a critical strategy to avoid inappropriate disenrollment of eligible people due to red tape and a lack of consumer assistance.
[Editor’s Note: This blog is apart of a two part series. Read the first part here.]