[Only 1,800 people enrolled — and critics blame the paltry
expansion on an overly complex program with too many hurdles for
people to clear.]
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GEORGIA OFFERED MEDICAID WITH A WORK REQUIREMENT. FEW HAVE SIGNED UP
 
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Megan Messerly and Robert King
December 26, 2023
Politico
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_ Only 1,800 people enrolled — and critics blame the paltry
expansion on an overly complex program with too many hurdles for
people to clear. _

Georgia's experiment requiring certain low-income individuals to have
a job to get Medicaid coverage is off to a slow start., Julie
Jacobson/AP

 

A GOP experiment forcing low-income people to work to qualify for
public health insurance benefits is stumbling in Georgia.

The state’s Republican governor, Brian Kemp, expected 31,000
Georgians to sign up
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in the first year of the program, which started in July. Through four
months, only 1,800 people enrolled — and critics blame the paltry
expansion on an overly complex program with too many hurdles for
people to clear.

“With such low enrollment numbers [in Georgia], it does feel a bit
like that,” said Chris Pope, a senior fellow at the Manhattan
Institute, a conservative think tank. “It’s a mountain of
paperwork, and it’s burdensome for people who are in a tough
spot.”

Democrats have long tried to persuade red states to expand the federal
Medicaid program and bring health insurance to more of their most
vulnerable residents. The Biden administration sweetened the pot in
2021 with additional federal money, but GOP officials, including Kemp,
have been reluctant to take the offer unless they can tie benefits to
employment.

The slow uptake in the Georgia program has done little to change the
state’s double-digit uninsured rate, one of the highest in the U.S.
And it could dissuade other red states that have yet to expand
Medicaid — including nearby Alabama, Mississippi and South Carolina
— from following in Georgia’s footsteps even as they come under
increasing pressure from the health care industry to expand the
government-run health insurance program.

Some in Georgia, however, maintain it’s too early to draw
conclusions about the program and that many people may still be
unaware the program exists.

“I’ve got my fingers crossed it’s going to be a good
solution,” said Georgia state Rep. Lee Hawkins, a Republican who
chairs the House health committee. “Getting the word out is always
difficult with any new program.”

Georgia is the only state that has a Medicaid work requirement, though
Kansas Gov. Laura Kelly, a Democrat, recently proposed one to entice
the Republican legislature. Arkansas Republican Gov. Sarah Huckabee
Sanders is awaiting federal approval for a similar idea.

Work requirements were a feature of the Trump administration’s plans
to overhaul Medicaid, and the Centers for Medicare and Medicaid
Services approved them in 13 states. But court rulings and the
Covid-19 pandemic snarled implementation, and the Biden administration
subsequently rescinded the approvals. Georgia, however, won a federal
court challenge in 2022 allowing it to implement the policy while
partially expanding Medicaid.

The move followed years of public debate over whether to expand the
low-income health insurance program, with Democrats making it the
centerpiece of gubernatorial campaigns in 2018 and 2022.

Kemp, who won both those elections, opted instead to limit expanded
coverage to adults earning up to the federal poverty line — $14,580
for a single person or $30,000 for a family of four. But coverage for
this new group is available only to those who document they are
working, studying or volunteering 80 hours a month.

“It feels like a political compromise between people who wanted an
expansion and people who didn’t want an expansion,” Pope said.
“And it ended up being a fairly slight expansion.”

Republicans in Georgia urge patience and note that the state Medicaid
agency has been busy reviewing eligibility for millions of people for
the first time since the pandemic.

“As with any newly launched program, we expect enrollment to build
over time,” a health department spokesperson said.

Kemp’s office did not respond to a request for comment.

For those on the right who have long wanted to limit Medicaid, the low
enrollment numbers are proof that too many people are content to rely
on government help that they don’t need instead of finding
employment or going to school.

“As so few able-bodied adults are willing to work, train or
volunteer even part time to qualify for the Pathways program, it’s
clear that a full expansion would discourage employment for those who
can work and risk resources meant for the truly needy — low-income
children and people with disabilities,” said Jonathan Ingram, vice
president of policy and research at the Foundation for Government
Accountability.

There is bipartisan agreement that the lack of awareness about the
program is also likely contributing to the low enrollment.

“It’s still early, and I think people need to be educated,” said
Rep. Buddy Carter (R-Ga.). “I wouldn’t read too much into that at
this point.”

For opponents of the limited expansion, the slow start has led to
renewed calls for the state to adopt full Medicaid expansion, covering
people who earn up to 138 percent of the poverty level without work
requirements.

“Pathways to Coverage has cost Georgia more money and covers far
fewer people than if the state simply joined 40 other states in
expanding Medicaid,” Sen. Raphael Warnock (D-Ga.) said in a
statement to POLITICO. “While state politicians continue playing
games with people’s lives, Georgians are dying because they can’t
afford the health care they need.”

The final judgment on Georgia’s program could determine whether red
states try again to impose Medicaid work requirements, especially if a
Republican wins the White House.

“Making sure that the path is cleared, and states like Georgia
taking the lead, might help create a new pathway that is seen as less
full of barriers and obstacles,” said Nina Owcharenko Schaefer,
director of the Center for Health and Welfare Policy at the Heritage
Foundation. “It’s important to have these kinds of experiments. We
have to learn from them. They’re not intended to be, hit it out of
the ballpark in one hit.”

In Kansas, Kelly’s proposal — to add a work requirement that is
reported once a year — is a concession that comes after five failed
attempts to convince the Republican-dominated legislature to expand
Medicaid.

The governor’s office rejected the idea that its program will face a
similar fate to Georgia’s.

“The reason they’ve struggled to get few enrollees is because of
the bureaucratic hurdles people have to jump through to prove
they’re working,” said Kelly spokesperson Brianna Johnson.

Arkansas has an application pending before CMS to reinstall work
requirements, but beneficiaries won’t lose coverage for not
complying. Instead, beneficiaries will receive more care coordination,
services and outreach.

The state imposed requirements in 2018, and more than 18,000 people
lost coverage over seven months. A federal judge struck down the
program in 2019, ruling that work requirements undermine Medicaid’s
primary mission to provide health care.

Courts also struck down work requirement programs in New Hampshire and
Kentucky. Other states like Arizona and Indiana paused their programs
due in part to actions in other states.

Liberals hope the Georgia program’s slow uptake gives states pause
before trying anything similar under a future Republican
administration.

“Given where we are with the enrollment, it seems that would be
extraordinarily foolish,” said Joan Alker, executive director of
Georgetown University’s Center for Children and Families. “Never
say never, but … the fact that nobody is getting covered doesn’t
address the pressures that states are feeling.”

 

* Medicaid; Georgia; Kemp; Biden;
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