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CONGRESS IS PUSHING FOR A MEDICAID WORK REQUIREMENT. HERE’S WHAT
HAPPENED WHEN GEORGIA TRIED IT.  
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Margaret Coker
June 26, 2025
ProPublica
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_ GOP lawmakers want to nationalize Medicaid work requirements to
offset Trump’s proposed tax cuts. Yet Georgia’s example shows that
this could threaten health care for nearly 16 million Americans and
cost taxpayers hundreds of millions of dollars. _

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_ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign
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Series: Broken Pathways:How a Medicaid Work Requirement Program Fails
Georgians
More in this series
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Congressional Republicans, looking for ways to offset their proposed
tax cuts, are seeking to mandate that millions of Americans work in
order to receive federally subsidized health insurance. The GOP tax
and budget bill passed the House in May, and Senate Republicans are
working feverishly to advance their draft of federal spending cuts in
the coming days.

Georgia, the only state with a Medicaid work mandate
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started experimenting with the requirement on July 1, 2023. As the
Medicaid program’s two-year anniversary approaches, Georgia has
enrolled just a fraction of those eligible, a result health policy
researchers largely attribute to bureaucratic hurdles in the state’s
work verification system
[[link removed]].
As of May 2025, approximately 7,500 of the nearly 250,000 eligible
Georgians were enrolled, even though state statistics show 64% of that
group is working.

Gov. Brian Kemp has long advocated for Medicaid reform, arguing that
the country should move away from government-run health care. His
spokesperson also told The Current and ProPublica that the program,
known as Georgia Pathways to Coverage, was never designed to maximize
enrollment
[[link removed]].

Health care analysts and former state Medicaid officials say
Georgia’s experience
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congressional bill, if it becomes law, would cost taxpayers hundreds
of millions of dollars in administrative costs as it is implemented
while threatening health care for nearly 16 million people
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Here’s how proposed federal work requirements compare to Georgia’s
— and how they may impact your state:

How will states determine who is eligible?

WHAT CONGRESS PROPOSES:

The House bill
[[link removed]], H.R. 1,
and draft Senate proposal require all states to verify that Americans
ages 19 through 64 who are receiving Medicaid-funded health coverage
are spending 80 hours a month working, training for a job, studying or
volunteering. These new verification systems would need to be in place
by Dec. 31, 2026, and would have to check on enrolled residents’
work status twice a year. That means people who already receive
coverage based on their income level would need to routinely prove
their eligibility — or lose their insurance.

The federal work requirements would apply to more than 10 million
low-income adults with Medicaid coverage as well as approximately 5
million residents of the 40 states that have accepted federal
subsidies for people to purchase private health coverage through
what’s commonly known as Obamacare.

The House bill exempts parents with children under 18 from the new
requirements, while the Senate version exempts parents with children
under 15. Neither bill exempts people who look after elderly
relatives.

GEORGIA’S EXPERIENCE:

Georgia’s mandate applies to fewer categories of people than the
proposed federal legislation would. Even so, officials failed to meet
the state’s tough monthly verification requirement for Pathways
enrollees due to technical glitches and difficulty confirming the
employment of those who work in the informal economy such as house
cleaners and landscapers because they may not have pay stubs or tax
records. The challenges were steep enough that Georgia has decided to
loosen its work verification protocols from monthly to once a year.

WHAT THIS MEANS FOR YOUR STATE:

The Congressional Budget Office estimates that H.R. 1 would result in
at least 10 million low-income Americans
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losing health insurance. Health care advocates say that’s not
because they aren’t working, but because of the bureaucratic hoops
they would need to jump through to prove employment. Research from KFF
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a health policy think tank, shows that the vast majority of people who
would be subject to the new law already work, are enrolled in school
or are unpaid stay-at-home caregivers, duties that restrict their
ability to earn a salary elsewhere.

Arkansas is the only state other than Georgia to have implemented work
requirements. Republican state lawmakers later changed their minds
after data showed that red tape associated with verifying eligibility
resulted in more than 18,000 people losing coverage within the first
few months of the policy. A federal judge halted the program in 2019,
ruling that it increased the state’s uninsured rate without any
evidence of increased employment.

House Speaker Mike Johnson, a Louisiana Republican, says Medicaid work
requirements in H.R. 1 are “common sense
[[link removed]].” He says the policy
won’t result in health coverage losses for the Americans whom
Medicaid was originally designed to help because the work requirements
won’t apply to these groups: children, pregnant women and elderly
people living in poverty. He points to the $344 billion in a
decade’s worth of projected cost savings resulting from Medicaid
work requirements as beneficial to the nation’s fiscal health.
“You find dignity in work, and the people that are not doing that,
we’re going to try to get their attention,” he said earlier this
year.

Who will pay for the work verification system in each state?

WHAT CONGRESS PROPOSES:

The House bill allocates $100 million to help states pay for
verification systems that determine someone’s eligibility. The
grants would be distributed in proportion to each state’s share of
Medicaid enrollees subject to the new requirements — an amount
health policy experts say will not be nearly enough. States, they say,
will be on the hook for the difference.

GEORGIA’S EXPERIENCE:

In the two years since launching its experiment with work
requirements, Georgia has spent nearly $100 million in mostly federal
funds to implement Pathways. Of that, $55 million went toward building
a digital system to verify participants’ eligibility — more than
half the amount House Republicans allocated for the entire country to
do the same thing.

Like other states, Georgia already had a work verification system in
place for food stamp programs, but it contracted with Deloitte
Consulting
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to handle its new Medicaid requirements. Georgia officials said the
state has spent 30% more than they had expected to create its digital
platform for Pathways due to rising consultant and IT costs. Deloitte
previously declined to answer questions about its Pathways work.

WHAT THIS MEANS FOR YOUR STATE:

All states already verify work requirements for food stamp recipients,
but many existing systems would need upgrades to conform to proposed
federal legislation, according to three former state Medicaid
officials. In 2019, when states last considered work requirements, a
survey by the nonpartisan Government Accountability Office
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expected administrative costs to top $200 million — double what H.R.
1 has allocated for the country.

Rep. Buddy Carter, the Republican who represents coastal Georgia and
chairs the health subcommittee of the House Energy and Commerce
Committee, which had recommended Medicaid cuts in H.R. 1, said that
upfront costs borne by states would be offset by longer-term savings
promised in the House bill. Some congressional Republicans concede
that the cost savings will come from fewer people enrolling in
Medicaid due to the new requirements. Savings from work mandates
amount to 43% of the $793 billion in proposed Medicaid cuts, according
to the Congressional Budget Office.

How will states staff the program?

WHAT CONGRESS PROPOSES:

Medicaid is a federal social safety net program that is administered
differently in each state. Neither H.R. 1 nor the Senate legislative
proposal provides a blueprint for how states should verify eligibility
or how the costs of overseeing the new requirements will be paid.

GEORGIA’S EXPERIENCE:

Georgia’s experience shows that state caseworkers are key to
managing applications and work requirement verifications for residents
eligible for Medicaid. The agency that handles enrollment in federal
benefits had a staff vacancy rate of approximately 20% when Georgia
launched its work requirement policy in 2023. Georgia at the time had
one of the longest wait times for approving federal benefits. As of
March, the agency had a backlog of more than 5,000 Pathways
applications. The agency has said it will need 300 more caseworkers
and IT upgrades to better manage the backlog, according to a report
submitted to state lawmakers in June
[[link removed]].

WHAT THIS MEANS FOR YOUR STATE:

Former state Medicaid officials and health policy experts say
Georgia’s staffing struggles are not unique. In 2023, near the end
of the COVID-19 public health emergency, KFF surveyed states about
staffing levels for caseworkers who verify eligibility for federal
benefits, including Medicaid. Worker vacancy rates
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exceeded 10% in 16 of the 26 states that responded; rates exceeded 20%
in seven of those states.

Adding caseworkers will mean higher costs for states. Currently, 41
states require a balanced budget, meaning that those state legislators
would either need to increase taxes and revenues to verify Medicaid
enrollees are working or lower enrollment to reduce costs, said Joan
Alker, executive director of Georgetown University’s Center for
Children and Families.

In about half a dozen large states where county governments administer
federal safety net programs, the costs of training caseworkers on the
new verification protocols could trickle from states to counties.

“There are provisions in there that are very, very, very
challenging, if not impossible, for us to implement,” Sen. Lisa
Murkowski, an Alaska Republican, told reporters in June of the costs
facing her state to meet the House bill requirements.

* Medicaid
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* health care policy
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* Work requirements
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* Donald Trump
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* health insurance
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* low income workers
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