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GEORGIA’S MEDICAID WORK REQUIREMENT PROGRAM SPENT TWICE AS MUCH ON
ADMINISTRATIVE COSTS AS ON HEALTH CARE, GAO SAYS  
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Margaret Coker, The Current
September 24, 2025
ProPublica
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_ Republican lawmakers cite Georgia’s Pathways to Coverage as a
national model for federal Medicaid work requirements that are set to
take effect in 2027. A new report shows the program has spent at least
$54 million on administrative costs alone. _

Georgia Gov. Brian Kemp promoted the state’s Pathways to Coverage
program as a model that conservative legislatures across the country
could follow., Credit:Justin Taylor/The Current GA/Catchlight Local

 

_ProPublica is a Pulitzer Prize-winning investigative newsroom. Sign
up for The Big Story newsletter
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to receive stories like this one in your inbox_.

Series: Broken Pathways:How a Medicaid Work Requirement Program Fails
Georgians
More in this series
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Most of the tax dollars used to launch and implement the nation’s
only Medicaid work requirement program have gone toward paying
administrative costs rather than covering health care for Georgians,
according to a new report by the Government Accountability Office
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that monitors federal programs and spending.

The government report examined administrative expenses for Georgia
Pathways to Coverage, the state’s experiment with work requirements.
It follows previous reporting by The Current and ProPublica
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showing that the program has cost federal and state taxpayers more
than $86.9 million while enrolling a tiny fraction of those eligible
for free health care.

The GAO analysis, which does not include all the Pathways
administrative expenses detailed by the news outlets
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shows that as of April the Georgia program had spent $54.2 million on
administrative costs since 2021, compared to $26.1 million spent on
health care costs. Nearly 90% of administrative expenditures came from
the federal budget, the report concluded, meaning that Georgia’s
experiment is being funded by taxpayers around the country. Federal
spending will likely increase given that the Centers for Medicare and
Medicaid Services has approved $6 million more in administrative costs
not reflected in this report because it was published before the state
submitted invoices.

The spending watchdog agency echoed its 2019 criticism of the Centers
for Medicare and Medicaid Services for a lack of oversight
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associated with state initiatives approved in the name of Medicaid
reform.

The September GAO report said the Medicaid agency never required
Georgia to detail the costs of building and implementing the program.
The federal approval process for states that want to experiment with
their Medicaid systems “does not take into account the extent to
which demonstrations will increase administrative costs,” the report
said.

Georgia Gov. Brian Kemp, a Republican, promoted Pathways as an example
of how fellow conservatives around the country could overhaul federal
safety net benefits and end reliance on what critics deride as
handouts to low-income Americans. Congressional Republicans cited
Pathways as a model for the federal Medicaid work requirement law
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passed in July that will take effect in 2027. The Georgia Pathways
program was slated to expire Oct. 1, but the Trump administration on
Tuesday
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approved an extension of the experiment through Dec. 31, 2026.

The Georgia program was supposed to expand free health care to a group
the state had previously deemed ineligible for Medicaid: adults under
65 years old who earn less than the federal poverty line of $15,650 a
year. To qualify, Georgians had to prove that they work, study or
volunteer at least 80 hours a month.

But enrollment in Georgia Pathways has remained low. The most recent
state data shows that 9,175 of the nearly quarter-million low-income
Georgians eligible for the program were enrolled as of Aug. 31.
Previous reporting by The Current and ProPublica revealed that was due
to glitches in the digital platform people must use to enroll, chronic
understaffing in the state agency charged with enrollment help and a
maze of bureaucratic red tape
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Georgia officials previously told The Current and ProPublica that
Pathways was never designed to maximize enrollment
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Carter Chapman, Kemp’s spokesperson, said Monday that the Kemp
administration remains committed to Pathways and making refinements to
meet the health care needs of Georgians.

In December Democratic senators critical of Medicaid work
requirements, including Georgia’s Jon Ossoff and Raphael Warnock,
had asked the GAO to report on the administrative costs of
implementing Pathways and verifying that recipients are working,
studying or volunteering.

“Administrative spending has outpaced spending for medical
assistance (e.g., health care services)” for Georgia Pathways, the
report said. “This was likely driven by the up-front administrative
changes needed to implement the demonstration, the delayed start date
for enrollment, and any duplication in administrative spending due to
the delay.”

Georgia officials told the GAO that the administrative costs
associated with Pathways increased by 20% to 30% because of a two-year
delay caused by legal battles with the Biden administration, which
tried to end all Medicaid work requirement programs that had been
approved before the Democratic president took office in 2021. State
officials said the delay resulted in having to duplicate some
spending, including IT system changes, staff training and other
implementation costs, the report said. The report did not provide
evidence to support the state’s assertion.

“This report was requested by the same individuals who have no new
or good ideas for addressing healthcare needs in Georgia,” Chapman
said in a statement. “Now, as other states prepare to adopt our
model and reject one-size-fits-none big government healthcare,
Democrats like Senators Ossoff and Warnock are trying to rewrite
history after four years of inaction and blame the State for costs
associated with their own stonewalling.”

Warnock said the GAO’s findings reinforce his opposition to the
Trump administration’s push to nationalize work requirements because
of the amount of tax dollars going to expenses other than health care.

“Now the entire country can see what we in Georgia already know:
Georgia’s Medicaid work reporting requirement program is the real
waste, fraud, and abuse,” Warnock said in a statement. “This
report shows that Pathways is incredibly effective at barring working
people from health coverage and making corporate consultants
richer.”

Ossoff called Georgia Pathways “a boondoggle that’s wasted tens of
millions on pricey consultants while Georgia hospitals struggle and
Georgians get sick without health insurance.”

The GAO report does not include the $27 million that Deloitte
Consulting earned to market Pathways
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or the approximately $10 million that went toward additional
consulting, including by other firms, and legal fees related to the
state’s two-year court battle with the Biden administration.

Deloitte did not respond to a request for comment. The firm previously
declined to answer questions about its Georgia Pathways work,
referring requests for information to the state’s Department of
Community Health. The agency did not respond to requests for comment
but previously described Deloitte’s marketing and outreach work as
“robust” and “comprehensive.”

* healthcare costs
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* Medicaid
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* Work requirements
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* Georgia
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* Brian Kemp
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* Jon Ossoff
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