Georgia’s Pathways to Coverage program, a unique state approach to Medicaid, has secured a one-year extension from the federal government, ensuring the program runs through 2026. The continuation comes with modifications intended to increase the number of people covered.
Pathways to Coverage was launched in July 2023 and was designed to offer health care coverage to adults with lower incomes who do not have access to affordable health insurance. The program covers many of the same medical services as traditional Medicaid, including prescriptions, doctor visits, and hospital stays. A key requirement is that eligible adults must work, attend school, volunteer, or complete another qualifying activity for at least 80 hours per month.
Despite delivering health benefits to enrollees, the program has drastically fallen short of enrollment targets. As of May, 23 months into the program, only 7,463 people were enrolled, significantly lower than the state’s initial projection of 47,000.
The Georgia Budget and Policy Institute (GBPI) noted that if the state continues enrolling approximately 4,231 people per year—the rate seen in the first year—it will take more than 12 years to reach the original five-year enrollment goal of 52,509. Enrollment remains concentrated, with more than 40% of Georgia’s counties reporting fewer than 10 enrollees.
Shortcomings in enrollment have been attributed to a cumbersome enrollment process and restrictive eligibility criteria. Potentially eligible Georgians face a steep “paperwork” burden, including compiling documents to verify qualifying hours. Only about half of individuals who show initial interest submit a complete application, and restrictive activity requirements lead to denials for at least one in every five complete applications.
The program has also been criticized for its high cost relative to enrollment. Through the end of the first year of implementation, almost $58 million in combined state and federal funds was spent, averaging $13,000 per enrollee. The majority of this spending went toward administrative expenses rather than health care benefits for those enrolled.
A report by the U.S. Government Accountability Office found that Georgia spent two-thirds of implementation costs on administration, with over half of the $80 million total going to contractors.
To address these implementation issues, Governor Brian Kemp’s administration received permission to amend the program. Modifications include shifting from requiring monthly reporting of qualifying activities to annual reporting.
Two new qualifying categories have also been added: parents of children under age 6 enrolled in Medicaid are now exempt from the work requirement, and childless, able-bodied adults can meet the requirements by complying with other assistance programs, such as the Supplemental Nutrition Assistance Program (SNAP).