Georgia's experience raises red flags for Medicaid work requirement moving through Congress

ATLANTA (AP) — Georgia's experiment with a work requirement for Medicaid offers a test of a similar mandate Republicans in Congress want to implement nationally, and advocates say the results so far should serve as a warning.
Just days shy of its two-year anniversary, the Georgia Medicaid program is providing health coverage to about 7,500 low-income residents, up from 4,300 in the first year, but far fewer than the estimated 240,000 people who could qualify. The state had predicted at least 25,000 enrollees in the first year and nearly 50,000 in the second year.
Applicants and beneficiaries have faced technical glitches and found it nearly impossible at times to reach staff for help, despite more than $50 million in federal and state spending on computer software and administration. The program, dubbed Georgia Pathways, had a backlog of more than 16,000 applications 14 months after its July 2023 launch, according to a renewal application Georgia submitted to the Trump administration in April.
'The data on the Pathways program speaks for itself,' said Laura Colbert, executive director of Georgians for a Healthy Future, an advocacy group that has called for a broader expansion of Medicaid without work requirements. 'There are just so many hurdles at every step of the way that it's just a really difficult program for people to enroll in and then to stay enrolled in too.'
Georgia's rules
A tax and spending bill backed by President Donald Trump and Republican lawmakers that passed the U.S. House in May would require many able-bodied Medicaid enrollees under 65 to show that they work, volunteer or go to school. The bill is now in the Senate, where Republicans want significant changes.
Pathways requires beneficiaries to perform 80 hours a month of work, volunteer activity, schooling or vocational rehabilitation. It's the only Medicaid program in the nation with a work requirement.
But Georgia recently stopped checking each month whether beneficiaries were meeting the mandate.
Colbert and other advocates view that as evidence that state staff was overburdened with reviewing proof-of-work documents.
Fiona Roberts, a spokeswoman for the state Department of Community Health, said Gov. Brian Kemp has mandated that state agencies 'continually seek ways to make government more efficient and accessible.'
Georgia's governor defends Pathways
The governor's office defended the enrollment numbers. Kemp spokesman Garrison Douglas said the early projections for Pathways were made in 2019, when the state had a much larger pool of uninsured residents who could qualify for the program.
In a statement, Douglas credited the Republican governor with bringing that number down significantly through 'historic job growth,' and said the decline in uninsured residents proved 'the governor's plan to address our healthcare needs is working.'
For BeShea Terry, Pathways was a 'godsend.' After going without insurance for more than a year, Terry, 51, said Pathways allowed her to get a mammogram and other screening tests. Terry touts Pathways in a video on the program's website.
But in a phone interview with The Associated Press, she said she also experienced problems. Numerous times, she received erroneous messages that she hadn't uploaded proof of her work hours. Then in December, her coverage was abruptly canceled — a mistake that took months of calls to a caseworker and visits to a state office to resolve, she said.
'It's a process,' she said. 'Keep continuing to call because your health is very important.'
Health advocates say many low-income Americans may not have the time or resources. They are often struggling with food and housing needs. They are also more likely to have limited access to the internet and work informal jobs that don't produce pay stubs.
Republican lawmakers have promoted work requirements as a way to boost employment, but most Medicaid recipients already work, and the vast majority who don't are in school, caring for someone, or sick or disabled.
Kemp's administration has defended Pathways as a way to transition people to private health care. At least 1,000 people have left the program and obtained private insurance because their income increased, according to the governor's office.
After a slow start, advertising and outreach efforts for Pathways have picked up over the last year. At a job fair in Atlanta on Thursday, staff handed out information about the program at a table with mints, hand sanitizer and other swag with the Pathways' logo. A wheel that people could spin for a prize sat on one end.
Since Pathways imposed the work requirement only on newly eligible state residents, no one lost coverage.
The Arkansas experiment
That's a contrast with Arkansas, where 18,000 people were pushed off Medicaid within the first seven months of a 2018 work mandate that applied to some existing beneficiaries. A federal judge later blocked the requirement.
The bill that passed the U.S. House would likely cause an estimated 5.2 million people to lose health coverage, according to an analysis from the nonpartisan Congressional Budget Office released Wednesday.
Arkansas Republican Gov. Sarah Huckabee Sanders has proposed reviving the work mandate but without requiring people to regularly report employment hours. Instead, the state would rely on existing data to determine enrollees who were not meeting goals for employment and other markers and refer those people to coaches before any decision to suspend them.
Arkansas is among at least 10 states pursuing work requirements for their Medicaid programs separate from the effort in Congress.
Republican state Sen. Missy Irvin said Arkansas' new initiative aims to understand who the beneficiaries are and what challenges they face.
'We want you to be able to take care of yourself and your family, your loved ones and everybody else,' Irvin said. 'How can we help you? Being a successful individual is a healthy individual.'
___
Associated Press writers Jonathan Mattise in Nashville, Tennessee, Andrew DeMillo in Little Rock, Arkansas, and Geoff Mulvihill in Philadelphia contributed to this report.

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