Governor Brian Kemp’s conservative alternative to the Affordable Care Act’s Medicaid expansion has proven to be a costly endeavor that has provided minimal medical care coverage to Georgia enrollees. The Georgia Pathways to Coverage plan (“Pathways”) places a requirement that people earning up to the federal poverty level provide proof that they are working, in school, or performing other qualifying activities. Just one example of why the Pathways work requirement has received an unfavorable response is that being a full-time caregiver is notably excluded as a qualifying activity. 

Merely 3,500 Georgians are currently enrolled in Pathways – that is less than one percent of the approximate 359,000 Georgians that would become eligible for Medicaid under the Affordable Care Act expansion.  This enrollment number is a far cry from the 25,000 people the plan projected would enroll during the first year of the program. In contrast to its enrollment numbers, Georgia’s Department of Community Health reported $26.6 million in spending for Pathways by December 21, 2023. The program was launched in July of 2023. Deloitte, the program’s primary consultant, was paid $2.4M to prepare and submit the program’s application to the federal government, while just $2M was paid to insurers for medical care coverage. Despite the low enrollment and high cost to taxpayers, Georgia filed a suit against the federal government on February 2, 2024, requesting that the Pathways program be allowed to continue through 2028, rather than the originally scheduled 2025 end date. The requested extension is to reclaim time lost due to CMS allegedly improperly delaying the program for over two years. 

Georgia has one of the highest uninsured rates in the nation and is currently the only state Medicaid expansion plan requiring that people show proof of work or other qualifying activities to be eligible to receive health coverage. Other states’ attempts to implement similar work requirements have been blocked by its courts and have resulted in tens of thousands of its citizens losing medical coverage. While Georgia continues to reject the Affordable Care Act’s Medicaid expansion and the fate of the Pathways program hangs in the balance, it is unlikely that the uninsured rate will show any signs of improvement. Undoubtedly, the ongoing lawsuit will continue to increase the cost of this program, with minimal medical coverage benefits to the taxpayers footing the bill. Given the impact that the 2020 presidential election had on the implementation of this program, bringing this federal lawsuit in an election year makes the future of Pathways unpredictable.

Chilivis Grubman represents healthcare providers in a variety of healthcare related legal matters, including government investigation, overpayments, board matters, and False Claims Act litigation.  If you need assistance with such a matter, please contact us today.