Georgia built the country’s only Medicaid work requirement, projected more than 25,000 enrollees after its first year, and had 20,606 as of Oct. 9, according to figures reported by KFF Health News. Its federal approval expires Dec. 31 unless the state and Washington agree on a new deal. That is the program the rest of the country is now being asked to copy.
Georgia Pathways to Coverage launched in 2023. Adults with incomes at or below the poverty line, about $33,000 for a family of four in 2026, must document up to 80 hours a month of work, job training or community service to get and keep coverage. State and federal governments have spent more than $128 million on it.
The people left outside are disproportionately Black. Georgia never expanded Medicaid, and the Georgia Budget and Policy Institute found in 2020 that about 36% of Georgians in the coverage gap were Black. Full expansion could cover roughly 347,000 uninsured Georgians, KFF Health News reports. Pathways enrolls about one for every 17 of them.
Now the program is stuck between two sets of rules. A new federal law makes work requirements national and forces Georgia to change its own in January, including broader exemptions for people who are medically frail, have substance use disorder or are caregivers. Georgia officials estimate that would cost an additional $1.4 billion by mid-2028. The state asked Washington for more money and was turned down, as were Wisconsin and Utah, WRDW reported.
State Medicaid officials have warned that without that money, “the state will have no alternative but to make decisions that imperil health policy goals around personal responsibility and healthy choices.” Read plainly, that is a warning that coverage for people already enrolled could shrink.
Supporters of work rules argue they push people toward jobs and keep the rolls sustainable. Georgia’s own record is the test of that claim. Three years in, the one program built on it enrolls a fraction of the people it was projected to reach, and the cost of bringing it in line with the federal version is $1.4 billion more.
The question is also on Tuesday’s ballot. Democrat Keisha Lance Bottoms, who is running to be Georgia’s first Black woman governor, supports full Medicaid expansion. Republican Rick Jackson proposes what he calls “intelligent Medicaid expansion” and has given few specifics.
Expansion would reach far more people than a work test ever has, without a single timesheet. The next governor will inherit the Pathways deadline less than two months after the votes are counted.
Have your say