Global Courant
Georgia is offering a new bargain starting Saturday for some adults without health insurance: Go to work or school and the state will cover you.
But proponents condemn the plan, which will insure far fewer people than a full expansion of the state-federal Medicaid program, as unnecessarily restrictive and expensive.
The program will likely be closely watched as Republicans in Congress push for states to require work from some current Medicaid enrollees.
Madeline Guth, a senior policy analyst at the Kaiser Family Foundation, said Democratic President Joe Biden’s administration is unlikely to approve the job requirements, but a future Republican president would.
“I think a lot of eyes will be on Georgia,” Guth said.
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Georgia is one of 10 remaining states that have not extended Medicaid entitlement to individuals and families earning up to 138% of the federal poverty line, or $20,120 per year for a single person and $41,400 for a family of four.
The expansion of Medicaid was a key part of President Barack Obama’s 2010 health care reform, but many Republicans have opposed it, including Georgia Governor Brian Kemp, a Republican.
Instead, Kemp limits expanded coverage to adults earning up to 100% of the poverty line — $14,580 for a single person or $30,000 for a family of four. And coverage is only available if able-bodied adults document working, volunteering, college, or vocational rehabilitation for 80 hours a month.
It fits Kemp’s argument, as he tries to drag his party away from former President Donald Trump, that the GOP needs to show tangible conservative achievements for everyday people.
“In our state, we want more people to be covered at a lower cost with more options for patients,” Kemp said in his January State of the State address.
Georgia Governor Brian Kemp delivers the State of the State address on the House floor of the State Capitol on January 25, 2023 in Atlanta. Georgia has announced that the state plans to provide comprehensive Medicaid for residents who are in school or employed. (AP Photo/Alex Slitz, file)
Those earning more continue to qualify for subsidized coverage, often with no premium costs, in the federal marketplace. Kemp’s administration argues that commercial coverage is better because it pays providers more than state-set Medicaid rates.
The Trump administration eventually authorized 13 states to impose work requirements on some Medicaid recipients. The Biden administration revoked all those waivers in 2021, governing work is not the primary goal of Medicaid. But Kemp’s administration won a battle in federal court last year to uphold Georgia’s plan, in part because it applies to new enrollees and not current Medicaid recipients.
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Caylee Noggle, commissioner of the Department of Community Health, told The Associated Press this week that Pathways to Coverage is a “Georgia-specific approach” that could cover up to 100,000 people in the first year.
But 100,000 is far fewer than the nearly 450,000 uninsured Georgians the Urban Institute estimates could get coverage with a full expansion of Medicaid.
Others say the nearly $118 million in state money, combined with another $229 million in federal money, is nowhere near enough to reach that goal. The liberal Georgia Budget & Policy Institute estimates that the funds will cover fewer than 50,000 people.
And the state taxpayer will pay much more per person. Partly at the urging of Democratic Senator Raphael Warnock of Georgia, the federal government is offering to pay 95% of any Medicaid expansion for two years and 90% after that. Instead, by refusing federal generosity, Georgia will continue to pay the same 34.2% of state contributions to its existing Medicaid program and reject additional federal funding that has been pledged.
“The inappropriate name ‘Pathways to Coverage’ will cost Georgia more money and cover fewer people than it would if the state joined 40 other states in Medicaid expansion,” Warnock said in a statement to the AP.
“As state politicians continue to play games with people’s lives, Georgians are dying because they cannot afford the health care they need,” he said.
Noggle and other Georgia officials say working, studying or volunteering leads to better health, a key argument why these requirements should be part of a health insurance program.
But those who treat uninsured people say many are unable to work because they are in poor health.
“The reason they have their challenges, they can’t work, is because they have a mental illness or a medical condition that affects their ability to do that,” said Dr. Reed Pitre, an addicted psychiatrist and interim chief medical officer at Mercy Care, a federally funded nonprofit in Atlanta.
Enrolling people in the new program is a priority for Mercy Care, Pitre said, noting that no one is eligible until a month after they determine they meet the work requirement.
The Kemp administration expects the program to serve low-income earners who can’t afford employer insurance as well as college students. The state is also reassessing eligibility for 2.4 million adults and children now covered by Medicaid.
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Georgia has deferred decisions about people it believes are ineligible for regular Medicaid but could move to the Pathways program, Noggle said.
Either way, once people are in the new program, they will have to meet activity requirements or lose coverage starting the next month, which could affect thousands. When Arkansas imposed work requirements for some adults in 2018, more than 18,000 people lost coverage in less than a year.
Georgia will be different, Noggle argued, saying recipients will only need to certify for the first three months of the year.
“I think we’re going to make it as easy as possible for our members to verify eligibility,” she said.
But only time will tell. Kemp’s expansion plan in Georgia could be a blueprint for other states and other Republicans to demand more from those using Medicaid.
