Georgia officials say new federal Medicaid rules threaten state’s partial expansion program

The state argued both at the meeting and in its public notice that new federal guidelines for Medicaid eligibility that were included in President Donald Trump’s tax break and spending cuts package that passed last year would make the state’s Medicaid program financially unsustainable. The new federal Medicaid rules take effect next year. 

“The federal government fundamentally reshaped the operational and financial realities of George’s waiver,” Stuart Portman, executive director of the division of medical assistance plans at the Georgia Department of Community Health, said at Thursday’s meeting. “Therefore, we ask that the federal government also provide the enhanced match necessary to make that expansion viable.” 

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Georgia’s current partial Medicaid expansion program, called Pathways to Coverage, requires low-income adults who earn up to 100% of the federal poverty level – or about $15,960 for a single adult – to complete 80 hours of qualifying activity per month, which includes work, school or community service. The current Pathways program doesn’t provide exceptions to the work requirement unless the person is a parent who is a caregiver of a child under the age of 6.

Under the new federal guidelines, Georgia will now provide more exemptions to its work requirements, such as for parents of children under 13 years old, those who were formerly in foster care and those who are considered medically frail.

Because these exemptions are expected to increase the number of Medicaid enrollees by about 100,000 people, according to the Department of Community Health’s projections, state officials argued in the public notice that “Georgia does not have the financial capacity to fund this expanded scope without additional federal dollars.”

“In turn, the long-term viability of the program serving as the foundation of the community engagement requirements … will be threatened and the state will have no alternative but to make decisions that imperil health policy goals around personal responsibility and healthy choices,” according to the public notice.

The current state’s program was temporarily extended last year until the end of 2026 while a request to continue Pathways through 2030 is still pending.

While the 90% federal match mirrors what is offered to states who fully expand Medicaid, a spokesperson for Gov. Brian Kemp’s administration, Annalise Morning, said “the waiver modification is NOT a Medicaid expansion for Georgia.” 

“Rather, it would preserve the long-term sustainability of Georgia Pathways as a valuable resource for beneficiaries,” Morning said in a statement.

When Georgia Pathways launched in 2023, it made Georgia the only state to require work or the equivalent for its newly covered Medicaid enrollees. The program, which is Kemp’s signature healthcare policy, covers about 20,000 “hard-working Georgians,” according to the public notice. 

Georgia already tried to receive the enhanced 90% match in 2019 under the first Trump administration without fully expanding Medicaid, but the U.S. Department of Health and Human Services at the time said that the enhanced match is provided for states that provide coverage for the income levels up to 138% of the federal poverty line – or about $22,025 for a single adult. 

“Georgia already tried this tactic in 2019 under the Trump administration, and it failed,” said Leah Chan, director of health justice at the left-leaning Georgia Budget and Policy Institute. “But I think what we do know is that the temporary federal approval for Pathways expires in December. So rather than wasting our time pursuing dead ends, we could simply just raise the Pathways income eligibility limit from 100% to 138% of the federal poverty level and pull down the enhanced 90% match authorized under the Affordable Care Act.” 

Georgia is one of 10 states that have not fully expanded Medicaid. Changing course now would require legislative approval and a signature from the governor.

To Whitney Griggs, director of health policy at Georgians for a Healthy Future, a patient advocacy organization that supports full Medicaid expansion, it seems like the state is doubling down on its Pathways program.

“What I’m getting from this is: ‘We’d like to continue Pathways as is,’” Griggs said.

Natalie Crawford, executive director of Georgia First, a bipartisan advocacy group, questioned whether the strategy is the most fiscally responsible in the long-term and whether full Medicaid expansion that “maximizes available federal dollars, further reduces the number of uninsured Georgians and better strengthens our healthcare system” would better serve Georgia.

“Our people are our greatest resource, and healthier Georgians mean a healthier economy,” Crawford said.

Members of the public can comment on the proposed waiver changes through written comments that can be submitted through Sept. 14. There will be a virtual public hearing on Aug. 19 at 11 a.m. and an in-person public hearing at the Department of Community Health’s board room at 12:30 p.m. on Aug. 24.

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