Background: In 2019, Georgia submitted a plan to the Centers Medicare and Medicaid Services (CMS) to expand Medicaid to a certain subset of Georgians. Under the plan, called the Georgia Pathways waiver, the state planned to allow individuals aged 19-64 making up to 100% of the federal poverty line (FPL) ($12,880 for an individual and $17,420 for a family of 2) to apply for Medicaid coverage. The Georgia Pathways plan also required these newly eligible adults to complete and document 80 hours of work or other “qualifying activities” each month to enroll in and maintain coverage. The plan further required some enrollees (those making 50-100% FPL) to pay a monthly premium to maintain their coverage, which is not required for traditional Medicaid.
In late 2020, the Trump Administration approved the Georgia Pathways plan and implementation was slated for the following July. In spring 2021, the Biden Administration changed the status of Georgia’s plan from “approved” to “pending” and stated they needed to review the plan, specifically the work and premium requirements, to ensure they were in keeping with the spirit, goals, and intent of the Medicaid program. You can learn more about the Georgia Pathways program and the approval timeline here.
On December 23rd, 2021, CMS approved the Georgia Pathways plan and will allow Georgia to extend Medicaid coverage to Georgians making up to the poverty line (or 100% FPL). However, CMS denied the state’s request to include work requirements and premium payments as a condition of enrolling in and maintaining Medicaid coverage. CMS cited concerns about the devastating impact the COVID-19 pandemic has had on both the health and economic security of Georgians as the reason for denying these provisions.
Now that CMS has issued its decision, Governor Kemp and the Georgia legislature must decide how to proceed, choosing one of these four options:
- Do nothing. Even though CMS approved a modified version of the Georgia Pathways waiver, Georgia is under no obligation to implement it. This action would mean the coverage gap remains in place and vulnerable low-income Georgians would largely remain uninsured.
- Appeal CMS’s decision on the work and premium requirements. On Jan. 22, 2022, Gov. Kemp initiated an appeal beginning a lengthy process with CMS (a process made even slower by the pandemic). While the state pursues the appeal, thousands of Georgians will remain without coverage. State leaders can move forward with the following two options even while the appeal is in process.
- Move forward with the Georgia Pathways plan as approved. Under this option, Georgians making less than 100% FPL would be eligible for Medicaid. An estimated 269,000 uninsured Georgians would gain coverage. This plan would cost the state 2.5 times more to implement than the following option.
- Expand Medicaid to cover more people at a lower cost. Under a full Medicaid expansion, individuals and families making up to (138% FPL) would be eligible for coverage. As many as 500,000 Georgians would be covered and the state would qualify for a 90% cost match from the federal government. Georgia would save millions of dollars annually over the Pathways waiver and earn a $1.3 billion bonus in the first two years.
With CMS’s approval of the Georgia Pathways program, the state is at a crossroads. Our state leaders can choose to meet the pressing health care needs of the state through Medicaid expansion, or they can choose to help fewer Georgians at a higher cost under the Pathways program.
Our state leaders cannot and should not choose to do nothing because Georgians can’t wait. Too many Georgians are without health coverage and the positive effects that come with coverage. It is far past time to act and the onus lies with our state leaders to decide the way forward. Click HERE to take action!