On September 5th, Georgia’s Comprehensive Health Coverage Commission (CHCC) held its second meeting. The CHCC, created by state leaders this past spring, is tasked with exploring ways to improve health care access for low-income and uninsured Georgians.
If you missed the first meeting, you can catch up by reading our July recap blog.
You can watch a recording of the September 5th meeting here.
Key focus of the meeting: Georgia Pathways to Coverage and enrollment struggles
A presentation from Grant Thomas, Deputy Commissioner of the Georgia Department of Community Health took up the bulk of the September meeting and sparked much of the Commission’s conversation. The presentation covered the state’s Pathways to Coverage program, its struggles to meet enrollment goals and the needs of uninsured Georgians, the new Georgia Access marketplace, and data about the size and scope of Georgia’s uninsured population. The agenda was built on the Commission’s July meeting, which introduced Georgia’s health coverage landscape, including Medicaid and Georgia Access to Commission members.
What is Georgia Pathways?
Georgia Pathways to Coverage is a relatively new Medicaid program that launched in July 2023. The program offers Medicaid coverage to adults aged 19-64 who have incomes up to 100% of the federal poverty level (FPL) if they can prove that they meet certain work, education, or volunteer requirements. Gov. Kemp’s administration projected that Pathways could potentially cover 30,000 Georgians in the first program year and up to 100,000 at full implementation.
As of July 31, 2024—over a year after its launch—only around 4,300 people are enrolled in the program. This low enrollment, compared to the state’s initial expectations, was a central concern for several Commission members. The Commission discussed the reasons behind these low numbers.
DCH’s Thomas outlined some potential strategies to boost Pathways enrollment, such as a planned outreach campaign (funded by $10 million in state taxpayer dollars) and simplifying the enrollment process. There was also discussion about leveraging data from other programs, like SNAP* and TANF*, to identify eligible participants.
- Supplemental Nutrition Assistance Program or SNAP (aka food stamps)
- Temporary Assistance for Needy Families program (TANF)
Thomas didn’t define what success for the Pathways program looks like currently or what its enrollment goals are following the outreach and marketing campaign. This lack of specificity led some Commission members to question the state’s long-term strategy for Pathways.
Several Commission members, including Dr. John Odum, cautioned that digital outreach alone may not be enough to reach the target populations, especially in rural areas where internet access is limited. The Commission also emphasized the need to improve provider participation across the state’s health care programs, as many enrollees struggle to find providers willing to accept Medicaid or Pathways coverage.
How is Pathways different than Georgia’s Medicaid Program?
Georgia’s Medicaid eligibility requirements are some of the most restrictive in the nation, limiting health coverage for many low-income adults. Only individuals with low incomes who meet very specific criteria—such as pregnant women, children, seniors, people with disabilities, and some very low-income parents—are eligible. This leaves hundreds of thousands of Georgians without the essential coverage and care they need.
Georgia’s restrictions in Pathways continue to leave hundreds of thousands in a coverage gap. Georgia Medicaid’s stringent eligibility criteria mean many low-income individuals who do not fall into specific categories cannot get covered. Meanwhile, Pathways’ paperwork requirements to prove work and other activities are major barriers to enrollment, even for those who meet the strict requirements. This further limits coverage options for many low-income Georgians.
Why low Pathways enrollment matters: Coverage Gap and costs
The Pathways program is seen by Gov. Kemp’s administration as an alternative solution to closing Georgia’s health insurance coverage gap, which affects about 240,000 residents according to data presented by DCH’s Thomas.
Even if Pathways hits its full enrollment goal of 100,000 individuals by late 2025—a figure that is 22 times higher than current enrollment—the program would still cover less than half of the Georgians in need and would cost the state significantly more per person than fully closing Georgia’s coverage gap.
Georgia’s waiver that established the Pathways program is currently set to expire in September 2025. The Kemp administration has stated that they plan to ask the federal government for permission to renew the program, despite its limited effectiveness and failure (to date) to meet enrollment goals.
Georgia Access: Celebrated success, underlying issues
Thomas’s presentation also spotlighted Georgia Access, the state’s soon-to-be health insurance marketplace. The Kemp administration has touted that the new marketplace already has more than 1.3 million enrollees, including 710,000 Georgians with lower incomes (100-150% FPL, for example, an individual making $15,060 to $22,590).
However, the state’s claim to this win is incomplete and a bit premature. Georgia Access is set to officially launch on November 1st, 2024. Because Georgia Access isn’t fully live yet, it cannot be the cause of the great enrollment growth among Georgia residents.
The primary driver for increased enrollment in private insurance over the past several years has been lower premiums. Two policies are helping contribute to lower premiums.
- Gov. Kemp’s administration began using a policy tool (called “reinsurance”) that helps to lower premiums, especially for rural Georgians.
- In 2021, Congress and the US President passed the American Rescue Plan (ARP) which lowered premiums by providing Georgians (and consumers across the country) with more financial assistance when they purchase health insurance. Since this extra help went into effect, health insurance enrollment through the Affordable Care Act has risen substantially nationwide, and it has doubled in Georgia. \
Enrollment increases among Georgians who are purchasing subsidized health insurance is incredibly exciting because it means more Georgians can use their insurance to access health care when they are sick, purchase affordable medicines, and stay healthy before developing a serious health issue.
However, Georgia’s progress is at risk. The federal subsidies that lower Georgians’ premiums are set to expire in 2025 unless Congress acts to renew them. Without these subsidies, Georgians would see their premiums rise by 85% on average, and the number of Georgians enrolled in coverage through Georgia Access is likely to drop by half. All 1.3 million Georgians who purchase their coverage through healthcare.gov (and GeorgiaAccess.gov starting this fall) would be impacted by these premium increases and would need to make decisions about whether they can afford to keep their coverage.
The state’s enrollment goal vs. reality
The Commission also heard DCH’s Thomas review 2022 census data about the number of uninsured Georgians. While this data is important for understanding which Georgians are uninsured and/or low-income, the presentation did not account for the Georgians who may have lost health coverage during the Medicaid unwinding. The 2022 level of uninsured Georgia children and adults presented to the Commission likely represents the lowest (and best) number our state has achieved in recent years. When 2024 data is analyzed and released, our state’s uninsured rate will almost certainly be worse.
Georgia has one of the highest uninsured rates in the country and a recent policy brief from the Georgia Health Initiative estimates that 434,000 Georgians could gain health coverage if the state fully closes the health insurance coverage gap.
While Georgia Access and Pathways may help at the margins, these programs do not and cannot fully close our state’s coverage gap.
Stay engaged with Cover Georgia—your voice matters!
The Commission needs to hear from people directly affected by these issues, especially as it prepares to report to state leaders.
Cover Georgia is creating a petition for you to share ideas on closing the coverage gap. Sign up for Cover Georgia emails to stay informed and share your thoughts. We’ll keep tracking the Commission’s progress and provide opportunities for you to advocate for the health solutions that all Georgians need.
Stay tuned for more updates!