The U.S. Government Accountability Office (GAO) is currently examining the costs associated with running Georgia’s Pathways to Coverage program, the nation’s only active Medicaid work requirement program. This analysis is expected to be released in the fall. As Republican state and federal lawmakers consider implementing similar requirements, the GAO’s findings could provide valuable insights.
In the first 100 days of the Trump administration, efforts were made to root out waste in federal programs, leading to potential changes in the operations of government agencies. The push for a nationwide mandate requiring Medicaid enrollees to work, study, or engage in other qualifying activities to maintain coverage is gaining traction as Republicans aim to cut $880 billion from the federal deficit over 10 years. These savings are intended to offset costs associated with President Donald Trump’s priorities, such as border security and tax cuts that primarily benefit the wealthy.
Despite the growing interest in Medicaid work requirements, a majority of the public, regardless of political affiliation, opposes funding cuts to Medicaid, as revealed by polling conducted by the Kaiser Family Foundation (KFF). This underscores the importance of understanding the implications of such programs before implementing them.
The experiences of Georgia and Arkansas, the only two states that have run Medicaid work requirement programs, have shown that these requirements can lead to a decrease in Medicaid enrollment while adding costly layers of bureaucracy. The GAO’s investigation aims to shed light on these issues, providing critical information to Congress as they consider potential changes to the Medicaid program.
While the Trump administration has supported work requirements, the GAO found in 2019 that these programs can be expensive for states to run, with costs reaching hundreds of millions of dollars in some cases. Federal officials failed to consider these costs when approving the programs, highlighting the need for a thorough examination of the financial implications.
As more states seek approval for Medicaid work requirements, the Centers for Medicare & Medicaid Services (CMS) plays a key role in approving pilot programs. However, there has been limited response from CMS regarding these initiatives.
The push for work requirements in Medicaid continues, with Mehmet Oz expressing support for such requirements during his confirmation hearing to lead CMS. Despite the approval of work requirements in 13 states under the Trump administration, many of these programs were subsequently blocked by the Biden administration or federal courts.
Georgia’s Pathways to Coverage program, launched in 2023, has incurred significant costs, with a substantial portion of funding going towards program administration. Although the program has enrolled a relatively small number of individuals compared to a full Medicaid expansion, it has had implications for processing times of other benefit programs in the state.
Looking ahead, the future of Medicaid work requirements remains uncertain, with ongoing discussions and debates surrounding their benefits and costs. As more states consider implementing similar programs, it is essential to carefully evaluate the impact of these requirements on Medicaid enrollees and the overall healthcare system. Georgia’s Work Requirement Program Under Investigation by GAO
Georgia’s controversial work requirement program, known as Pathways to Coverage, is under scrutiny once again as the Government Accountability Office (GAO) investigates its costs and effectiveness. The program, which was halted by a court order in 2019 after more than 18,000 individuals lost coverage in less than a year, is set to undergo changes as Georgia plans to request renewal with modifications.
One of the proposed changes includes reducing the frequency with which enrollees must prove they are working or engaging in other qualifying activities to the state. This adjustment aims to make the program more accessible to participants while still maintaining its core objectives.
The GAO investigation was initiated following a request from three Democratic U.S. senators – Jon Ossoff and Raphael Warnock of Georgia, and Ron Wyden of Oregon. The senators raised concerns about the program’s costs and its impact on coverage. They pointed to a report by KFF Health News, which highlighted the disparities in spending and coverage compared to other states.
Warnock, in a statement, expressed his confidence that the GAO report will shed light on the inefficiencies of the Pathways to Coverage program. He emphasized the importance of closing the healthcare coverage gap and ensuring that taxpayer money is utilized effectively.
The GAO’s investigation aims to determine the total expenditure incurred by Georgia in running the program, the proportion of federal funds allocated, and the mechanisms in place to track spending. This comprehensive analysis will provide valuable insights into the program’s financial implications and its overall effectiveness.
KFF Health News, a national newsroom dedicated to in-depth health journalism, has been instrumental in bringing attention to the issues surrounding Georgia’s work requirement program. As an independent source for health policy research and reporting, KFF Health News continues to advocate for transparency and accountability in healthcare initiatives.
As the GAO investigation unfolds, stakeholders and policymakers will have a better understanding of the challenges and opportunities associated with Georgia’s Pathways to Coverage program. By addressing the concerns raised by the senators and the broader community, Georgia can work towards improving access to healthcare for all its residents.
