Georgia: How're work reporting requirements for Medicaid working out these days anyway? Ummmm...

I last checked in on the "Georgia Pathways" program (the Peach State's partial-Medicaid expansion program which offiically extends up to 100% of the Federal Poverty Level but which also includes a draconian work reporting requirement) back in January.

At the time, only around 2,500 Georgians had actually enrolled in Georgia Pathways, for a number of rather obvious reasons:

As Leonardo Cuello of the Georgetown University McCourt School of Public Policy noted last winter:

So, first, individuals who fail to report and document sufficient hours in any month (even, for example, someone with variable job hours) are suspended the next month – their health coverage completely stops. This means that many individuals will cycle on and off coverage, based on whether they are able to report and document enough hours every month. This isn’t a three-strikes policy such as Arkansas had – it’s one strike and you’re out. This policy will be devastating to enrollment and continuity of care in Georgia Pathways and will create an incredible amount of administrative hassle for individuals, providers, and state staff. Georgians won’t get far on this “Pathway” lined with red tape.

Second, of course, the strict requirements on documentation will lead to many reporting failures. Consider, for example, individuals who have informal employment arrangements or are self-employed. While the state does offer some good cause exceptions, they are time-limited and also almost always require submitting documentation. So this too will be a failure point.

Finally, as we have discussed from the outset, one of the most harmful and anti-family features of the Pathways model is that, unlike every work requirement proposal before it, there is no exemption of any kind for parents or caregivers. Parents will have to choose between taking care of their children or having health insurance – a terrible situation for parents and children alike.

Anyway, Sudhin Thanawala of the AP News Service published an updated look at Georgia Pathways on the first anniversary of it being implemented, and the data isn't exactly impressive one year in:

By now, Georgia officials expected their new Medicaid plan, the only one in the nation with a work requirement, to provide health insurance to 25,000 low-income residents and possibly tens of thousands more.

But a year since its launch, Pathways to Coverage has roughly 4,300 members, much lower than what state officials projected and a tiny fraction of the roughly half-million state residents who could be covered if Georgia, like 40 other states, agreed to a full Medicaid expansion.

Georgia Gov. Brian Kemp’s office has presented Pathways as a compromise that would add people to Medicaid while also helping them transition off it. Blaming the Biden administration for delaying the program’s start, Kemp’s office says it’s redoubling efforts to sign people up.

Health and public policy experts believe the enrollment numbers, dismal even compared to what Kemp’s office had said Pathways could achieve, reflect a fundamental flaw: The work requirement is just too burdensome.

“It’s clear that the Georgia Pathways experiment is a huge failure,” said Leo Cuello, a research professor at the Georgetown University McCourt School of Public Policy.

Pathways requires all recipients to show at least 80 hours of work monthly, volunteer activity, schooling or vocational rehabilitation. It also limits coverage to able-bodied adults earning no more than the federal poverty line, which is $15,060 for a single person and $31,200 for a family of four.

Cuello noted the program makes no exceptions for people who are caring for children or other family, lack transportation, suffer from drug addiction or face a myriad other barriers to employment. Then there are people with informal jobs that make documenting their hours impossible.

In rural Clay County in southwest Georgia, Dr. Karen Kinsell said many of her patients are too sick to work.

For comparison, North Carolina (which has a nearly identical population to Georgia...both have around 10.8 million people) just announced that they've enrolled over 500,000 residents in Medicaid via full ACA expansion without work requirements...after only seven months.

I should note that work reporting requirements would be just one of the many draconian additions to Medicaid nationally if Donald Trump's Project 2025 were to be implemented.