(AP Photo/Mark Humphrey)

Governor’s signature health initiative aims to address Georgia’s gap of 370,000 poor uninsured adults.

Gov. Brian Kemp’s limited expansion of Medicaid that launched July 1 for certain working or active adults has approved 265 people for enrollment in its first month, state officials said Thursday — a small step towards the 90,000 enrollees Kemp aides hope to enroll after it fully ramps up.

Kemp’s program, which was four years in the making, is meant to address the state’s health insurance coverage gap: An estimated 370,000 poor Georgia adults have no insurance through a job, but earn too little money to qualify for subsidized plans on the Affordable Care Act marketplace.

Georgia’s unique plan, known as Pathways to Coverage, would not cover all of them, but those who meet certain requirements. Georgia’s plan includes requiring new enrollees under Pathways to work or do other approved activities in order to become eligible for the Medicaid coverage. Existing or new enrollees for traditional Medicaid, such as children or some poor elderly adults, don’t face a work requirement.

Political critics of Georgia’s requirements pounced at Thursday’s news of the modest number of enrollees. But Garrison Douglas, a spokesman for Kemp, said to give it time.

“As applications continue to be reviewed, those who will benefit from this new and innovative program will continue to grow,” Douglas said.

Medicaid is the government-funded health insurance program for poor children. Most states have decided to expand it under the federal Affordable Care Act to also cover all poor adults. Georgia is one of 11 states that have not fully expanded it, but instead added limited categories of adults to coverage. Partly as a result, Georgia has the nation’s third-worst rate of people who are uninsured.

Kemp has said Georgia will be better off with a program tailored by the state, for the state.

Under Kemp’s new program, called a “waiver,” adults can enroll in Pathways to Coverage if they file monthly reports showing that they met specific work or activity requirements adding up to 80 hours a month. Volunteering at a nonprofit would qualify, but a mother taking care of her children would not.

Although about 370,000 people are eligible to apply for Pathways, even Kemp aides know through their research that the majority of them will not end up meeting the requirements. Experts say the requirement to file a monthly report on hours spent on activities is a barrier to coverage.

Robin Rudowitz, director of the Program on Medicaid and the Uninsured at the nonprofit research organization KFF, said that that’s what KFF saw in the brief implementation of a work requirement in Arkansas. “Many people who were working were just not able to navigate the reporting on an ongoing basis,” she said.

Advocates for full Medicaid expansion criticize Kemp’s plan for failing to offer health insurance to every low-income person who needs it. They also say that Kemp’s plan will cost the state more to implement than full expansion would, all while covering fewer people.

The higher cost comes from having to devise the computer infrastructure and train staff for implementing the new requirements, and from the loss of billions of dollars in new federal funding given to states.

Georgia Republicans have repeatedly turned down that federal incentive, saying they can’t guarantee it will be there in future years. Georgia Democrats have pointed out the money has continued to flow over the last decade to other states.

Leah Chan, director of health justice at the left-leaning Georgia Budget and Policy Institute, said it was early, but “They have had many years knowing that this was a program they wanted to launch. … My first reaction is it just falls very short of the number of Georgians who are in the coverage gap.”

Kemp bills the Georgia program as a conservative alternative to full Medicaid expansion. He developed it in concert with the Trump administration, the two arguing that the lure of Medicaid may draw people to a more active and thus a more healthy life.

The program is in its infancy and the governor’s office has always expected it would take about two years to reach full enrollment. Initial numbers estimated that of about 400,000 eligible adults, about 50,000 would be enrolled after two years. Those estimates changed during pandemic fluctuations in job and income data. Kemp aides now estimate it will cover about 90,000.

Kemp allies urged against a rush to judgement, and said that however it worked out, that would be a lesson going forward.

“We are glad to see Georgia Pathways up and running, and we look forward to reviewing its results after it has had sufficient time to ramp up,” said Kyle Wingfield, president and CEO of the libertarian-leaning Georgia Public Policy Foundation. “It’s important to remember that these kinds of demonstration programs are meant to show us if there’s a better way for states to operate Medicaid, and it will take time for Georgia Pathways to compile the experiences needed to evaluate whether it fulfills that promise.”

Lynnette Rhodes, Georgia Department of Community Health chief health policy officer, disclosed the number approved so far in a presentation to a department committee Thursday morning. “There’s still some more work that we have to do for Pathways, but overall the core functionality has stood up and the program (is) working,” she said.
At the same time, Rhodes is helping manage the largest undertaking in more than a decade at Medicaid: the “unwinding” of pandemic emergency protections that allowed hundreds of thousands of people to join the program without getting kicked off when they no longer qualified.

Like all states, Georgia is re-evaluating all 2.8 million of the state’s Medicaid case files to make sure every enrollee still qualifies. Rhodes said Thursday that 68,000 Georgia Medicaid enrollees were terminated. Over 100,000 Georgians have been dropped from Medicaid since April.

Kemp’s spokesman, Douglas, in a statement to the AJC emphasized the positive nature of Kemp’s goals in contrast to the re-qualification process.

“While the Federal Government has initiated and dictated the process for redetermining current Medicaid recipients, Georgia is the only state in the country simultaneously providing a new pathway to healthcare coverage and opportunity.”

Georgia is now among 11 states that have not fully expanded Medicaid. On the same day Georgia opened its limited expansion plan, South Dakota launched a full expansion to all its poor. North Carolina has approved full expansion in theory and now is awaiting a funding decision, which would bring the number down to 10.

HEALTH NEWS/ AJC , August 10, 2023