Medicaid Work Requirements to Go Into Effect This Summer

The countdown to the launch date of Georgia’s Medicaid work requirements program is underway.

The new plan – officially called Pathways to Coverage – goes into effect on July 1 and will require enrollees to complete 80 hours of work, education, job training, or community service per month to get Medicaid health insurance.

Many will also have to pay a monthly premium.

Once the program begins, Georgia will be the only state with work requirements for Medicaid.

Adults between ages 18 and 64 who earn less than 100% of the federal poverty level – and who are not otherwise eligible for Medicaid – are the targeted group.

For 2022, the federal poverty level was $13,590 for a single person and $27,750 for a family of four.

Though exact numbers are difficult to calculate, it’s expected that the Pathways program will provide insurance to only a small percentage of the 1.3 million Georgians without health insurance.

State officials estimate around 345,000 Georgians would be eligible for the new program.

Now that the program is becoming a reality, the Georgia Department of Community Health (DCH), the state Medicaid agency, has requested funds to cover up to 100,000 people in the upcoming budget, said spokesman David Graves. That’s 29% of those who will be eligible.

Critics of Pathways contend the program will cover far fewer Georgians and cost more than a full expansion of Medicaid, as 39 states have done.

Leonardo Cuello, research professor at Georgetown University’s Center for Children and Families, told Capitol Beat News that Georgia leadership has put in place barriers that they know, that they have calculated, will prevent … people from enrolling.

Enrollees in Georgia Pathways will need to certify their employment each month.

Those who earn more than 50% of the federal poverty level will also be required to pay a monthly premium ranging from $7 to $11, with an additional surcharge for people who use tobacco products.

The program will provide a two-month grace period for people who do not pay their premiums. But after three months of non-payment, they will lose the insurance. They can be reinstated if they make at least one monthly payment within 90 days.

The state plans to use the existing benefits portal, Georgia Gateway, for program applicants to manage their work-requirement reporting, said Graves, the DCH spokesperson. He said Georgians can expect to learn more about the details of the program over the coming months.

The Pathways program allows some exceptions to the work-requirement rules.

Enrollees will be allowed 120 hours of “non-compliance,” that is of not meeting the work requirements, in every 12-month period.