Georgia is on track to become the only state to have work requirements for Medicaid coverage.
The re-election of Republican Gov. Brian Kemp — and a surprising decision by the Biden administration not to appeal a federal court decision — allowed the state to present its plan that would allow for a limited increase in the pool of residents to low income eligible for Medicaid.
Questions remain about the rollout of Kemp’s plan. But that would make Georgia a test case for a labor provision that has been proposed by several states and struck down by federal courts and the Biden administration.
Meanwhile, advocacy groups worry about barriers to getting and keeping coverage. They also point out that the Kemp plan would be more expensive per enrollee and would cover a fraction of those who would receive Medicaid under a full expansion. Georgia’s new eligibility program would require a minimum of 80 hours of work or volunteer work per month.
“The best-case scenario is that some uninsured Georgians would get coverage for a while,” said Laura Colbert, executive director of consumer advocacy group Georgians for a Healthy Future. “It’s going to be a big headache for the state and for people who sign up or try to sign up.”
The Trump administration has approved Medicaid work requirements for Georgia and 12 other states. Georgia won approval under a “waiver” or federal authorization that allows states to run programs that differ from the standard rules of Medicaid, the government insurance that covers the poor and disabled.
But the Biden White House rejected the Georgian plan.
In August, however, a federal judge in Georgia ruled that the Biden administration had overstepped its authority, clearing the way for the Kemp plan to continue. The federal government let the 60-day appeal window expire without doing anything.
The rationale for the White House’s decision not to appeal the court ruling remains unclear. A spokesperson for the Centers for Medicare & Medicaid Services, Bruce Alexander, said “as a matter of policy, CMS does not comment on litigation.”
CMS’s reluctance to appeal may be related to the aftermath of the case, said Leonardo Cuello, research professor at the Center for Children and Families at Georgetown University’s McCourt School of Public Policy. If appealed, the case would go to a conservative federal court that could favor the lower court’s decision — and set it as a stronger precedent.
“The decision not to appeal may have been based on fear that the result would be upheld on appeal, since most 11th Circuit appellate judges are Republican appointees,” he said.
Biden administration officials could also wait for the plan to materialize before intervening, said Catherine McKee, senior counsel for the National Health Law Program, a nonprofit advocacy program. Federal health officials “could let the state go ahead and monitor it, and take action in the future,” she said.
Kemp’s office did not respond to KHN’s requests for comment on the status of the plan. But after this article was published, the governor’s office confirmed it was moving forward with the plan, with the goal of having it operational by July.
Previously, Kemp celebrated the federal court’s August decision in a series of tweets“Despite the left’s efforts to salvage good politics for partisan politics, this week the judiciary…ruled that Biden’s administrator erred in reversing our innovative health care waiver. that would serve Georgians better than a one-time Medicaid expansion.”
The Georgia Department of Community Health, which oversees the state’s Medicaid program, declined an interview to answer questions about the work requirements plan.
But the agency recently posted two pages related to the “Georgia Pathways” program on its website: one with information on how to enroll, the other with details of the plan’s requirements. Both pages were taken down after KHN questioned the agency about them.
“Pathways is not live yet, so the links have been disabled to avoid confusion,” said Fiona Roberts, spokesperson for the agency.
Work requirements for Medicaid have a short history of nationwide implementation.
The only state to run a full-fledged work requirement program was Arkansas, which launched the rule in 2018. It led to about 18,000 people losing Medicaid coverage. A federal court suspended the requirement the following year.
Kemp’s victory over Democrat Stacey Abrams in this month’s midterm elections also thwarted — at least for now — Georgia Democrats’ longstanding push for a full Medicaid expansion, which should cover about 450,000 people, compared to about 50,000 under the Kemp plan. On Nov. 8, voters in South Dakota approved a ballot measure for full expansion, which would cover more than 40,000 more people in that state.
Georgia’s cost per enrollee for the work requirement program is expected to be at least three times higher than it would be under a steady Medicaid expansion, Colbert said.
The federal government would have paid at least 90% of insurance costs for hundreds of thousands of Georgians under a full expansion. That compares to the expected 67% match rate from federal authorities under the slimmer Kemp plan. And that difference does not take into account a Biden administration expansion incentive that would net Georgia $710 million, according to a KFF estimate.
Administrative hurdles to Kemp’s work plan would be significant, say consumer advocates. Full-time caregivers, people with mental health or addiction issues, and people unable to work but not yet eligible for disability coverage would struggle to qualify, Colbert said.
Other challenges could include a lack of transportation that makes it difficult for registrants to get to work and, for potential registrants, limited access to computers to register.
Besides volunteering, other activities eligible for Kemp plan coverage include education and job training.
Many people struggling with homelessness in Georgia would likely not meet the work or volunteer thresholds, said Kathryn Lawler, CEO of Saint Joseph’s Health System, an Atlanta-based nonprofit. Sixty percent of patients at her Mercy Care Community Health Centers are homeless, she said. Coverage through the Medicaid expansion would allow patients to afford health care, treat chronic conditions and relieve the stress of medical bills, she said.
People who need medical attention are often too sick to go to work, Lawler said, adding that a single mother with three small children could be considered ineligible. Fully expanding Medicaid, through increased payments to providers, would ultimately allow Mercy Care to serve more people in need, she said.
CMS’ decision not to appeal “was a bit surprising,” Colbert said, but she added that another adverse court ruling could pose a risk to other states’ Medicaid programs, paving the way for other work requirements.
CMS’s inaction could inspire similar bids for work requirements in other GOP-led states, McKee said.
The Georgian plan, meanwhile, would likely not begin until the end of the Covid public health emergency, which provided continued coverage for many Medicaid enrollees during the pandemic, and is expected to continue into the early part of the year. next year.
Kaiser Health News is a national newsroom that produces in-depth journalism on health issues. Along with policy analysis and polls, KHN is one of the three main operating programs of the KFF (Kaiser Family Foundation). KFF is an endowed non-profit organization providing information on health issues to the nation.
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