Georgia's Medicaid Work Requirement Program Reveals Administrative Challenges and Costs

Georgia's limited Medicaid expansion program, Pathways to Coverage, which requires enrollees to prove engagement in work or qualifying activities like schooling or volunteering, highlights the complexities and challenges states face with Medicaid work requirements.

Despite eligibility, many applicants, such as full-time students, report repeated denials and difficulty navigating the system, pointing to significant administrative barriers. Georgia remains one of only ten states that has not expanded Medicaid to a broader low-income population and is currently the only state enforcing such work-related criteria.

The program has incurred over $100 million in costs since its launch in July 2023, yet only a fraction of the budget has been spent on direct health benefits, with marketing expenses notably high. Challenges include ineffective verification of qualifying activities, long delays in processing eligibility, and strains imposed on other public assistance programs. A pending Government Accountability Office investigation will further examine the financial and operational aspects of the program.

Recent state efforts seek to ease administrative demands, such as less frequent work documentation, yet critics argue the program's complexity overshadows its stated goal of promoting employment. The federal government, via recent legislation, is pushing states to implement systems to monitor work requirements, with some exemptions outlined for certain populations.

Georgia's experience serves as a cautionary example of the resource demands and operational hurdles associated with Medicaid work requirements, influencing future state-level policy and compliance strategies.