Federal Medicaid Cuts Impact Georgia's Coverage Gap and Disability Support Programs
The recently signed federal spending bill, labeled by former President Trump as the “One Big Beautiful Bill,” includes over $1 trillion in healthcare spending cuts over the next decade. These cuts will significantly impact Medicaid programs across the U.S., particularly those in states that have not expanded Medicaid under the Affordable Care Act (ACA). Georgia, one of the 10 non-expansion states, instead implemented the Pathways to Coverage program, which has been criticized for high costs and limited effectiveness.
Georgia's uninsured rate stands at 13.6% for under-65 residents, above the national average of 9.5%. The bill also imposes new Medicaid work requirements on states that expanded Medicaid, affecting 40 states. Disability advocacy groups warn that funding reductions and new restrictions could severely undermine Medicaid services for disabled individuals, including home and community-based waiver programs such as Georgia’s NOW/COMP waivers.
Georgia's Medicaid eligibility is limited to specific low-income groups but excludes the coverage gap population—those earning too much for Medicaid but without Marketplace subsidies. Approximately 192,000 Georgians fall into this gap. Pathways to Coverage imposes work or education requirements plus a lower income threshold than expansion would allow, leading to limited enrollment and increased administrative burdens.
Studies by Georgia Budget & Policy Institute and the Southern Poverty Law Center have criticized Pathways for inefficient enrollment, technical issues, and administrative costs that outweigh benefit spending. Despite millions spent on consultants and outreach, enrollment remains far below projections, with significant application backlogs.
State politicians hold divergent views on Medicaid expansion versus Pathways. Some consider Medicaid flawed, emphasizing program access and care, while others point out the higher cost and loss of federal funds under Pathways. Uninsured individuals often end up using expensive emergency services, shifting costs to taxpayers.
Advocates highlight the broader impacts on families reliant on Medicaid waivers for disability support and care services. The waiting lists for critical waivers are long, and potential funding cuts risk reducing services that help disabled people participate in their communities. The story of a family caring for a son with Down syndrome illustrates these challenges.
Federal Medicaid funding cuts also threaten healthcare providers, especially rural hospitals and senior care facilities dependent on Medicaid reimbursements. In Georgia, 20 rural hospitals are at risk of closure, exacerbating medical access issues, notably in maternal and infant health outcomes, where Georgia ranks poorly.
Alternative waiver programs like TEFRA/Katie Beckett are crucial for disabled children with high medical needs, supplementing private insurance but remain variably available and vulnerable to funding threats. Public investigations reveal substantial taxpayer funds have been allocated to consulting with little measurable improvement in program outcomes.
Georgia's experience reflects broader national debates on Medicaid expansion, work requirements, and support programs for vulnerable populations under shifting federal healthcare policies. The state’s approach and ongoing legislative proposals will continue to be monitored by stakeholders concerned with coverage access, cost efficiency, and service quality.