New Georgia Medicaid Expansion ‘Will Come at the Expense of Low-income Georgians’
New work requirements and premium contributions in Georgia’s partially expanded Medicaid program will lead to unstable coverage, discourage or complicate applications, and yield no effect on employment, write Sarah Gordon, Megan Cole, and Nicole Huberfeld in a new JAMA viewpoint.
This past July, Georgia became the first state to partially expand its Medicaid program and impose requirements that force low-income Americans to work, volunteer, study, or train to become eligible for this healthcare coverage.
The state claims this new program, called Georgia Pathways to Coverage, will increase access to affordable health insurance for the 15+ percent of its residents who are uninsured, while also helping them become financially independent and begin a path to private coverage.
Even though Georgia Pathways may help close Georgia’s coverage gap, key features of the program impede its ability to effectively deliver coverage to low-income Georgians, write three SPH researchers in the Department of Health Law, Policy & Management in a new commentary published in JAMA.
Georgia is one of only 10 states that has not adopted Medicaid expansion under the Affordable Care Act, which gave states the option to expand Medicaid to adults with incomes up to 138 percent of the federal poverty level (FPL). Instead, the new Pathways program maintains some of the strictest Medicaid eligibility requirements in the country, limiting the expanded coverage to working-ageadults earning up to 100 percent of the FPL—$14,580 for a single person or $30,000 for a family of four. The program also doesn’t permit any exemptions to its 80-hour-per-month work requirements, only “good cause exceptions” that allow for modifications, but not full exemptions for people with disabilities, care giving responsibilities, or other burdens that may prevent them from being able to work.
“Although Georgia’s stated goal is to support employment, education, and professional development, it may be difficult to meaningfully increase employment rates because national data indicate that 61% of Medicaid enrollees work full-time or part-time, and an additional 30% are not working due to being the primary caregiver, illness, disability, or enrollment in school,” write Sarah Gordon, assistant professor of HLPM and codirector of BU’s Medicaid Policy Lab (MPL), Megan Cole, associate professor of HLPM and codirector of MPL, and Nicole Huberfeld, Edward R. Utley Professor of Health Law and an MPL affiliated faculty member. “Due to the lack of exemptions for those with dependents, many families with caregiving responsibilities will be unable to meet the minimum threshold of hours to satisfy the requirements to maintain coverage.”
In another first-in-the-nation Medicaid requirement, Georgia Pathways enrollees earning 50 to 100 percent of the FPL must pay a monthly premium up to 1.5 percent of their household income, conflicting with data that shows that Medicaid premiums actually discourage enrollment, the authors point out.
Furthermore, since Georgia opted not to fully expand Medicaid, the state will not benefit from an enhanced federal matching rate. “Georgia Pathways will cost more per person to cover fewer people,” they write.
In a possible signal of the program’s complicated application process, as well as the state’s lack of outreach about the program, Georgia Pathways only enrolled 265 applicants in the first month of the launch.
As Congressional Republicans continue to support federal Medicaid work requirements, Georgia Pathways could have implications for future national policy—but the program “will come at the expense of low-income Georgians and the health care clinicians who serve them,” the authors conclude.
Read the full commentary here.