Georgia offered a work requirement for Medicaid. Few have signed up.

Democrats have long tried to get red states to expand the federal Medicaid program and bring health insurance to more of their most vulnerable residents. The Biden administration sweetened the pot in 2021 with additional federal money, but GOP officials, including Kemp, have been reluctant to accept the offer unless they can tie the benefits to employment.

Georgia’s slow rollout of the program has done little to change the state’s double-digit uninsured rate, one of the highest in the U.S., and could dissuade other red states that have yet to expand Medicaid, including nearby Alabama, Mississippi and South Carolina, from following suit. Following in Georgia’s footsteps, even as they come under increasing pressure from the health care industry to expand their government-run health insurance program.

However, some in Georgia believe it is too early to draw conclusions about the program and that many people may not yet know the program exists.

I’ve got my fingers crossed it’s going to be a good solution, said Georgia state Rep. Lee Hawkins, the Republican who chairs the House Health Committee. Getting the word out is always difficult with any new program.

Georgia is the only state with a Medicaid work requirement, although Kansas Gov. Laura Kelly, a Democrat, recently proposed one to woo the Republican legislature. Arkansas Republican Governor Sarah Huckabee Sanders is awaiting federal approval for a similar idea.

The work requirements were part of the Trump administration’s plans to reform Medicaid and were approved by the Centers for Medicare and Medicaid Services in 13 states. But court rulings and the Covid-19 pandemic disrupted implementation, and the Biden administration later rescinded the approvals. However, Georgia won a federal court challenge in 2022, allowing it to implement the policy and partially expand Medicaid.

The move followed years of public debate over whether to expand the low-income health insurance program, with Democrats making it a focus of the 2018 and 2022 gubernatorial campaigns.

Kemp, who won both elections, chose instead to limit expanded coverage to adults earning up to the federal poverty line of $14,580 for a single person or $30,000 for a family of four. But coverage for this new group is only available to those who document that they work, study or volunteer for 80 hours a month.

It feels like a political compromise between people who wanted expansion and people who didn’t want expansion, Pope said. And it ended up being quite a small extension.

Georgia Republicans are urging patience, noting that the state’s Medicaid agency has been busy verifying the eligibility of millions of people for the first time since the pandemic.

As with any newly launched program, we expect enrollment to increase over time, a health department spokesperson said.

Kemps’ office did not respond to a request for comment.

For those on the right who have long wanted to limit Medicaid, the low enrollment numbers are evidence that too many people are content to rely on government help they don’t need instead of finding a job or going to school.

Since so few able-bodied adults are willing to work, train, or volunteer, even part-time, to qualify for Pathways, it is clear that a full expansion would reduce employment for those who can work and jeopardize resources intended for low-income people who are truly in need. children and the disabled, said Jonathan Ingram, vice president of policy and research at the Foundation for Government Accountability.

The parties agree that the lack of awareness of the program is also likely to contribute to the low number of participants.

It’s still early and I think people need to be educated, Rep said. Dude Carter (R-Ga.). I wouldn’t read too much into it at this point.

For opponents of the limited expansion, the slow start has led to renewed calls for the state to enact a full Medicaid expansion that would cover people earning up to 138 percent of the poverty level without work requirements.

Pathways to Coverage has cost Georgia more money and covers far fewer people than if the state simply joined 40 other states in expanding Medicaid, state Sen. Raphael Warnock (D-Ga.) said in a statement to POLITICO. While state politicians continue to gamble with people’s lives, Georgians are dying because they cannot afford the health care they need.

The final verdict on Georgias program could determine whether red states try to reimpose Medicaid work requirements, especially if a Republican wins the White House.

Making sure the path is cleared and states like Georgia take the lead can help create a new path that’s less fraught with obstacles, said Nina Owcharenko Schäfer, director of Heritage’s Center for Health and Wellness Policy. foundation. Doing such experiments is important. We must learn from them. They are not meant to be, knock it out of the ballpark in one hit.

In Kansas, the Kellys’ proposal to increase the annual work requirement is a concession that comes after five failed attempts to get the Republican-controlled legislature to expand Medicaid.

The governor’s office dismissed the idea that its program would face a similar fate to Georgia’s.

The reason they’ve struggled to get a few signups is because of the bureaucratic hurdles people have to clear to show they’re working, Kelly spokeswoman Brianna Johnson said.

Arkansas has an application pending with CMS to reinstate work requirements, but beneficiaries will not lose coverage if they do not comply. Instead, beneficiaries get more care coordination, services and closeness.

The state imposed the requirements in 2018, and more than 18,000 people lost coverage in seven months. A federal judge struck down the program in 2019, ruling that work requirements undermine Medicaid’s primary mission of providing health care.

Courts also ended work requirement programs in New Hampshire and Kentucky. Other states, such as Arizona and Indiana, suspended their programs in part because of actions taken in other states.

Liberals hope the slow rollout of Georgia’s programs will give states pause before trying something similar under a future Republican administration.

Considering where we are with enrollment, it seems like it would be very foolish, said Joan Alker, executive director of Georgetown University’s Center for Children and Families. Never say never, but the fact that no one is protected does not answer the pressures that states feel.

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