Rejected: Georgia’s Medicaid work requirement won’t work

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The Biden administration Thursday rejected Georgia’s bid to make a limited expansion of Medicaid subject to a work requirement.

The state proposed the work requirement as part of a demonstration waiver from provisions of the Affordable Care Act (ACA). The waiver was approved by the Trump administration last year.


After putting the waiver on hold last winter, the federal Centers for Medicare & Medicaid Services (CMS) raised objections in a letter to the state Thursday, citing disruptions resulting from the coronavirus pandemic.

“Georgia’s work requirements significantly compromise the state demonstration’s effectiveness in promoting coverage for intended beneficiaries,” the agency stated in a news release. “The lingering health consequences of COVID-19 infections further exacerbate the harms of these barriers to coverage for people with low income.”

Republican Gov. Brian Kemp rolled out Georgia Pathways, the state’s alternative to the ACA, two years ago. The program would provide health coverage to Georgians who work or volunteer at least 80 hours per month.

For those eligible, the state either would cover their portion of an employer-based health plan or, if they can’t get health insurance though their jobs, it would enroll them in Medicaid.

The program would cover Georgians who earn annual incomes of up to 100% of the federal poverty level.

Kemp pitched Georgia Pathways as a more conservative, fiscally sound approach to Medicaid expansion.

The full expansion of Medicaid in the ACA and supported by Democrats does not include a work requirement and covers adults with incomes up to 138% of the poverty level. All but 12 states have adopted a full Medicaid expansion.

A provision in President Joe Biden’s Build Back Better Act now before the U.S. Senate would let low-income residents in states that have not approved a full Medicaid expansion receive coverage.

The U.S. House of Representatives has passed the legislation. However, opposition from U.S. Sen. Joe Manchin, D-W.Va., threatens to sink the bill in the Senate, which is split 50-50 between Republicans and Democrats.

Georgia House Speaker David Ralston criticized the Biden administration Thursday for rejecting a state plan that would offer Medicaid coverage to additional Georgians sooner rather than later.

“It is shameful that President Biden has denied thousands of Georgians health-care coverage,” said Ralston, R-Blue Ridge. “Like the Grinch, he has stolen hope away from so many families who need it — right at Christmas.”

This story available through a news partnership with Capitol Beat News Service, a project of the Georgia Press Educational Foundation.

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