Why Georgia’s Medicaid work requirements are a crucial test case

Georgia will soon become the first state to require Medicaid recipients to work. The success or failure in this plan could serve as a model for other states planning for the next Republican White House.

This weekend, the new program will be launched. It will allow adults with disabilities who never qualified for Medicaid before to apply. The program could provide health insurance to tens or thousands of additional residents, but only if the resident can prove that they are working or enrolled in training programs or other activities 80 hours per month.

Conservatives are focusing more on Medicaid work requirements. While the Biden administration will not approve any state’s request, an upcoming GOP president would.

The Trump administration approved 13 Medicaid programs with work requirements. After a federal court struck down two approvals for 2019 and the Biden Administration quietly revoked 10 more, momentum to impose work requirements ceased.

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The House Republicans renewed the effort this spring and work requirements became a sticking-point in negotiations over debt ceilings. The policy was not included in final compromise legislation as both President Biden, and Democrats, said it would be a non-starter.

The Congressional Budget Office estimated that Medicaid work requirements could save the government $109 Billion, but not by increasing employment.

The bill would have affected about 600,000 adult Medicaid beneficiaries, but the Department of Health and Human Services stated that it could be many more.

The Georgetown University Center for Children and Families’ executive director, Joan Alker said, “Despite the evidence showing that Medicaid work requirements do not work to their stated goal of supporting employment, they persist and continue to be an interest in certain states.”

“I wouldn’t be shocked if there was a change of administration and this policy would be brought back.”

Republicans have long argued work requirements are needed to encourage people to lift themselves out of poverty. Conservatives believe Georgia’s program is very promising.

“I believe the benefits of the program are that it is a way to get health insurance but Medicaid coverage, not the end-goal,” said Chris Denson. He’s the policy and research director at the Georgia Public Policy Foundation. “It is a way to get commercial insurance, instead of staying on Medicaid.”

Some GOP state officials now try different tactics to avoid the previous legal challenges.

Arkansas officials sent a new waiver request to the Biden Administration earlier this month, asking that the federal government allow work requirements to be placed on people who are enrolled in the expanded Medicaid program.

Gov. Sarah Huckabee Sanders, a former White House Press Secretary in the Trump Administration, said that reviving the work requirement will “address the workforce challenges of our state and empower thousands Arkansans to break free from government dependency.”

In 2019, a federal judge halted the previous program after it resulted in an estimated 18,000 people losing their insurance coverage in the first 7 months of its implementation.

The new approach does not eliminate anyone who fails to comply. It will instead move them away from the private insurance that was used to expand Arkansas’s Medicaid program and onto the traditional fee for service Medicaid program which is less generous.

Biden’s health officials haven’t commented on any pending waiver requests.

Georgia’s application to its Pathways to Coverage Program was approved during the final days of the Trump Administration. The Biden White House repealed work requirements in early 2021 and the policy that some beneficiaries would pay a monthly fee.

Gov. Brian Kemp (R), sued and a federal court ruled in favor of the State, ruling that it would see a net increase in coverage, even if some people were removed because they did not meet the requirement to work. Biden’s administration, in a surprising decision, did not appeal and allowed the program to go into effect.

The state estimates of how many people would benefit differ.

Kemp’s original plan estimated that about 50,000 people would gain coverage. According to the latest estimates, about 345,000 people will be covered. However, advocates are skeptical that most of them would be able meet reporting requirements.

Georgia has some of the most strict Medicaid requirements. It will only cover parents who earn up to 30 percent of federal poverty level (a maximum annual income of $8,000 for a three-person family).

Since 2010, the state has refused to fully expand under the Affordable Health Care Act (ACA). The critics say that the state is losing significant federal funds, and that the Pathways program costs more for fewer people to cover than full expansion.

Laura Colbert, Director at Georgians for a Healthy Future, said: “We know that more than 400,000 Georgians could be covered if Georgia expanded Medicaid.”

Leah Chan is the director of health justice for Georgia Budget and Policy Institute. She said that if Georgia expands to cover 100,000 people it would cost taxpayers in Georgia $10 million per year more than a full expansion.

Georgia has also renounced the temporary bonus of the American Rescue Plan, which was meant to be an incentive for expanding coverage.

KFF estimates that this bonus will total over $1.3 billion in two years.

Pathways will extend Medicaid coverage for people earning up to the federal poverty line: less than $25,000. This is about $25,000 per annum for a three-person family. People will have to show that they meet the 80 hour requirement to be eligible. There is no grace period and no exceptions are made for those who care for children full-time or for other family members.

All Medicaid recipients will be able to maintain their coverage as long as they do not have to meet any work requirements.

Denson of the Georgia Public Policy Foundation said that he believes the partial expansion element of Georgia’s Program makes it unique, and it sets it up for its success.

Denson stated that they were “very hopeful” that other states will follow their example in serving this population.