Latest news with #GeorgiaPathwaystoCoverage
Yahoo
02-05-2025
- Health
- Yahoo
Government watchdog expects Medicaid work requirement analysis by fall
The GAO report could outline for Congress the full extent of problems with work requirements 'before they rush forward and do this without thinking.' (Photo by Jennifer Shutt/States Newsroom) This article first appeared on KFF Health News. The country's top nonpartisan government watchdog has confirmed it is examining the costs of running the nation's only active Medicaid work requirement program, as Republican state and federal lawmakers consider similar requirements. The U.S. Government Accountability Office told KFF Health News that its analysis of the Georgia Pathways to Coverage program could be released this fall. In its first 100 days, the Trump administration has said rooting out waste in federal programs was a priority, allowing billionaire Elon Musk and the newly created Department of Government Efficiency broad latitude to fundamentally alter the operations of federal agencies. The idea of a nationwide mandate that requires Medicaid enrollees to either work, study, or complete other qualifying activities to maintain coverage is gaining traction as congressional Republicans weigh proposals to cut $880 billion from the federal deficit over 10 years. The savings are intended to offset the costs of President Donald Trump's priorities, including border security and tax cuts that would largely benefit the wealthy. A majority of the public — regardless of political leaning — oppose funding cuts to Medicaid, according to polling released May 1 by KFF, a health information nonprofit that includes KFF Health News. The GAO investigation comes at a critical time, said Leo Cuello, a research professor at Georgetown University's Center for Children and Families. 'Congress seems to be pursuing cuts in Medicaid in a frenetic and rushed manner,' he said. The GAO report could outline for Congress the full extent of problems with work requirements 'before they rush forward and do this without thinking.' The experiences of Georgia and Arkansas — the only two states to have run such programs — show that work requirements depress Medicaid enrollment while adding costly layers of bureaucracy. Now, more states are trying to get signoff from the Trump administration to approve work requirements for Medicaid, the state-federal program that offers health coverage to millions of Americans with low-incomes and disabilities. The Centers for Medicare & Medicaid Services, which approves Medicaid pilot programs such as work requirements, did not respond to a request for comment by publication. The GAO found in 2019 that work requirement programs can be expensive for states to run — hundreds of millions of dollars, in some cases — and that federal officials failed to consider those costs when approving the programs, which cannot increase Medicaid spending. Still, the Trump administration has supported work requirements. The programs require state employees to manually verify whether enrollees meet eligibility requirements and monitor their continued compliance. In 2023, more than 90% of U.S. adults eligible for Medicaid expansion were already working or could be exempt from requirements, according to KFF. During his confirmation hearing to lead CMS, Mehmet Oz said he was in favor of work requirements but didn't think they should be used as 'an obstacle, a disingenuous effort to block people from getting on Medicaid.' The first Trump administration approved work requirements in 13 states. Nearly all the programs were blocked by the Biden administration or federal courts. Georgia is one of 10 states that hasn't fully expanded Medicaid to nearly all low-income adults. The state launched Pathways to Coverage on July 1, 2023. It's been a main policy priority of Republican Gov. Brian Kemp, whose office engaged in a lengthy court fight with the Biden administration after it tried to block the program. The program cost more than $57 million in state and federal dollars through the end of 2024, with much of that going toward its administration. As of April 25, 7,410 people were enrolled, a small percentage of those who would be covered by a full Medicaid expansion. Pathways has also slowed processing times for other benefit programs in the state. When asked about the costs and benefits of Pathways, Kemp spokesperson Garrison Douglas instead pointed to Georgia's recently launched state-based Obamacare exchange. It saw record enrollment due, in part, to enhanced subsidies passed by the Biden administration. 'We are covering more Georgians than traditional Medicaid expansion would have, and for less money,' said Douglas, referring to the state, not federal, share of spending. The enhanced subsidies that boosted enrollment are set to expire this year. The Congressional Budget Office estimates that extending them would cost the federal government about $335 billion over 10 years. In March, Arkansas asked the Trump administration to relaunch its Medicaid work requirement program. The federal public comment period on the program runs through May 10. A previous version was halted by a court order in 2019, but not before more than 18,000 lost coverage in less than a year. Georgia plans to request that the White House renew its program with modest changes, including reducing how frequently enrollees must prove to the state they're working or engaging in other qualifying activities. The GAO investigation into Georgia's work requirement program comes after three Democratic U.S. senators — Jon Ossoff and Raphael Warnock of Georgia and Ron Wyden of Oregon — asked the GAO in December for an investigation into the program's costs. Their request cited reporting by KFF Health News. 'I pushed for this GAO report because I am confident its findings will further support what we already know: Pathways to Coverage costs the taxpayers more money and covers fewer people than had the state simply joined 40 other states in closing the health care coverage gap,' Warnock said in a statement. The GAO said it aims to figure out how much Georgia has spent to run the program, how much of that was federal money, and how that spending is being tracked. This article first appeared on KFF Health News and is republished here under a Creative Commons license.
Yahoo
19-02-2025
- Health
- Yahoo
As states mull Medicaid work requirements, 2 scale theirs back
As Republicans consider adding work requirements to Medicaid, Georgia and Arkansas — two states with experience running such programs — want to scale back the key parts supporters have argued encourage employment and personal responsibility. (iStock/Illustration by Getty Images Plus) President Donald Trump's return to the White House sent a clear signal about Medicaid to Republicans across the country: Requiring enrollees to prove they are working, volunteering, or going to school is back on the table. The day after Trump's inauguration, South Carolina GOP Gov. Henry McMaster asked federal officials to approve a work requirement plan. Ohio Republican Gov. Mike DeWine plans to soon follow suit. Republicans in Congress are eyeing Medicaid work requirements as they seek to slash billions from the federal budget. SC governor asks to expand Medicaid eligibility for working parents But, just as a second Trump administration reignites interest in work requirements, Georgia is proposing to scale back key parts of the nation's only active program. And Arkansas announced an effort to revive — with fundamental changes — a program that ended after a legal judgment in 2019. The Georgia and Arkansas proposals, from the only two states to have implemented Medicaid work requirements, reveal the disconnect between rhetoric behind such programs and the realities of running them, said consumer advocates and health policy researchers. 'They recognize that what they did the first time didn't work,' said Ben Sommers, a Harvard professor and a former health official in the Biden and Obama administrations. 'It should be a signal to federal policymakers: Don't point to Georgia and Arkansas and say, 'Let's do that.'' More than a dozen states, including South Carolina, had Medicaid work requirement programs approved during Trump's first administration. After an expensive and bumpy rollout, Georgia in January posted a draft renewal plan for its Georgia Pathways to Coverage program. The plan removes the requirement to document work every month and to pay premiums. Those key elements — which supporters have argued promote employment and personal responsibility — were never implemented, the state said. Enrollees would still have to meet the work requirement when they first apply and when they renew each year. The draft plan also expands the group of people who can opt out of work reporting to include parents of children under age 6. A public comment period on the plan is open through Feb. 20. Arkansas' latest request to federal officials doesn't require enrollees to report their work hours. Instead, it proposes checking whether people are working, caregiving, or fulfilling other qualifying activities by using data, which could include income, job history, educational status, whether a child lives at home, and other criteria, said Gavin Lesnick, a spokesperson for the state's Medicaid agency. People deemed 'not on track towards meeting their personal health and economic goals' won't be disenrolled but can participate in a 'success coaching' program to maintain coverage, according to the state's proposal. A public comment period on Arkansas' program runs through March 3. More than 90% of U.S. adults eligible for Medicaid expansion are already working or could be exempt from requirements, according to KFF. Still, several states are quickly moving to restart Medicaid work requirements. Besides the three states of Arkansas, Ohio, and South Carolina, Iowa and South Dakota are considering similar proposals. Lawmakers in Montana are weighing them as they debate renewing the state's Medicaid expansion. Last week, House Republicans floated a budget proposal to cut $880 billion from the Energy and Commerce Committee, which oversees Medicaid, the state-federal health insurance program for people with low incomes or disabilities. Before the release of that plan, Speaker Mike Johnson said Republicans were discussing changes to Medicaid that include imposing work requirements. Supporters of such requirements say Medicaid should be reserved for people who are working. South Carolina is among 10 states that have not expanded Medicaid eligibility with federal money made available under the 2010 Affordable Care Act, also known as Obamacare. The state's proposal, which hasn't yet been submitted, will seek to expand coverage to more parents with low incomes if they can show they're working or going to school at least 80 hours a month. Those work requirements and exemptions will be similar to existing federal rules for people receiving grocery benefits through the Supplemental Nutrition Assistance Program, or SNAP, commonly called food stamps. That eligibility alignment is intentional, 'so we're not producing administrative burdens for us or the people applying,' said Jeff Leieritz, spokesman for South Carolina's Medicaid agency. People already enrolled in Medicaid wouldn't be subject to the work-or-school requirement — only those newly eligible — so no one would lose their Medicaid coverage because of it, he said about the proposal still in the works. That would make a major shift from the state's program that was approved during the first Trump term but never implemented. Right now, the coverage gap 'disincentivizes many low-income families from earning additional income' because parents lose health coverage if they make too much money to qualify for Medicaid, but not enough money to qualify for federal subsidies toward private insurance, said South Carolina Gov. McMaster in his January letter to federal officials. He has argued that a work-reporting requirement for people in that gap is 'fiscally responsible' and 'will incentivize employment.' There is no evidence showing work requirements improve economic outcomes for people; they don't help people find jobs, but not having health insurance can keep them from working, health policy researchers say. The goal of Ohio's plan is to focus 'resources and efforts on those who are engaged with their health choices and independence,' said the state. The plan doesn't require most individuals to regularly 'report activities, fill out forms, or take any action' beyond what is generally required for Medicaid enrollment. Ohio estimates that more than 61,000 people, or 8% of enrollees subject to its measure, would lose Medicaid eligibility in the first year. Consumer advocates, health policy analysts, and researchers said the scaling back seen in recent work requirement proposals speaks to the challenges of mandating them for public benefits — and could serve as a cautionary tale for Republicans in Washington, D.C., and across the country. The programs can eliminate people from the Medicaid rolls or suppress enrollment, while adding costly layers of bureaucracy, they said. 'As a matter of health policy, work-reporting requirements in Medicaid are fundamentally flawed,' said Leo Cuello, a researcher at the Georgetown Center for Children and Families. Arkansas got its initial program off the ground in 2018 before a federal judge said it was illegal. Unlike Georgia, the state had already expanded Medicaid. That work-reporting requirement led to more than 18,000 people losing coverage, in part because enrollees were unaware or confused about how to report they were working. In his ruling that ended the program, Judge James Boasberg said its approval was 'arbitrary and capricious' because it failed to address a core goal of Medicaid: 'the provision of medical coverage to the needy.' Arkansas' latest proposal tries to address a potential legal challenge by suspending, rather than terminating, health coverage through the end of the calendar year for people who don't meet requirements. 'We have worked to design this amendment taking into account lessons learned from previous work requirements,' said Arkansas Medicaid Director Janet Mann at a press conference in late January announcing the new proposal. But the requirements are 'subjective,' and the difference between suspension and termination isn't meaningful, said Camille Richoux, health policy director of Arkansas Advocates for Children and Families. 'The impact is the same: You can't go to the doctor,' she said. 'You can't get your prescriptions filled.' In Georgia, the Pathways program, launched in 2023, has offered coverage to a small portion of those who would qualify for Medicaid if the state had fully expanded it to all low-income adults, as 40 others have done. With the proposed changes, the state estimates enrollment in Pathways would grow to as many as 30,000 people in the final year of the pilot. The state currently estimates at least 246,000 would become eligible for Medicaid under a full expansion. About 6,500 people were enrolled in Pathways as of late January, said Grant Thomas, the state's deputy Medicaid commissioner, in a legislative hearing. According to state officials, the program has cost more than $57 million in state and federal funds through December, with most of that money going toward program administration, not benefits. 'Pathways is doing what it is designed to do: increase access to affordable health care coverage while lowering the uninsured rate across Georgia,' said Russel Carlson, who oversees the state's Medicaid program as Commissioner of the Department of Community Health. The changes to Pathways are an attempt to 'improve the member experience' while finding ways 'to make government more efficient and accessible,' he added. Pathways requires that enrollees regularly submit documentation to prove they are working, but the program doesn't include meaningful measures to help people find work, critics said. People who could be eligible for Pathways have said the whole process is time-consuming due to lengthy questionnaires, a glitchy system for uploading documents, and confusing technical language on the website, according to those working with potential enrollees. 'There's stuff that sounds good on paper, but when you go to implement it in real life, it's costly and burdensome,' said Leah Chan, director of health justice at the Georgia Budget and Policy Institute. So far, Pathways has cost state and federal taxpayers nearly $9,000 per enrollee, largely back-end costs to run the program. States that have expanded Medicaid spent about $6,500 per enrollee in that group in 2021, according to KFF researchers. Georgia GOP Gov. Brian Kemp has said he's committed to his signature health program, but some Republican state lawmakers have shown an openness to consider full expansion. A group of Democratic senators cited KFF Health News' reporting last year when they asked the federal government's top watchdog to investigate Pathways spending. Even with the proposed changes, some people, including those who work in the informal or gig economy, may not have official records and may be locked out of health coverage, said Laura Colbert, executive director of Georgians for a Healthy Future, a nonprofit consumer health advocacy organization. People caring for older children or aging relatives, older adults who struggle to find work, and those with medical conditions that prevent them from working still wouldn't qualify for health coverage, she said. 'The Pathways program just doesn't reflect the reality of how people are working,' Colbert said. 'Pathways is a program that has clearly been developed by people who have had salaried jobs with predictable incomes.' Seanna Adcox, editor for the South Carolina Daily Gazette, contributed to this report. KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Yahoo
14-02-2025
- Health
- Yahoo
‘The first time didn't work': Georgia and Arkansas scale back Medicaid work requirements
Arkansas Department of Human Services Sec. Kristi Putnam discusses the state's waiver request for Medicaid work requirements on Jan. 28, 2025 as State Medicaid Director Janet Mann (left) and Gov. Sarah Huckabee Sanders listen. (Antoinette Grajeda/Arkansas Advocate) President Donald Trump's return to the White House sent a clear signal about Medicaid to Republicans across the country: Requiring enrollees to prove they are working, volunteering, or going to school is back on the table. The day after Trump's inauguration, South Carolina GOP Gov. Henry McMaster asked federal officials to approve a work requirement plan. Ohio Republican Gov. Mike DeWine plans to soon follow suit. Republicans in Congress are eyeing Medicaid work requirements as they seek to slash billions from the federal budget. But, just as a second Trump administration reignites interest in work requirements, Georgia is proposing to scale back key parts of the nation's only active program. And Arkansas announced an effort to revive — with fundamental changes — a program that ended after a legal judgment in 2019. The Georgia and Arkansas proposals, from the only two states to have implemented Medicaid work requirements, reveal the disconnect between rhetoric behind such programs and the realities of running them, said consumer advocates and health policy researchers. 'They recognize that what they did the first time didn't work,' said Ben Sommers, a Harvard professor and a former health official in the Biden and Obama administrations. 'It should be a signal to federal policymakers: Don't point to Georgia and Arkansas and say, 'Let's do that.'' More than a dozen states had Medicaid work requirement programs approved during Trump's first administration. After an expensive and bumpy rollout, Georgia in January posted a draft renewal plan for its Georgia Pathways to Coverage program. The plan removes the requirement to document work every month and to pay premiums. Those key elements — which supporters have argued promote employment and personal responsibility — were never implemented, the state said. Enrollees would still have to meet the work requirement when they first apply and when they renew each year. The draft plan also expands the group of people who can opt out of work reporting to include parents of children under age 6. A public comment period on the plan is open through Feb. 20. Arkansas' latest request to federal officials doesn't require enrollees to report their work hours. Instead, it proposes checking whether people are working, caregiving or fulfilling other qualifying activities by using data, which could include income, job history, educational status, whether a child lives at home, and other criteria, said Gavin Lesnick, a spokesperson for the state's Medicaid agency. People deemed 'not on track towards meeting their personal health and economic goals' won't be disenrolled but can participate in a 'success coaching' program to maintain coverage, according to the state's proposal. A public comment period on Arkansas' program runs through March 3. More than 90% of U.S. adults eligible for Medicaid expansion are already working or could be exempt from requirements, according to KFF. Still, several states are quickly moving to restart Medicaid work requirements. Besides the three states of Arkansas, Ohio, and South Carolina, Iowa and South Dakota are considering similar proposals. Lawmakers in Montana are weighing them as they debate renewing the state's Medicaid expansion. This week, House Republicans floated a budget proposal to cut $880 billion from the Energy and Commerce Committee, which oversees Medicaid, the state-federal health insurance program for people with low incomes or disabilities. Before the release of that plan, Speaker Mike Johnson said Republicans were discussing changes to Medicaid that include imposing work requirements. Supporters of such requirements say Medicaid should be reserved for people who are working. Right now, it 'disincentivizes many low-income families from earning additional income' because they would lose health coverage if they make too much money, said South Carolina Gov. McMaster in his January letter to federal officials. He has argued that a work-reporting requirement is 'fiscally responsible' and 'will incentivize employment.' There is no evidence showing such programs improve economic outcomes for people; the requirements don't help people find jobs, but not having health insurance can keep them from working, health policy researchers say. The goal of Ohio's plan is to focus 'resources and efforts on those who are engaged with their health choices and independence,' said the state. The plan doesn't require most individuals to regularly 'report activities, fill out forms, or take any action' beyond what is generally required for Medicaid enrollment. Ohio estimates that more than 61,000 people, or 8% of enrollees subject to its measure, would lose Medicaid eligibility in the first year. Consumer advocates, health policy analysts, and researchers said the scaling back seen in recent work requirement proposals speaks to the challenges of mandating them for public benefits — and could serve as a cautionary tale for Republicans in Washington, D.C., and across the country. The programs can eliminate people from the Medicaid rolls or suppress enrollment, while adding costly layers of bureaucracy, they said. 'As a matter of health policy, work-reporting requirements in Medicaid are fundamentally flawed,' said Leo Cuello, a researcher at the Georgetown Center for Children and Families. Arkansas got its initial program off the ground in 2018 before a federal judge said it was illegal. Unlike Georgia, the state had already expanded Medicaid. That work-reporting requirement led to more than 18,000 people losing coverage, in part because enrollees were unaware or confused about how to report they were working. In his ruling that ended the program, Judge James Boasberg said its approval was 'arbitrary and capricious' because it failed to address a core goal of Medicaid: 'the provision of medical coverage to the needy.' Arkansas' latest proposal tries to address a potential legal challenge by suspending, rather than terminating, health coverage through the end of the calendar year for people who don't meet requirements. 'We have worked to design this amendment taking into account lessons learned from previous work requirements,' said Arkansas Medicaid Director Janet Mann at a press conference in late January announcing the new proposal. But the requirements are 'subjective,' and the difference between suspension and termination isn't meaningful, said Camille Richoux, health policy director of Arkansas Advocates for Children and Families. 'The impact is the same: You can't go to the doctor,' she said. 'You can't get your prescriptions filled.' In Georgia, the Pathways program, launched in 2023, has offered coverage to a small portion of those who would qualify for Medicaid if the state had fully expanded it to all low-income adults, as 40 others have done. With the proposed changes, the state estimates enrollment in Pathways would grow to as many as 30,000 people in the final year of the pilot. The state currently estimates at least 246,000 would become eligible for Medicaid under a full expansion. About 6,500 people were enrolled in Pathways as of late January, said Grant Thomas, the state's deputy Medicaid commissioner, in a legislative hearing. According to state officials, the program has cost more than $57 million in state and federal funds through December, with most of that money going toward program administration, not benefits. 'Pathways is doing what it is designed to do: increase access to affordable health care coverage while lowering the uninsured rate across Georgia,' said Russel Carlson, the state's Medicaid director. The changes to Pathways are an attempt to 'improve the member experience' while finding ways 'to make government more efficient and accessible,' he added. Pathways requires that enrollees regularly submit documentation to prove they are working, but the program doesn't include meaningful measures to help people find work, critics said. People who could be eligible for Pathways have said the whole process is time-consuming due to lengthy questionnaires, a glitchy system for uploading documents, and confusing technical language on the website, according to those working with potential enrollees. 'There's stuff that sounds good on paper, but when you go to implement it in real life, it's costly and burdensome,' said Leah Chan, director of health justice at the Georgia Budget and Policy Institute. So far, Pathways has cost state and federal taxpayers nearly $9,000 per enrollee, largely back-end costs to run the program. States that have expanded Medicaid spent about $6,500 per enrollee in that group in 2021, according to KFF researchers. Georgia GOP Gov. Brian Kemp has said he's committed to his signature health program, but some Republican state lawmakers have shown an openness to consider full expansion. A group of Democratic senators cited KFF Health News' reporting last year when they asked the federal government's top watchdog to investigate Pathways spending. Even with the proposed changes, some people, including those who work in the informal or gig economy, may not have official records and may be locked out of health coverage, said Laura Colbert, executive director of Georgians for a Healthy Future, a nonprofit consumer health advocacy organization. People caring for older children or aging relatives, older adults who struggle to find work, and those with medical conditions that prevent them from working still wouldn't qualify for health coverage, she said. 'The Pathways program just doesn't reflect the reality of how people are working,' Colbert said. 'Pathways is a program that has clearly been developed by people who have had salaried jobs with predictable incomes.' KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.
Yahoo
14-02-2025
- Health
- Yahoo
As states mull Medicaid work requirements, two scale theirs back
Stock photo from Getty Images. President Donald Trump's return to the White House sent a clear signal about Medicaid to Republicans across the country: Requiring enrollees to prove they are working, volunteering, or going to school is back on the table. The day after Trump's inauguration, South Carolina GOP Gov. Henry McMaster asked federal officials to approve a work requirement plan. Ohio Republican Gov. Mike DeWine plans to soon follow suit. Republicans in Congress are eyeing Medicaid work requirements as they seek to slash billions from the federal budget. But, just as a second Trump administration reignites interest in work requirements, Georgia is proposing to scale back key parts of the nation's only active program. And Arkansas announced an effort to revive — with fundamental changes — a program that ended after a legal judgment in 2019. The Georgia and Arkansas proposals, from the only two states to have implemented Medicaid work requirements, reveal the disconnect between rhetoric behind such programs and the realities of running them, said consumer advocates and health policy researchers. 'They recognize that what they did the first time didn't work,' said Ben Sommers, a Harvard professor and a former health official in the Biden and Obama administrations. 'It should be a signal to federal policymakers: Don't point to Georgia and Arkansas and say, 'Let's do that.'' More than a dozen states had Medicaid work requirement programs approved during Trump's first administration. After an expensive and bumpy rollout, Georgia in January posted a draft renewal plan for its Georgia Pathways to Coverage program. The plan removes the requirement to document work every month and to pay premiums. Those key elements — which supporters have argued promote employment and personal responsibility — were never implemented, the state said. Enrollees would still have to meet the work requirement when they first apply and when they renew each year. The draft plan also expands the group of people who can opt out of work reporting to include parents of children under age 6. A public comment period on the plan is open through Feb. 20. Arkansas' latest request to federal officials doesn't require enrollees to report their work hours. Instead, it proposes checking whether people are working, caregiving, or fulfilling other qualifying activities by using data, which could include income, job history, educational status, whether a child lives at home, and other criteria, said Gavin Lesnick, a spokesperson for the state's Medicaid agency. People deemed 'not on track towards meeting their personal health and economic goals' won't be disenrolled but can participate in a 'success coaching' program to maintain coverage, according to the state's proposal. A public comment period on Arkansas' program runs through March 3. More than 90% of U.S. adults eligible for Medicaid expansion are already working or could be exempt from requirements, according to KFF. Still, several states are quickly moving to restart Medicaid work requirements. Besides the three states of Arkansas, Ohio, and South Carolina, Iowa and South Dakota are considering similar proposals. Lawmakers in Montana are weighing them as they debate renewing the state's Medicaid expansion. This week, House Republicans floated a budget proposal to cut $880 billion from the Energy and Commerce Committee, which oversees Medicaid, the state-federal health insurance program for people with low incomes or disabilities. Before the release of that plan, Speaker Mike Johnson said Republicans were discussing changes to Medicaid that include imposing work requirements. Supporters of such requirements say Medicaid should be reserved for people who are working. Right now, it 'disincentivizes many low-income families from earning additional income' because they would lose health coverage if they make too much money, said South Carolina Gov. McMaster in his January letter to federal officials. He has argued that a work-reporting requirement is 'fiscally responsible' and 'will incentivize employment.' There is no evidence showing such programs improve economic outcomes for people; the requirements don't help people find jobs, but not having health insurance can keep them from working, health policy researchers say. The goal of Ohio's plan is to focus 'resources and efforts on those who are engaged with their health choices and independence,' said the state. The plan doesn't require most individuals to regularly 'report activities, fill out forms, or take any action' beyond what is generally required for Medicaid enrollment. Ohio estimates that more than 61,000 people, or 8% of enrollees subject to its measure, would lose Medicaid eligibility in the first year. Consumer advocates, health policy analysts, and researchers said the scaling back seen in recent work requirement proposals speaks to the challenges of mandating them for public benefits — and could serve as a cautionary tale for Republicans in Washington, D.C., and across the country. The programs can eliminate people from the Medicaid rolls or suppress enrollment, while adding costly layers of bureaucracy, they said. 'As a matter of health policy, work-reporting requirements in Medicaid are fundamentally flawed,' said Leo Cuello, a researcher at the Georgetown Center for Children and Families. Arkansas got its initial program off the ground in 2018 before a federal judge said it was illegal. Unlike Georgia, the state had already expanded Medicaid. That work-reporting requirement led to more than 18,000 people losing coverage, in part because enrollees were unaware or confused about how to report they were working. In his ruling that ended the program, Judge James Boasberg said its approval was 'arbitrary and capricious' because it failed to address a core goal of Medicaid: 'the provision of medical coverage to the needy.' Arkansas' latest proposal tries to address a potential legal challenge by suspending, rather than terminating, health coverage through the end of the calendar year for people who don't meet requirements. 'We have worked to design this amendment taking into account lessons learned from previous work requirements,' said Arkansas Medicaid Director Janet Mann at a press conference in late January announcing the new proposal. But the requirements are 'subjective,' and the difference between suspension and termination isn't meaningful, said Camille Richoux, health policy director of Arkansas Advocates for Children and Families. 'The impact is the same: You can't go to the doctor,' she said. 'You can't get your prescriptions filled.' In Georgia, the Pathways program, launched in 2023, has offered coverage to a small portion of those who would qualify for Medicaid if the state had fully expanded it to all low-income adults, as 40 others have done. With the proposed changes, the state estimates enrollment in Pathways would grow to as many as 30,000 people in the final year of the pilot. The state currently estimates at least 246,000 would become eligible for Medicaid under a full expansion. About 6,500 people were enrolled in Pathways as of late January, said Grant Thomas, the state's deputy Medicaid commissioner, in a legislative hearing. According to state officials, the program has cost more than $57 million in state and federal funds through December, with most of that money going toward program administration, not benefits. 'Pathways is doing what it is designed to do: increase access to affordable health care coverage while lowering the uninsured rate across Georgia,' said Russel Carlson, the state's Medicaid director. The changes to Pathways are an attempt to 'improve the member experience' while finding ways 'to make government more efficient and accessible,' he added. Pathways requires that enrollees regularly submit documentation to prove they are working, but the program doesn't include meaningful measures to help people find work, critics said. People who could be eligible for Pathways have said the whole process is time-consuming due to lengthy questionnaires, a glitchy system for uploading documents, and confusing technical language on the website, according to those working with potential enrollees. 'There's stuff that sounds good on paper, but when you go to implement it in real life, it's costly and burdensome,' said Leah Chan, director of health justice at the Georgia Budget and Policy Institute. So far, Pathways has cost state and federal taxpayers nearly $9,000 per enrollee, largely back-end costs to run the program. States that have expanded Medicaid spent about $6,500 per enrollee in that group in 2021, according to KFF researchers. Georgia GOP Gov. Brian Kemp has said he's committed to his signature health program, but some Republican state lawmakers have shown an openness to consider full expansion. A group of Democratic senators cited KFF Health News' reporting last year when they asked the federal government's top watchdog to investigate Pathways spending. Even with the proposed changes, some people, including those who work in the informal or gig economy, may not have official records and may be locked out of health coverage, said Laura Colbert, executive director of Georgians for a Healthy Future, a nonprofit consumer health advocacy organization. People caring for older children or aging relatives, older adults who struggle to find work, and those with medical conditions that prevent them from working still wouldn't qualify for health coverage, she said. 'The Pathways program just doesn't reflect the reality of how people are working,' Colbert said. 'Pathways is a program that has clearly been developed by people who have had salaried jobs with predictable incomes.' KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 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Yahoo
29-01-2025
- Health
- Yahoo
State senators, introduce bipartisan effort to expand Medicaid in Georgia
With the Georgia legislative session getting into full swing, four Republican senators signed on as co-sponsors for a state expansion of Medicaid. The senators, Billy Hickman of Statesboro, Russ Goodman of Cogdell, Sam Watson of Moultrie and Carden Summers of Cordele, joined 18 of their Democratic colleagues to sponsor the legislation. The State Office of Rural Health has a map of Georgia's 159 counties, color-coded by the availability of medical options for their populations. The counties for each of the senators who signed on to the bill from the Republican side of the aisle are in rural, medically underserved areas, meaning they have a shortage of primary care services for patients. [DOWNLOAD: Free WSB-TV News app for alerts as news breaks] The legislation, Senate Bill 50, would expand access to medical coverage to Georgians making less than 138% of the federal poverty limit and would request a waiver to do so from the U.S. Department of Health and Human Services Centers for Medicare and Medicaid Services. The expansion would allow for the full payment of any premiums or other direct costs associated with enrolling in qualified healthcare plans for those in the low-income group mentioned. The legislation would also create an 11-member advisory council for the PeachCare Plus program. Georgia is one of 10 states in the U.S. that has not adopted Medicaid expansions resulting from the Affordable Care Act. 'It is time that we stand up in Georgia,' Sen. David Lucas, of Macon, said at a Tuesday news briefing. 'Across Democratic and Republican lines, not only do we need to be one of the donor states, but we need to be one of the states that benefits ... Some of our counterparts from across (the aisle) are joining us to help provide healthcare insurance for Georgians. You have to realize one thing, it's about families.' Lucas said that Medicaid expansion was not about work, it is about healthcare. He said expansion of Medicaid in Georgia could help half a million residents in the state receive medical coverage. RELATED STORIES: Kemp proposes changes to Georgia Pathways to Coverage program as legislative session starts Nonprofit says Georgia Pathways to Coverage program enrollment levels hurt barriers to access More than 100,000 applied, but only 4,200 people are in Georgia Pathways to Coverage program US Senators push for federal investigation of Medicaid work program Georgia Pathways to Coverage Gov. Kemp still opposed to Medicaid expansion despite growing support from both sides Gov. Kemp sues Biden administration, tells it to not 'play politics' with Georgia Medicaid program Georgia Medicaid program with work requirement has enrolled only 1,343 residents in 3 months Georgia's push for work requirements on some Medicaid coverage set to start Nearly 100,000 Georgians kicked off Medicaid, PeachCare for Kids in June, state says U.S. Secretary of Health pushes Georgia to improve healthcare access to children in need 'That's the reason that we have put our efforts behind trying to make sure that half a million Georgians can receive healthcare. The plan the government has, you don't see anyone running to jump on the plan,' Lucas added. 'We've spent $29 million, we have about 4,200 folks who have signed up. The premiums are high and there is a work requirement. It's time that we, as legislators, see about the people of Georgia.' Harold V. Jones II, the minority leader and senator for Augusta, said that for the current session, having bipartisan support was helping them pursue the expansion. 'We have bipartisanship, that's number one. The fact that we know rural hospitals are closing, that's number two, that's something that's real. Those are some things that are real and happening, Jones said. 'We know rural hospitals are closing. Now we have bipartisan buy-in, we know that Georgia actually lags behind the national average as far as doctors are concerned, also lags behind the national average as far as nurses are concerned, because of the fact that our reimbursement rates really are not there. 'I think when the facts are there, and as long as we're pushing the issue openly, we welcome bipartisanship, we welcome dialogue. I think as long as we push this issue in good fashion, we can get the governor on board.' Since taking office, Gov. Brian Kemp has been steadfast in his refusal to consider expanding Medicaid in Georgia. He has promoted a test-piloted health coverage program called Pathways to Coverage, which introduced work requirements for some Medicaid-eligible beneficiaries, making Georgia the first state in the country to do so successfully. That test pilot program ends in September, and Kemp has announced one of his priorities for the current legislative session is to expand who is eligible for Pathways. State officials have said Pathways could cover about 200,000 people, but the latest data from Georgia officials said the program had covered 8,385, a jump from the previously confirmed total of 5,120 near the end of October. As Channel 2 Action News reported previously, the number of eligible Georgians who applied for the program was closer to 100,000 as of August, but just a fraction of them had proceeded to receive coverage. At the start of the legislative session, Kemp said he wanted to expand Pathways to Coverage by adding a new qualifying activity, which would allow more families access to enroll. Kemp's office said the new activity 'would provide Medicaid coverage to parents and legal guardians in households with incomes at or below 100% of the federal poverty level who have children ages 0-6 - furthering the state's focus on healthy families, improving maternal and child health, and supporting parents who are trying to get back in the workforce but struggling due to lack of health insurance.' If Georgia does expand Medicaid, it would leave Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wisconsin and Wyoming as those who have not opted into the federal program and funds available for their residents. [SIGN UP: WSB-TV Daily Headlines Newsletter]
