Latest news with #GeorgiaPathwaystoCoverage
Gulf Today
4 days ago
- Health
- Gulf Today
Work requirements, red tape ahead for millions on Medicaid
Now that the Republicans' big tax-and-spending bill has become law, new bureaucratic hurdles have emerged for millions of Americans who rely on Medicaid for health coverage. A provision in the new law dictates that, in most states, for the first time, low-income adults must start meeting work requirements to keep their coverage. Some states have already tried doing this, but Georgia is the only state that has an active system using work requirements to establish Medicaid eligibility — and recipients must report to the system once a month. When she first started using the system, Tanisha Corporal, a social worker in Atlanta, wasn't opposed to work requirements — in principle. But when she left her job at a faith-based nonprofit to start her own project, the Be Well Black Girl Initiative, she needed health coverage. She soon came face-to-face with how daunting it can be to prove you are meeting the state's work requirements. 'I would have never thought that I was going to run into the challenges that I did, with trying to get approved, because I'm like, I know the process,' Corporal said. 'I've been in human services.' Corporal has been a social worker for more than two decades in Georgia and was familiar with the state's social service programs. For years, it had been her job to help others access benefit programmes. But her challenges with paperwork and the process had only begun. Health advocates point to Georgia's system as a sign that the new law will lead to excessive red tape, improper denials, and lost health coverage. Beginning in 2027, the law will require adults on Medicaid who are under 65 to report how they engaged in at least 80 hours per month of work, education, or volunteer activities. Alternatively, these adults could submit documentation showing they qualify for an exemption, such as being a full-time caregiver. Most states will have to set up verification systems similar to Georgia's, which can be expensive to implement and run. In the two years since launching its program, Georgia has spent more than $91 million in state and federal funds, according to state data. More than $50 million of that was spent on building and operating the eligibility reporting system. Right now, just under 7,500 people are enrolled in Georgia. For Corporal, 48, forgoing coverage wasn't an option. She had been diagnosed with pre-diabetes and had other medical concerns. 'I have breast cancer in my family history,' she said. 'So it was like, I gotta get my mammograms.' On paper, it looked as if she qualified for Georgia's program, called Georgia Pathways to Coverage. It offers Medicaid to adults — who otherwise wouldn't qualify for traditional Medicaid in Georgia — with incomes up to the federal poverty level ($15,650 per year for an individual, or $26,650 per year for a family of three), as long as they can show that for at least 80 hours a month they're working, attending school, training for a job, or volunteering. Corporal was eager to apply. She was already volunteering at least that much, including with the nonprofit Focused Community Strategies, and helping with other South Atlanta community improvement efforts. She gathered up the various documents and forms needed to verify her duties and volunteer hours, then submitted them through Georgia's online portal. 'And we were denied. I was like, this makes no sense,' said Corporal, who has a master's degree in social work. 'I did everything right.' In the end, it took eight months fighting to prove that she and her son, a full-time college student in Georgia, qualified for Medicaid. She repeatedly uploaded their documents, only for them to bounce back or seemingly disappear into the portal. She went through numerous rounds of denials and appeals. Corporal recently pulled up one of the denial notices on her cellphone to read aloud: 'Your case was denied because you didn't submit the correct documents. And you didn't meet the qualifying activity requirement,' she read from the email. When she tried to call the state Medicaid agency for answers, it was difficult reaching anyone who could explain what was wrong with her application paperwork, she said. 'Or, they'll say they called you, and we look at our call log. Nobody called me,' she said. 'And the letter will say, you missed your appointment, and it'll come on the same day' as it was scheduled. Corporal's Pathways to Coverage application was finally approved in March after she spoke about her experience at a public hearing covered by Atlanta news outlets. When asked about the delays and difficulties Corporal experienced, Ellen Brown, a spokesperson for Georgia's Department of Human Services, emailed this statement: 'Due to state and federal privacy laws, we cannot confirm or deny our involvement with any person related to a benefits case.' Brown added that Georgia is implementing tech fixes to streamline the uploading and processing of participants' documents. They include 'rolling out a refresh to the Gateway Customer Portal in late July that will include easier navigation and training videos for users as well as built-in prompts to ask customers to upload required documents.' Now that Corporal has coverage, she is having to recertify her volunteer hours every month using the same glitchy reporting system. It's stressful, she said. 'It's still a nightmare, even once I got through the red tape and got approved,' Corporal said. 'Now maintaining it is bringing another level of anxiety.'
18-07-2025
- Health
Georgia shows rough road ahead for states as Medicaid work requirements loom
This is a KFF Health News story. Every time Ashton Alexander sees an ad for Georgia Pathways to Coverage, it feels like a "kick in the face." Alexander tried signing up for Pathways, the state's limited Medicaid expansion, multiple times and got denied each time, he said, even though he met the qualifying terms because he's a full-time student. Georgia is one of 10 states that haven't expanded Medicaid health coverage to a broader pool of low-income adults. Instead, it offers coverage to those who can prove they're working or completing 80 hours a month of other qualifying activities, like going to school or volunteering. And it is the only state currently doing so. "Why is this marketing out here?" said the 20-year-old, who lives in Conyers, east of Atlanta. "It's truly not accessible." Each denial used the same boilerplate language, Alexander said, and his calls to caseworkers were not returned. State offices couldn't connect him with caseworkers assigned to him from the same state agency. And when he requested contact information for a supervisor to appeal his denial, he said, the number rang to a fax machine. "It's impenetrable," Alexander said. "I've literally tried everything, and there's no way." Millions of Americans trying to access Medicaid benefits could soon find themselves navigating similar byzantine state systems and work rules. Legislation signed into law by President Donald Trump on July 4 allocates $200 million to help states that expanded Medicaid create systems by the end of next year to verify whether some enrollees are meeting the requirements. Conservative lawmakers have long argued that public benefits should go only to those actively working to get off of government assistance. But the nation's only Medicaid work requirement program shows they can be costly for states to run, frustrating for enrollees to navigate, and disruptive to other public benefit systems. Georgia's budget for marketing is nearly as much as it has spent on health benefits. Meanwhile, most enrollees under age 65 are already working or have a barrier that prevents them from doing so. What Georgia shows is "just how costly setting up these administrative systems of red tape can be," said Joan Alker, executive director of Georgetown University's Center for Children and Families. Over the past two years, KFF Health News has documented the issues riddling Georgia's Pathways program, launched in July 2023. More than 100,000 Georgians have applied to the program through March. Just over 8,000 were enrolled at the end of June, though about 300,000 would be eligible if the state fully expanded Medicaid under the terms of the Affordable Care Act. The program has cost more than $100 million, with only $26 million spent on health benefits and more than $20 million allocated to marketing contracts, according to a KFF Health News analysis of state reports. "That was truly a pretty shocking waste of taxpayer dollars," Alker said. The Government Accountability Office is investigating the costs of the program after a group of Democratic senators -- including both members of the Georgia delegation -- asked the government watchdog to look into the program. Findings are expected this fall. A state report to the federal government from March said Georgia couldn't effectively determine if applicants meet the qualifying activities criteria. The report also said the state hadn't suspended anyone for failing to work, a key philosophical pillar of the program. Meanwhile, as of March, more than 5,000 people were waiting to have their eligibility verified for Pathways. The Pathways program has strained Georgia's eligibility system for other public benefits, such as food stamps and cash assistance. In April, the state applied to the federal government to renew Pathways. In its application, officials scaled back key elements, such as the requirement that enrollees document work every month. Critics of the program also say the red tape doesn't help enrollees find jobs. "Georgia's experience shows that administrative complexity is the primary outcome, not job readiness," said Natalie Crawford, executive director of Georgia First, which advocates for fiscal responsibility and access to affordable health care. Despite the struggles, Garrison Douglas, a spokesperson for Georgia's Republican governor, Brian Kemp, defended the program. "Georgia Pathways is doing what it was designed to do: provide free healthcare coverage to low-income, able-bodied Georgians who are willing to engage in one of our many qualifying activities," he said in an emailed statement. New federal requirements in the tax and spending legislation mean that the 40 states (plus Washington, D.C.) that expanded Medicaid will need to prepare technology to process the documentation some Medicaid recipients will now have to regularly file. The federal law includes exemptions for people with disabilities, in addiction treatment, or caring for kids under 14, among others. The Trump administration said other states won't face a bumpy rollout like Georgia's. "We are fully confident that technology already exists that could enable all parties involved to implement work and community engagement requirements," said Mehmet Oz, head of the Centers for Medicare & Medicaid Services, in an emailed statement. In a written public comment on Georgia's application to extend the program, Yvonne Taylor of Austell detailed the difficulties she faced trying to enroll. She said she tried to sign up several times but that her application was not accepted. "Not once, not twice, but three times. With no response from customer service," she wrote in February. "So now I am without coverage." Victoria Helmly of Marietta wrote in a January comment that she and her family members take care of their dad, but the state law doesn't exempt caregivers of older adults. "Georgia should recognize their sacrifices by supporting them with health insurance," she wrote. "Let's simplify this system and in the end, save money and lives."
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.
