ATLANTA — Georgia’s U.S. Senators Rev. Raphael Warnock and Jon Ossoff are pushing for a federal investigation of the Georgia Pathways to Coverage program.
When Georgia launched the Pathways program, it became the first state in the country to have work requirements for some Medicaid beneficiaries.
According to a joint statement from the Georgia senators, and Sen. Ron Wyden, the Government Accountability Office should investigate the program “citing concerns over mismanagement and high costs.”
The Georgia Pathways to Coverage Program currently has just 5,542 Georgians enrolled, the senators said. In August, Channel 2 Action News reported the number of enrollees was just over 4,200 people as of June, according to data shared by the Gerogia Department of Community Health.
[DOWNLOAD: Free WSB-TV News app for alerts as news breaks]
Separately, there are about 200,000 Georgians in what’s known as the coverage gap, meaning the Georgians who make too much money per year to qualify for Medicaid but earn too little to get the federal insurance marketplace’s tax credits.
For Georgians to qualify for the Pathways program and its health coverage, single people need to be making roughly $15,000 per year or less. Members of a family of three need to have a household income of less than $26,000. They also need to meet the following requirements:
- Had to be between the ages of 19 to 64
- Have a household income up to 100% of the federal poverty level ($15,060 per year in 2024 for one person, or $25,820 for a family of three)
- Be a Georgia resident
- Complete at least 80 hours per month of full or part-time employment, on the job training, job readiness assistance programs, community service, vocational education training, enrollment in Georgia’s Vocational Rehabilitation Program or be enrolled in public or private universities or technical colleges for higher education
- Not be qualified for other types of Medicaid
- Not be incarcerated
RELATED STORIES:
- More than 100,000 applied, but only 4,200 people are in Georgia Pathways to Coverage program
- Georgia to move Medicaid, Medicare to state-run marketplace in November
- Judge rules against extension for Georgia’s Pathways to Coverage Medicaid work program
Both of Georgia’s U.S. Senators took issue with enrollment levels and cost management. The letter from them, and Wyden, to GAO said fewer than 1% of Georgians who would be eligible for coverage, if the state expanded Medicaid fully, had enrolled in the program since it’s start. Additionally, the program has reportedly cost more than $40 million.
“Despite the high administrative cost of implementing and operating a work reporting requirement for Medicaid coverage, Georgia Pathways has enrolled less than one percent of the individuals who would be eligible to enroll had the state opted to fully expand its Medicaid program due to onerous barriers created by this policy. While hundreds of thousands of Georgians are left without the health coverage they need, taxpayer dollars are being routed into the pockets of eligibility system vendors and consultants,” the senators said in a statement.
The letter from the three senators said more than 80% of those funds had been used for administrative and consulting costs, not health services for those enrolled in the program.
Additionally, the senators said the Pathways program has been “mired in design flaws and system failures.”
“Accordingly, we request that the Government Accountability Office (GAO) investigate both federal and state administrative burdens and costs associated with the Pathways section 1115 demonstration,” the senators continued in the letter. “This analysis is crucial to understand the impact administering Pathways has on federal and state spending, as well as the barriers to health care coverage Pathways has created either because of inherent design failure or mismanagement by state administrators.”
In response to the request for a GAO investigation of the Pathways Program, a spokesman for the Georgia governor’s office said the senators should focus on the ways the federal government was failing, rather than the Pathways program.
“From record-long wait times to be approved for SSDI and a 24-month waiting period for SSDI recipients to receive Medicaid, to the disastrous management of the United States Postal Service and southern border, the Senators should be more focused on examining the failures of the federal government to adequately provide the services they’re required to administer than looking for every opportunity to criticize states that are taking innovative approaches to providing healthcare to their people,” Garrison Douglas, a spokesman for Gov. Brian Kemp, said in a statement. “The fact of the matter is that Georgia Pathways and Georgia Access, have covered over 715,000 people in Georgia under 138% FPL, which is more than double the amount of people traditional Medicaid expansion is estimated to cover.”
During the program’s test run, Kemp and other state leaders worked to get the program’s deadline extended, but after suing the federal government, a judge rejected those efforts.
[SIGN UP: WSB-TV Daily Headlines Newsletter]
©2024 Cox Media Group
