Georgia offered Medicaid with a work requirement. Some have signed up.

Democrats have long been trying to convince red states to expand the federal Medicaid program and bring health insurance to more of their most vulnerable residents. The Biden administration sweetened the pot in 2021 with additional federal money, but GOP officials including Kemp have been reluctant to take up the offer unless they can tie the benefits to employment.

Slow progress in the Georgia program has done little to change the state’s double-digit uninsured rate, which is the highest in the U.S. And it could discourage other red states that have yet to follow suit, including nearby Alabama, Mississippi and South Carolina. Medicaid has not been expanded. Following in Georgia’s footsteps even as they face increasing pressure from the health care industry to expand their government-run health insurance program.

However, some in Georgia say it is too early to draw conclusions about the program and that many people may still be unaware of its existence.

“I have my fingers crossed that this will be a good solution,” said Georgia state Rep. Lee Hawkins, a Republican who chairs the House Health Committee. Getting the word out about any new program is always difficult.

Georgia is the only state that requires Medicaid work, although Kansas Governor Laura Kelly, a Democrat, recently floated a proposal to woo the Republican legislature. Arkansas Republican Governor Sarah Huckabee Sanders is awaiting federal approval for a similar idea.

Work requirements were a feature of the Trump administration’s plan to overhaul Medicaid, and the Centers for Medicare and Medicaid Services approved them in 13 states. But court rulings and the COVID-19 pandemic hindered implementation, and the Biden administration later revoked the approval. However, Georgia won a federal court challenge in 2022, allowing it to implement the policy while partially expanding Medicaid.

The move follows years of public debate about expanding the low-income health insurance program, with Democrats making it a centerpiece of gubernatorial campaigns in 2018 and 2022.

Kemp, who won both of those elections, opted to limit expanded coverage to adults earning up to the federal poverty line, $14,580 for an individual or $30,000 for a family of four. But coverage for this new group is only available to people who document that they are working, studying or volunteering 80 hours a month.

“It seems like a political compromise between those who wanted expansion and those who did not want expansion,” the Pope said. And it ended up being a fairly minor expansion.

Republicans in Georgia urge patience and note that the state Medicaid agency is busy reviewing eligibility for millions of people for the first time since the pandemic.

A Department of Health spokesperson said, like any newly launched program, we expect enrollment to increase over time.

Kemp’s office did not respond to a request for comment.

To people on the right who have long wanted to limit Medicaid, the low enrollment numbers are proof that too many people are content to rely on government help they don’t need rather than finding employment or going to school.

Since so few able-bodied adults are willing to work, train, or volunteer part-time to qualify for the Pathways program, it is clear that a full expansion would discourage employment for those who can and actually do the work. This could put resources at risk for low-income people in need. Children and people with disabilities, said Jonathan Ingram, vice president of policy and research at the Foundation for Government Accountability.

There is bipartisan consensus that a lack of awareness of the program is also contributing to low enrollment.

It’s still early, and I think people need to be educated, the representative said. buddy carter (R-Ga.). I wouldn’t read too much into it at this point.

For opponents of limited expansion, the slow start has renewed calls for the state to adopt full Medicaid expansion, covering people who earn up to 138 percent of the poverty level without work requirements.

It costs Georgia more money in the way of coverage and the state covers far fewer people than it would if it joined 40 other states in expanding Medicaid, Sen. raphael warnock (D-Ga.) said in a statement to POLITICO. While state politicians continue to play games with people’s lives, Georgians are dying because they cannot afford needed health care.

The final decision on Georgia’s program could determine whether red states will again try to impose Medicaid work requirements, especially if a Republican wins the White House.

Nina Ovcharenko Schaefer, director of the Health and Wellness Policy Center at Heritage, said making sure the path is clear, and that states like Georgia are leading, can help forge a new path that is less filled with barriers and obstacles. It is believed to have happened. foundation. It is necessary to have such experiments. We have to learn from them. They don’t intend to do that, knock it out of the ballpark in one fell swoop.

In Kansas, Kelly’s proposal to add a once-a-year reporting work requirement is a concession that comes after five failed attempts to persuade the Republican-dominated legislature to expand Medicaid.

The governor’s office rejected the idea that its program would suffer the same fate as Georgia’s.

Kelly spokeswoman Briana Johnson said she struggled to get some nominations because of the bureaucratic hurdles people have to jump through to prove they’re working.

An application is pending before CMS to reestablish work requirements in Arkansas, but beneficiaries will not lose coverage if they do not comply. Instead, beneficiaries will receive greater care coordination, services and outreach.

The state imposed the requirements in 2018, and more than 18,000 people lost coverage in seven months. A federal judge struck down the program in 2019, ruling that work requirements undermine Medicaid’s primary mission to provide health care.

Courts also struck down work requirement programs in New Hampshire and Kentucky. Other states, such as Arizona and Indiana, halted their programs due in part to actions in other states.

Liberals hope the slow pace of Georgia’s programs will give states pause before attempting anything similar under a future Republican administration.

Given where we are in terms of enrollment, it seems like this would be exceptionally foolish, said Joan Elker, executive director of Georgetown University’s Center for Children and Families. Never say never, but the fact that no one is being covered does not address the pressures that states are feeling.

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