Clock ticks as feds threaten to remove work requirement from Georgia’s partial Medicaid expansion


The federal Centers for Medicare & Medicaid Services (CMS) could decide in a matter of weeks whether it will remove the work or activity requirement in Georgia's partial Medicaid expansion plan.

The CMS said the plan, which was approved by former President Donald Trump's administration in October, does not “promote the objectives of the Medicaid program” and would be impossible to accomplish because of the COVID-19 pandemic.

The federal agency, now under President Joe Biden's administration, has placed the program on hold for 30 days until the state can explain why the requirements should stay in place.

“The COVID-19 pandemic has made community engagement infeasible,” Elizabeth Richter, acting CMS administrator, wrote Feb. 12 in a letter to Georgia Department of Community Health Commissioner Frank Berry. “CMS has serious concerns about testing policies that condition health care coverage on meeting work or other community engagement requirements.”

Under Georgia's Medicaid waiver, Pathways to Coverage, Georgians would have to complete a minimum of 80 hours of work per month or other activities, such as training or education, to qualify for the program. It is scheduled to start July 1.

Richter said COVID-19's effect on access to child care and transportation could make it difficult for Georgians who qualify for the program to seek work, go to school or get training. She also cited the health consequences of the coronavirus as a cause for concern.

The federal government gives states the option to raise the income eligibility requirement for Medicaid to open the taxpayer-funded program to more participants. States can choose to do a full expansion of the program and raise the income limit to 138% of the federal poverty level – or $17,000 for an individual. Georgia Pathways would extend the Medicaid income eligibility to a maximum of 100% (a partial expansion) of the federal poverty line – or a little more than $12,000 annually.

Neither Berry nor Gov. Brian Kemp's office immediately responded to a request for comment Friday. Some proponents of the plan, however, have called on CMS to reinstate the approval.

In a statement released Friday, the nonprofit Georgia Center for Opportunity (GCO) said CMS' decision could lead to court battles, leaving the thousands of Georgians who stand to get coverage under the program in a lurch.

“Instead of using our resources and time to bicker before the courts, we should apply them to seek out the best ways to improve people's lives,” said Erik Randolph, GCO's director of research. “[Georgia Pathways] is based on the idea of helping adults escape poverty, plain and simple. It will propel them into situations where they have better opportunities and more resources for health coverage, such as through affordable individual markets or employed-based coverage.”

Georgia Democrats continuously have pushed for a full expansion of the Medicaid program, arguing it extends more health care coverage to Georgians and costs the state less.

According to the Georgia Budget and Policy Institute (GBPI), removing work requirements from the partial Medicaid expansion plan would provide health coverage to about 269,000 people, costing $651 million in the first year. A full Medicaid expansion, however, would cover 481,000 Georgians and cost $239 million in the first year, GBPI said.

“We could insure 500,000 Georgians and save our rural hospitals, but Georgia GOP selfishly continues to refuse to fully expand Medicaid,” the Democratic Party of Georgia said in a tweet Wednesday.

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