The state has not publicized a monthly enrollment goal. But if enrollment ramped up evenly to 90,000 over two years, about 11,250 would be expected to sign up over three months’ time.
In a statement to The Atlanta Journal-Constitution, Kemp’s office said enrollment would increase eventually. “We will continue working to educate Georgians about Pathways’ innovative, first-of-its-kind opportunity and enroll more individuals in the months to come,” the statement read.
The plan, called Georgia Pathways to Coverage, aims to address the state’s problem with uninsured poor adults. Georgia has the third worst rate in the nation of uninsured people.
Under the Affordable Care Act, people below the poverty line make too little money to qualify for health insurance credits on the federal Affordable Care Act marketplace exchange. So ACA officials encouraged states to expand Medicaid to all of them — a move that also brings in major federal subsidies. Washington pays 90% of the cost of expansion. Most states have done that.
But Kemp rejected the federal Medicaid expansion offer. Instead, he worked with the Trump administration to develop his own program. It limits coverage to people who can prove they work 80 hours a month, or perform other specified activities.
Around the country, 39 states have already expanded their Medicaid program, including many that have engineered their own expansion programs. But Georgia will be the only one to launch an expansion with built-in work requirements.
Unique, and contested
Kemp’s office has said he wants to encourage people to improve their lives by working, attending school or doing other activities, helping move them up into the workforce where private health insurance would become available.
But the state’s plan would not cover, for example, a poor single mom who can’t afford child care and stays home to watch her children. Others who would not be covered are those caring for a relative with dementia, and those who are physically or mentally disabled but not federally declared disabled.
Health advocates expressed concern at the slow pace of signups in the first three months. “At this rate, it will take GA more than 61 years” to cover everyone, Laura Colbert, president of Georgians for a Healthy Future, which supports Medicaid expansion, said in a post on social media.
Joan Alker, director of Georgetown University’s Center for Children and Families, said the uniqueness of the plan was likely part of the lag. “This kind of complicated structure creates a lot of red tape,” Alker said. In addition, she said, most adults who are not on Medicaid already face some kind of barrier and need health care to make them healthy enough to work.
In response, Kemp’s office says his plan is more sustainable.
Supporters at the the libertarian-leaning Georgia Public Policy Foundation called for patience in the early days of Pathways. “Given the time and energy put into creating, gaining approval for, and standing up this program, I don’t think it’s appropriate to reach any sweeping conclusions after three months,” said Kyle Wingfield, the group’s president. He has also pointed out that the Georgia plan is a type of pilot program that is meant to experiment and find out if a policy works.
Data “critically important”
The low enrollment number is a potentially touchy subject. When a state employee in a public meeting this fall revealed only 265 had enrolled in Pathways’ first month, Democrats pounced, calling the program a “loser.”
The state Department of Community Health later declined to provide the AJC with any sign-up numbers when requested under the Georgia Open Records Act, saying the data would be made public later.
They should have provided documents, unless there were no documents at all, said an open government advocate, Richard T. Griffiths, president emeritus of the Georgia First Amendment Foundation.
“It’s clearly a violation of the law,” said Richard T. Griffiths, president emeritus of the Georgia First Amendment Foundation. “This is an example of disrespect for the public’s records. This is a disrespect of the taxpayers who deserve to know how their government is functioning. "
A representative for DCH did not respond to that allegation during the reporting of this story. Hours after the AJC told Kemp’s office the story would report the apparent violation, the DCH began providing the records requested under the law and strongly denied violating the law.
Leah Chan, a researcher at the left-leaning Georgia Budget and Policy Institute, also requested the records for research on the program. Groups like hers say they are diving into the data to figure out which populations appear to be hanging back and what steps might be done to increase enrollment.
She pointed out that time matters, because Georgia is currently in the process of disenrolling hundreds of Medicaid beneficiaries every week because of a national “redetermination” process to clean up the Medicaid rolls. Georgia Pathways might be an option for them, if advocates know how to find them and help them enroll.
“Some folks who are going to be losing Medicaid coverage could potentially transition to Pathways to Coverage,” Chan said. “But without good timely data ... there’s no way to know what can we do to make sure that happens. What can we do to help people with that transition? So the timeliness of the data is critically important.”