Georgia escalates legal battle with Biden over Medicaid waiver

October 15, 2020 Atlanta - Governor Brian Kemp makes a special announcement on healthcare reform at the Georgia State Capitol on Thursday, October 15, 2020. The federal government approved Gov. Brian KempÕs plan to reshape Medicaid and individual insurance in Georgia under the Affordable Care Act, the governor and a top Trump administration health official announced on Thursday. (Hyosub Shin / Hyosub.Shin@ajc.com)

Credit: HYOSUB SHIN / AJC

Credit: HYOSUB SHIN / AJC

October 15, 2020 Atlanta - Governor Brian Kemp makes a special announcement on healthcare reform at the Georgia State Capitol on Thursday, October 15, 2020. The federal government approved Gov. Brian KempÕs plan to reshape Medicaid and individual insurance in Georgia under the Affordable Care Act, the governor and a top Trump administration health official announced on Thursday. (Hyosub Shin / Hyosub.Shin@ajc.com)

Georgia filed a lawsuit Friday against the Biden administration seeking an extension on a program set to expire in 2025 that requires some Georgians to meet a work and activity requirement to qualify for Medicaid insurance.

Gov. Brian Kemp said the federal complaint, which seeks a three-year extension through September 2028, aims to force the White House to “adhere to the terms they agreed to rather than play politics by refusing to give us back the time they stole” during litigation.

The lawsuit is an escalation of a legal battle over Kemp’s signature healthcare policy, a program called Georgia Pathways, that his administration once predicted could extend coverage to many of Georgia’s 370,000 poorest uninsured adults.

But the program has failed to live up to Kemp’s ambitions. Only 2,344 Georgians signed up for coverage as of Dec. 15, prompting renewed calls by leaders from both parties to explore a broader expansion of Medicaid. Georgia is one of only 10 states that has not agreed to a full expansion of Medicaid.

Kemp has long opposed a full-scale Medicaid expansion as too costly and inflexible in the long term. The legal action could provide him cover with fellow Republicans by blaming President Joe Biden and Democrats for its struggles.

The litigation is also a clear sign that the second-term Republican governor isn’t giving up on the program, which he has long framed as a conservative method to add more Georgians to the Medicaid rolls, without outright rejecting a broader expansion.

“After the Biden administration’s lengthy, failed attempt to interfere with Georgia’s innovative plan to afford thousands of Georgians the opportunity to receive quality healthcare, they are back at it again,” Kemp said.

It’s a reference to the prolonged legal battle over the policy, a centerpiece of Kemp’s 2018 election campaign. State lawmakers adopted the program in 2019 and then-President Donald Trump’s administration approved it a year later.

It included work and activity requirements. That same year, employment cratered at the start of the pandemic.

Georgia Gov. Brian Kemp and Centers for Medicare and Medicaid Services Administrator Seema Verma celebrate with a fist bump after Verma announced the Trump administration's approval of Kemp's health care "waiver" initiatives, at the Georgia State Capitol on Thursday, Oct. 15, 2020. (Hyosub Shin/The Atlanta Journal-Constitution/TNS)

Credit: TNS

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Credit: TNS

Biden’s top health official blocked the program in 2021, saying the state can’t impose work requirements on Georgians receiving Medicaid benefits because the coronavirus pandemic will “significantly compromise” the program’s effectiveness.

Kemp’s administration successfully challenged that decision in court in 2022, clearing the way for Georgia to become the only state in the nation to have work requirements connected to Medicaid coverage.

But the program’s struggles to sign up enrollees — and the likelihood that Biden would reject an extension next year if he wins a second term — has fueled new calls for a broader Medicaid expansion.

For the first time in a decade, senior Republican leaders are openly discussing ways to extend the program by using the “private option” model championed by Arkansas.

U.S. Sen. Raphael Warnock this week reminded lawmakers there’s $1.2 billion in federal funding to help sweeten the pot, and Democratic leaders in the Legislature are vowing to support an initiative they’ve pressed for decades.

Alex Yerkey of the Democratic Party of Georgia said the lawsuit effectively doubles down on Kemp’s “same tired, failed policies that cost more and do less.”

“I think the time has come to ask: how much more taxpayer money does he intend to waste on this failed program when there’s a more effective, less expensive option available right now?”

Rep. Sam Park, D-Lawrenceville, speaks as Sen. Gloria Butler, D-Stone Mountain (center) and Sen. Elena Parent, D-Atlanta, stand next to him during a press conference calling for full Medicaid expansion. (Hyosub Shin/hyosub.shin@ajc.com)

Credit: Hyosub Shin/AJC

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Credit: Hyosub Shin/AJC

House Minority Leader James Beverly, the chamber’s top Democrat, said in an interview this week that his party will fight to ensure every Georgian has access to healthcare, but that his caucus is “wide open” to different options.

Any change would have to secure Kemp’s approval, and his aides have quietly sent word to legislators that he’s skeptical of the idea. Still, he hasn’t rejected the possibility that he would sign an expansion into law if it reaches his desk.

In the meantime, Kemp’s litigation sends a signal that he still believes his GOP alternative could be successful — if given more time to take root. His top health official echoed that sentiment.

“I applaud Governor Kemp for working to give our team the opportunity to continue implementing this innovative program,” said Department of Community Health Commissioner Russel Carlson.

Staff Writer Michelle Baruchman contributed to this report.