Congress Eyes Medicaid Work Requirements,Georgia’s Experience Under Scrutiny

⁤ Updated June 26,2025

As Congress debates federal spending cuts,Republican lawmakers are exploring Medicaid work‍ requirements,a move that could affect millions of Americans receiving subsidized health insurance.The House passed a bill in May,and the Senate⁣ is currently working on its version.

Georgia launched its‍ Medicaid work mandate on‍ July 1, 2023. However, enrollment in the state’s “Pathways to Coverage”⁢ program remains⁣ low. Health policy researchers attribute this to bureaucratic obstacles within Georgia’s verification ⁤system.As of May 2025,⁤ only about 7,500 of nearly 250,000 eligible Georgians had enrolled, despite state data indicating that 64% of ⁢that group is employed.

Gov. Brian Kemp has advocated for Medicaid reform, arguing for a shift away from government-run healthcare. A spokesperson ⁤for Kemp stated⁤ that the Georgia Pathways ⁢to Coverage program was not designed to maximize enrollment.

health care analysts suggest georgia’s experience indicates that a congressional bill⁤ mandating work requirements ⁤could cost⁢ taxpayers ⁤millions in administrative expenses while jeopardizing health care ⁣for nearly 16 million people, according‍ to the Congressional Budget Office.

Proposed⁣ Federal work Requirements ⁢vs.Georgia’s ⁣Mandate

the House bill, H.R. ⁤1, ‍and⁤ a draft Senate proposal would require ‍states to verify that Medicaid recipients ages 19-64 work, train, study, or volunteer for⁤ 80 hours per month. States would ‍need to implement these verification systems by Dec. 31, 2026, checking enrollees’ work status twice ⁢yearly. This would affect⁣ over 10 million low-income⁤ adults with Medicaid and about 5 million residents in states using federal subsidies for private health coverage through the Affordable Care act.

The House⁣ bill exempts parents with ‍children under 18, while the Senate version exempts ‍parents with children under 15.⁣ Neither bill ⁢exempts caregivers of ⁢elderly relatives.

Georgia’s⁣ mandate applies to fewer categories than the proposed federal legislation. Even so, the‍ state struggled with monthly verification due to technical issues and⁤ difficulty confirming employment for those in the informal⁤ economy.⁤ Georgia has⁣ since loosened its verification protocols⁤ to once a year.

The Congressional ⁤Budget Office estimates H.R. 1⁢ could cause at least 10 million low-income americans to lose⁣ health insurance, not necessarily due to lack of work, ⁣but due to bureaucratic hurdles. Research from KFF indicates that moast affected individuals already work, attend school, or provide unpaid care.

Arkansas, the only other state to implement work requirements, later reversed⁢ course⁤ after data showed ⁤that red tape led to over 18,000 people losing coverage within months. A federal judge halted the program in 2019,⁢ citing an ⁢increased⁢ uninsured rate without⁣ evidence of⁣ increased⁤ employment.

House Speaker Mike Johnson, R-La., calls Medicaid work requirements ⁤”common⁣ sense,” arguing they⁢ won’t affect ⁤those Medicaid was designed to help: ⁤children, pregnant women, and impoverished elderly ‍individuals. He cites ‍projected cost ⁤savings of $344 billion over a decade. “You find dignity in work, and the people that are not doing that, we’re going to try ‍to get their attention,” Johnson said.

funding the Verification ⁣Systems

The House bill⁢ allocates $100 million to help states pay ‍for verification systems, distributed proportionally⁣ to each‍ state’s share of Medicaid enrollees subject to the new requirements. Health policy ⁤experts say this amount is⁣ insufficient, leaving states to cover the‍ difference.

Georgia has spent nearly $100 million, mostly federal funds,‍ on ⁢its ⁢Pathways program, including $55 ⁣million on a digital verification system. This is more than half the amount House Republicans allocated for the entire country. Georgia officials said the state spent 30% more ⁣than expected on its digital platform due to rising consultant and IT costs.

While states already ⁣verify work requirements for food stamp⁣ recipients, many existing systems would need upgrades to⁣ meet proposed federal legislation, according‍ to former state Medicaid officials.In 2019,the Government⁣ Accountability Office found that Kentucky expected administrative costs to exceed $200 million,double the amount allocated in H.R. 1 for the entire country.

Rep. Buddy Carter,⁤ R-Ga., said that upfront costs for states would be offset by ‍longer-term savings⁢ promised in the House bill. Some Republicans concede that the cost savings⁢ will come from fewer people enrolling in medicaid ⁤due to the⁢ new requirements.Savings from work mandates account ⁢for 43% of the $793 billion in proposed Medicaid‍ cuts,according to the Congressional ⁢Budget Office.

Staffing Challenges

Medicaid is administered differently in each state. Neither H.R. 1 nor the Senate proposal outlines how states should ⁣verify eligibility or fund the oversight of new requirements.

georgia’s experience highlights the importance⁣ of state caseworkers ⁢in ⁢managing applications and work requirement verifications.⁤ In 2023, the agency handling federal benefits enrollment had a 20%⁤ staff vacancy rate. As of⁣ March, the agency had a backlog of over ⁢5,000 Pathways applications and has requested ⁤300 more caseworkers and IT upgrades ⁣to manage the backlog.

Former ⁣state Medicaid officials and health policy experts say‍ Georgia’s ⁣staffing struggles are not unique. In 2023, KFF ⁢surveyed ⁣states about staffing levels for caseworkers verifying eligibility for federal benefits, including Medicaid. Worker vacancy rates exceeded 10% in 16 of 26 responding states,and exceeded 20%⁢ in seven of those states.

Adding caseworkers will ‍increase costs⁤ for states.

What’s next

As congress continues to debate Medicaid work requirements, the experiences⁣ of states like Georgia will likely play a crucial role in shaping the⁣ final legislation⁤ and its potential impact on millions of Americans.