The U.S. Government Accountability Office (GAO), the country’s top nonpartisan government watchdog, is currently examining the costs associated with running the nation’s only active Medicaid work requirement program. The program, known as Georgia Pathways to Coverage, is under scrutiny as Republican state and federal lawmakers consider implementing similar requirements across the country. The GAO has stated that its analysis of the Georgia program could be released this fall.
In the first 100 days of the Trump administration, a focus on rooting out waste in federal programs was emphasized. This initiative allowed for significant changes in the operations of federal agencies, with a particular interest in the cost-effectiveness of programs such as the Medicaid work requirements. The push for work requirements in Medicaid enrollment comes as congressional Republicans seek to cut $880 billion from the federal deficit over the next 10 years to offset costs associated with President Donald Trump’s priorities, including border security and tax cuts that primarily benefit the wealthy.
Despite the growing support for work requirements, a majority of the public, regardless of political affiliation, opposes funding cuts to Medicaid, as revealed by polling conducted by KFF Health News. Leo Cuello, a research professor at Georgetown University’s Center for Children and Families, highlighted the importance of the GAO’s investigation in providing Congress with a comprehensive understanding of the potential pitfalls of work requirements before rushing into implementing such programs.
The experiences of Georgia and Arkansas, the only two states that have implemented Medicaid work requirement programs, have shown that these requirements can lead to a decrease in Medicaid enrollment while adding costly layers of bureaucracy. The GAO’s previous findings indicated that these programs can be expensive for states to run, with costs reaching hundreds of millions of dollars in some cases. Despite these challenges, the Trump administration has continued to support work requirements, emphasizing the need for manual verification of enrollee eligibility and compliance monitoring.
As more states seek approval for work requirements in Medicaid, the Centers for Medicare & Medicaid Services (CMS) plays a crucial role in approving pilot programs. However, the GAO’s 2019 report highlighted that federal officials did not adequately consider the costs associated with these programs when approving them, potentially leading to budgetary challenges for states.
Georgia’s Pathways to Coverage program, launched in 2023, has cost over $57 million in state and federal funds by the end of 2024. While Governor Brian Kemp has touted the program as a success, critics point to its administrative costs and impact on enrollment numbers. The program has also slowed processing times for other benefit programs in the state, raising concerns about its overall efficiency.
In conclusion, the ongoing examination of the Georgia Medicaid work requirement program by the GAO sheds light on the complexities and challenges associated with implementing such requirements. As more states consider similar programs, the need for a thorough cost-benefit analysis and consideration of potential impacts on enrollees is paramount. The findings of the GAO’s investigation will provide valuable insights for policymakers and stakeholders as they navigate the future of Medicaid work requirements. Georgia is making plans to request the renewal of its Medicaid work requirement program with some modest changes. The program, known as Pathways to Coverage, was halted by a court order in 2019 after more than 18,000 individuals lost their coverage in less than a year. Now, the state is looking to renew the program with adjustments that include reducing how often enrollees need to prove they are working or engaging in other qualifying activities.
The decision to investigate the costs of Georgia’s work requirement program came after Democratic U.S. senators Jon Ossoff, Raphael Warnock of Georgia, and Ron Wyden of Oregon requested the Government Accountability Office (GAO) to look into the program’s expenses. The senators cited reporting by KFF Health News, a national newsroom that focuses on health issues and is part of the Kaiser Family Foundation (KFF).
Senator Warnock expressed confidence that the GAO report will reveal that Pathways to Coverage is costing taxpayers more money and covering fewer people compared to if Georgia had expanded Medicaid like 40 other states. The GAO’s investigation aims to determine the total amount Georgia has spent on running the program, the proportion of federal funds used, and how the state is monitoring and tracking its spending.
KFF Health News is recognized for its in-depth journalism on health-related topics and is a key program at KFF, an independent source for health policy research, polling, and journalism.
As Georgia seeks to make changes to its Medicaid work requirement program, the GAO’s investigation will shed light on the program’s financial implications and effectiveness in providing coverage to its residents. The outcome of this report will likely influence the state’s future decisions regarding its Medicaid program and could have broader implications for healthcare policies across the country.
