July 17, 2023
In June 2023, Georgia announced the implementation of the Pathways to Coverage program, effective July 1, 2023. If successful, it could allow able-bodied adults who have not previously qualified for Medicaid to join the program and have access to health coverage if they meet certain conditions.
What Is Medicaid?
Medicaid is a public assistance program that was created to provide health care coverage for those who otherwise would not be able to afford it. In most cases, qualifying for this program requires that you have no more than $2,000 in assets. Tens of millions of low-income people in the United States are enrolled in Medicaid; more than 7 million of them are adults aged 65 and older.
A joint federal-state program, Medicaid across different states can vary widely depending on where you live. For example, the federal government requires all states to include things such as hospital services, x-rays, and nursing facility services in its Medicaid benefits. However, with other benefits, like dental or vision services, states can opt against providing such services as part of Medicaid.
Background on Medicaid Work Requirements
Some states have been seeking to impose additional requirements (beyond the income limit) in order to qualify for Medicaid. For example, proposals have included obligating Medicaid recipients to work, engage in community service, or participate in job training for a certain number of hours per month. Enrollees who do not meet these conditions could see their coverage come to an end.
Medicaid work requirements have not been around for long. The Trump administration, which signed off on 13 such programs in different states, was the first to implement them. However, a federal judge struck down work requirements in several programs in 2019, and the current administration revoked 10 additional programs.
In 2022, the Biden administration also attempted to prevent Georgia from imposing certain requirements as part of its Medicaid program. However, when a federal court found this unlawful, the program moved forward.
The Georgia Pathway to Coverage Program and Its Potential Implications
To a certain extent, what happens with Georgia’s program could pave the way for other states in future presidential administrations to try pursuing work requirements once again.
Arkansas, for example, has submitted a revised proposed Medicaid waiver that aims to increase its workforce. Arkansas officials state that their proposal does not seek to take people off Medicaid for failing to meet work requirements. Instead, it would move them to the traditional fee-for-service Medicaid program, which shares health care costs with the recipient.
If Georgia’s program does indeed increase the state’s workforce, other states may decide it makes sense to impose similar requirements on their Medicaid recipients and applicants. Georgia’s program will expand Medicaid coverage to people with incomes up to the federal poverty level. (In 2023, 100 percent of the federal poverty level equates to about $1,215 of income per month.)
In exchange, people in Georgia who applying for Medicaid will need to demonstrate they already meet the 80-hour week requirement. Per the program terms, Medicaid could now become available to low-income adults who are not disabled and are under 65. These are people who would normally not be eligible for Medicaid but may now qualify. Individuals already covered by standard Medicaid will get to keep their coverage without having to meet work requirements.
Qualifying activities, as Georgia envisions them, include, but are not limited, to:
Having a job in the public or private sector, including self-employment and employment as an independent contractor
Engaging in job training in the public or private sector
Participating in job readiness activities such as rehabilitation activities and GED programs
Performing community service projects through qualifying entities
Engaging in vocational educational training
Being enrolled in an institution of higher education
The Pathways to Coverage Program has its critics. Many say that this and similar programs will not significantly close the gap of individuals who are uninsured or do not qualify for Medicaid. Others state that only time will tell the true story once sufficient data has been tracked and analyzed.
One thing is for sure – states such as Arkansas, North Carolina, Iowa, and West Virginia are taking note and developing their own work requirement waiver requests. However, unlike Georgia, these states are seeking to add a work requirement to their current Medicaid recipients rather than creating a new group of people who would have access to coverage. This could mean that in states that follow suit, people who have traditionally been out of the workforce and receiving benefits may find themselves having to return to it.
To receive guidance about your Medicaid eligibility in the state where you reside, consult with one of our elder law attorneys today.