The Georgia Pathways to Coverage program shows the hurdles ahead for states looking to follow its lead. Georgia\u2019s GOP leaders have spent millions of dollars <\/a>to launch Pathways. By July 29, nearly 4,500 people had enrolled, the state\u2019s Medicaid agency told KFF Health News.<\/p>\n That\u2019s well short of the state\u2019s own goal of more than 25,000<\/a> in its first year, according to its application to the federal government, and a fraction of the 359,000<\/a> who might have been eligible had Georgia simply expanded Medicaid under the Affordable Care Act, as 40 other states did.<\/p>\n So far, the pricey endeavor has forced participants to navigate bureaucratic hurdles rather than support employment. The state would not confirm whether it could even verify if people in the program are working.<\/p>\n Research shows such red tape<\/a> disproportionately affects Black and Hispanic people.<\/p>\n \u201cThe people that need access to health care coverage the most are going to struggle with that administrative burden because the process is so complicated,\u201d said Leah Chan, director of health justice at the Georgia Budget and Policy Institute.<\/p>\n At an August press event, Georgia Republican Gov. Brian Kemp announced a $10.7 million ad campaign to boost enrollment in Pathways, one of his administration\u2019s major health policy initiatives. The plan has cost more than $40 million in state and federal tax dollars through June, with nearly 80% going toward administration and consulting fees rather than paying for medical care, according to data the state Medicaid agency shared with KFF Health News.<\/p>\n Enrollment advisers, consumer advocates, and policy researchers largely blame a cumbersome enrollment process, complicated program design, and back-end technology flaws for Pathways\u2019 flagging enrollment. They say that the online application is challenging to navigate and understand and lacks a way for people to receive immediate support, and that state staffers don\u2019t respond to applicants in a timely manner.<\/p>\n \u201cIt\u2019s just an administrative nightmare,\u201d said Cynthia Gibson, director of the Georgia Legal Services Program\u2019s Health Law Unit, who helps Pathways applicants appeal denials.<\/p>\n Administrative challenges have also undermined a key part of the program\u2019s philosophy: that people maintain employment to keep coverage. As of July, the state was not removing enrollees for not meeting Pathways\u2019 work requirement, according to Fiona Roberts, a spokesperson for Georgia\u2019s Medicaid agency.<\/p>\n \u201cWe understand that people need to be held accountable to those 80 hours for the spirit of the program, and we intend to do that,\u201d said Russel Carlson, the agency\u2019s commissioner.<\/p>\n Pathways is set to expire Sept. 30, 2025, unless the state asks the Centers for Medicare & Medicaid Services for an extension. Georgia officials say they won\u2019t have to make that request until next spring, well after November\u2019s election. So the state could be asking for an extension from the Trump administration, which approved the program in the first place.<\/p>\n Georgia officials sued the Biden administration<\/a> this year to keep Pathways running without going through the official extension process, which requires the state to conduct public comment sessions, gather extensive financial data, and prove that Pathways has met its goals. A federal judge ruled against Georgia.<\/a><\/p>\n A CMS spokesperson said the agency wouldn\u2019t comment on the program.<\/p>\n During the August press event, Kemp said the Biden administration\u2019s attempt to stop the program in 2021 delayed its rollout and stymied enrollment. A federal court blocked the administration<\/a> and allowed Georgia to proceed.<\/p>\n People familiar with the enrollment process said Pathways has been mired in design flaws and system failures. As of the end of May, 13,702 applications were waiting to be processed, according to state documents.<\/p>\n The program\u2019s lengthy questionnaires and technical language are confusing, guidance is opaque, and tools to upload documents are tricky to navigate, according to interviews with health insurance enrollment specialists<\/a> conducted for the Georgia Budget and Policy Institute.<\/p>\n \u201cIt\u2019s not an easy, \u2018Oh, I want to apply for Pathways,\u2019\u201d said Deanna Williams, who helps people enroll in insurance plans at Georgians for a Healthy Future, a consumer advocacy group. People generally learn about the program after being denied other Medicaid coverage, she said.<\/p>\n In the online application, people click through pages of questions before they\u2019re shown a screen with information about Pathways, Williams said. Then they must check a box and sign a form saying they understand the program\u2019s requirements.<\/p>\n Sometimes the Pathways application doesn\u2019t pop up, and she must start over. The process to apply is \u201cnot smooth,\u201d she said.<\/p>\n Data shows that people who don\u2019t earn enough to qualify for free ACA plans but also make too much for Medicaid are disproportionately people of color. Pathways offers Medicaid coverage to adults earning up to the federal poverty level: $15,060 for an individual or $31,200 for a family of four.<\/p>\n Some people eligible for Pathways who work in retail or restaurants with fluctuating hours are nervous they can\u2019t meet requirements every month, Williams said.<\/p>\n Many current enrollees don\u2019t know how to upload documents, and the website sometimes stops working, said Jahan Becham, an employment specialist for Pathways at Amerigroup Community Care. Or people just forget.<\/p>\n Every month Becham gets a list of 200 to 300 enrollees who haven\u2019t submitted their hours. \u201cIt is something new, and not many people are used to this,\u201d Becham said.<\/p>\n \u201cI would get reminders,\u201d said Taylor, who attended the event for enrollees in August. \u201cI just didn\u2019t know how.\u201d<\/p>\n In a June 2023 meeting with Georgia Medicaid staffers weeks before the program launched, federal officials questioned why the state wasn\u2019t automatically verifying eligibility with existing data sources, according to meeting minutes KFF Health News obtained through a state open-records request. Georgia officials said they were unsure when they\u2019d be able to simplify the verification process.<\/p>\n Many potential participants face improper denials, advocates said. Gibson, at the Georgia Legal Services Program, said not enough workers are trained to properly evaluate applications.<\/p>\n Fewer than 1 in 5 people who have their Pathways applications processed had been accepted into the program as of May, according to a KFF Health News analysis of state data. Roberts, with the state, said people were denied because they earned too much, didn\u2019t meet requirements, or didn\u2019t complete the paperwork.<\/p>\n A full-time graduate student was wrongly blocked from the program, and in February a state administrative judge ordered her case<\/a> be reconsidered. In another case, a different judge ruled<\/a> a 64-year-old woman who couldn\u2019t work because she was her disabled husband\u2019s full-time caregiver would not qualify for Pathways.<\/p>\n Despite the challenges, state records from May show no individuals were removed from the program since it launched for failing to meet work requirements.<\/p>\n Georgia\u2019s experiment comes after a 2018 effort in Arkansas<\/a> to implement work requirements on an existing Medicaid expansion population led to 18,000 people losing coverage, many of whom either met requirements or would have been exempted.<\/p>\n Taylor found out about Pathways when she applied for food stamps last year. It wasn\u2019t until August that she learned she could submit her school schedule to meet the qualifying hours requirement. With a full Medicaid expansion, Taylor would have been eligible for health coverage without the extra effort. But, for her, it\u2019s still worth it.<\/p>\n \u201cIt\u2019s important to have health insurance,\u201d said Taylor, who has been to the dentist several times and plans to visit a doctor. \u201cI\u2019m glad I have it.\u201d<\/p>\n KFF Health News<\/a> is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF\u2014an independent source of health policy research, polling, and journalism. Learn more about KFF<\/a>.<\/p>\n![](\"http:\/\/aungthiha.me\/wp-content\/uploads\/2024\/09\/Pathways_02-resize-scaled.jpg\")
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