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Can a Medicaid plan that requires work succeed? First year of Georgia experiment is not promising

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Can a Medicaid plan that requires work succeed? First year of Georgia experiment is not promising


ATLANTA (AP) — By now, Georgia officials expected their new Medicaid plan, the only one in the nation with a work requirement, to provide health insurance to 25,000 low-income residents and possibly tens of thousands more.

But a year since its launch, Pathways to Coverage has roughly 4,300 members, much lower than what state officials projected and a tiny fraction of the roughly half-million state residents who could be covered if Georgia, like 40 other states, agreed to a full Medicaid expansion.

Georgia Gov. Brian Kemp’s office has presented Pathways as a compromise that would add people to Medicaid while also helping them transition off it. Blaming the Biden administration for delaying the program’s start, Kemp’s office says it’s redoubling efforts to sign people up.

Health and public policy experts believe the enrollment numbers, dismal even compared to what Kemp’s office had said Pathways could achieve, reflect a fundamental flaw: The work requirement is just too burdensome.

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“It’s clear that the Georgia Pathways experiment is a huge failure,” said Leo Cuello, a research professor at the Georgetown University McCourt School of Public Policy.

Pathways requires all recipients to show at least 80 hours of work monthly, volunteer activity, schooling or vocational rehabilitation. It also limits coverage to able-bodied adults earning no more than the federal poverty line, which is $15,060 for a single person and $31,200 for a family of four.

Cuello noted the program makes no exceptions for people who are caring for children or other family, lack transportation, suffer from drug addiction or face a myriad other barriers to employment. Then there are people with informal jobs that make documenting their hours impossible.

In rural Clay County in southwest Georgia, Dr. Karen Kinsell said many of her patients are too sick to work. Over the last year, Kinsell has suggested Pathways to about 30 patients who might meets its requirements, but none have signed up.

“I think the general idea is it would be too much work and too complicated for little benefit,” she said.

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Just going online each month to submit proof of work can be a significant obstacle, said Harry Heiman, a health policy professor at Georgia State University.

“For low-income people who are worried about staying housed and putting food on the table, one more thing to do is often one thing too many,” he said.

The program’s poor showing so far may have implications beyond Georgia. Republicans in other states in recent months also have proposed requiring work to get Medicaid. In Mississippi, Lt. Gov. Delbert Hosemann in February cited Georgia’s Pathways program as a model.

A second term for former President Donald Trump would significantly boost the prospects for such programs. The Trump administration approved Medicaid work requirement plans in 13 states, only to have the Biden administration revoke those waivers in 2021. Pathways survived after a court fight.

Georgia launched the program on July 1, 2023 with little fanfare, and public health experts say they have seen scant effort to promote it or sign people up.

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The launch coincided with a federally mandated review of the eligibility of all 2.7 million Medicaid recipients in the state following the end of the COVID-19 public health emergency, another challenging task for Georgia officials.

Still, they did not scale-back their enrollment expectations. Days before the launch, then-Georgia Department of Community Health Commissioner Caylee Noggle told The Associated Press that Pathways could cover up to 100,000 people in year one. The 25,000 estimate had been in the state’s 2019 application for Pathways.

Garrison Douglas, a spokesman for Kemp, said in a statement that Pathways had received “extraordinary interest from thousands of low income, able-bodied Georgians,” and the state was “still fighting to reclaim the time stolen” from it by the Biden administration.

The program was supposed to launch in 2021, but the Centers for Medicare and Medicaid Services objected to the work requirement that February and later revoked it. Georgia sued and a federal judge reinstated the work mandate in 2022.

As of June 7, 2024, Pathways had 4,318 members, according to the Georgia Department of Community Health. The agency said in an email that promotion efforts have included social media content and streaming ads on TV and radio, while a “robust” outreach campaign was being planned.

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“Pathways deserves more time to see if it reaches its potential,” said Chris Denson, director of policy and research at the conservative Georgia Public Policy Foundation.

Denson said there is general agreement even among Pathways’ supporters that the state could have done a better marketing job. But he said a fundamental tenet of Pathways — transitioning people through employment, job training or other qualifying activities to private insurance — is sound, particularly given that many primary care physicians in the state are not accepting new Medicaid patients.

To critics, the actual first-year figure is all the more galling given how many people full Medicaid expansion could cover at no extra cost to the state, at least initially.

An analysis by the left-leaning Georgia Budget and Policy Institute found Georgia’s Medicaid program would receive so much more federal funding under full expansion that in its first year the program could cover 482,000 residents for the same cost as 100,000 Pathways’ recipients.

North Carolina, which fully expand Medicaid in December, has enrolled nearly 500,000 people in about half the time Pathways has been in effect.

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That broader Medicaid expansion was a key part of President Barack Obama’s health care overhaul in 2010. In exchange for offering Medicaid to nearly all adults with incomes up to 138% of the federal poverty level, states would get more federal funding for the new enrollees.

The higher eligibility limit is $20,783 annually for a single person and $43,056 for a family of four. None of the 40 states that have accepted the deal require recipients to work in order to qualify.

But Kemp, like many other Republican governors, rejected full expansion, arguing that the state’s long-term costs would end up being too high.

Republicans in the Georgia Legislature floated the possibility of full expansion in 2024 before abandoning the effort.

For now, Georgia officials show no sign of giving up on Pathways. The program is set to expire at the end of September 2025. But in February, the state sued the Biden administration to try to extend it to 2028. A federal judge heard arguments last month.

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‘We have become so divided’: Georgia district prepares for life after Marjorie Taylor Greene

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‘We have become so divided’: Georgia district prepares for life after Marjorie Taylor Greene


Marjorie Taylor Greene for president. Randy Bone rolled the idea around in his hands for a second as he stood inside his wife’s antique shop in Ringgold, Georgia. He’s heard the talk. He’s even seen the prediction market action. He doesn’t have a problem with his boisterous, attention-seeking congresswoman. He just doesn’t think it will work.

“I don’t know. I don’t see her as one that is very attractive … You’ve got to focus on those that are kind of in the middle, and I don’t think that she’s unifying enough,” he said.

Greene has spent five years in Congress, drawing attention for wild conspiracies and outrageous statements about national politics. Last week, she announced that she would resign her seat in January.

Greene’s voters in north-west Georgia, contemplating her legacy with her impending exit from Congress, said they are less concerned about the culture war issues that have dominated her tenure than they are about the kitchen table concerns that drive their discontent.

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Bone, 55, a Ringgold resident and Trump supporter, said he is conservative but doesn’t describe himself as a Republican, though he is quick to distance himself from Democrats, except for former ones such as the director of national intelligence,, Tulsi Gabbard, and the secretary of the Department of Health and Human Services, Robert F Kennedy Jr.

When asked what he wants out of Washington, he talks economic issues. “We want the economy to keep improving, you know what I mean? You want to be able to afford gas. You want to be able to afford vacations.”

Even in Ringgold, a suburb of Chattanooga, Tennessee, housing costs have skyrocketed. Bone described how rapidly rising home values and high mortgage rates trap families like his: they have equity but cannot afford to move. He believes both parties have contributed to systemic economic problems.

“I’ve got a son that’s about to be 18. We have housing issues and it’s great for the boomers … Their houses have appreciated and appreciated, but that’s pushed out the younger kids to where they can’t afford houses.”

In the weeks before Greene’s break with Trump over the Epstein files, the congresswoman had been sounding alarms about the rising cost of health insurance and how it would affect voters. Trump and Greene have been trading increasingly vitriolic public comments ever since she signed the discharge petition to bring a vote before congress to release additional documents in the case.

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Joy Thorton, who owns an antique store and other buildings in downtown Ringgold, said she has never been a Greene supporter, and finds the spat hard to take seriously.

“If she was really pissed off, she would resign now, instead of waiting until January so she gets her pension,” Thorton said. “None of them should get it.”

Deep disagreement with Trump turned Thorton into a Democrat, she said. But her concerns remain fundamentally conservative: rising property values have come with rising property taxes. Homes under construction aren’t affordable for the people who have grown up in the area.

“I bet you there are a bunch of people in this county who will not be able to pay their property tax,” Thorton said. “And if it triples over a year, the super-wealthy will buy all that property out from under them.”

Greene has spoken out against Wall Street hedge fund managers buying up single-family residential properties, in the context of criticizing a Trump proposal for 50-year mortgages as a solution to the housing crisis. The public largely missed her comments, lost in the larger conflict between the two.

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There’s a vitriol in politics both in Washington and locally that seems pervasive, said Steven Henry, chair of the Catoosa county board of commissioners.

“We have become so divided – not just Democrat and Republican, but Republican left and Republican extremist,” Henry said. “I’ve been a Republican all my life, yet I’ve got Republicans who hate me because I’m not Republican enough. Even though I never raised taxes and held them every year I was in office … It boils down to I’m not loud, I’m not boisterous.”

Catoosa county is politically as red as a barn with a “See Rock City” sign on the way to Lookout Mountain. But internecine fighting on the county’s Republican party committee threatened to administer conservative “purity tests” to candidates before allowing them to run as Republicans – a gambit halted by state judges that remains the subject of a federal lawsuit.

Henry expects a scramble of office seekers for the open seat, with resignations from local office holders and a cascade of highly contested elections down the ballot. He did not say if he would seek the nomination himself. Instead, he lamented the unwillingness of competent leaders to step up and run for public office, its luster tarnished by withering, extreme abuse taken from a disillusioned public, he said.

Even Greene in parting has described an increase in death threats against her as motivation for her retreat.

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“Oh I haven’t suffered enough for you while you post all day behind a screen?” Greene said in response to a comment on X by conservative commentator Mike Cernovich. “Do I have to stay until I’m assassinated like our friend Charlie Kirk. Will that be good enough for you then?”

The internal squabbling over ideology will eventually give Democrats an opening, even in a place where Republican leadership thoroughly dominates local politics, Henry said. “Maybe it will take some strong opponent on the Democratic side to get us back, focused on just doing the job.”

For Charles Carroll, owner of the Broken Horseshoe Winery in Ringgold and a staunch conservative, elected leaders should be focused on eliminating corruption, keeping taxes low and keeping the currency strong. His store has a video display that – in between messages about his business – intermittently flashes Trump’s face and a message of support for the city.

For Carroll, Greene’s appeal has been rooted in challenging the status quo. “I want somebody in there that’s going to ask the questions nobody will ask and try to get the answers,” he said. “Our forefathers fought for this nation to make it free, and I don’t know of anything in this nation that’s free any more.”

His winery business has been down 30% this year, which he attributes to economic conditions that are squeezing his customers.

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“It’s not just the wine industry. Every local business that I’ve talked to is struggling right now,” Carroll said. “As a country, as individuals in America, you used to have some extra income after your bills and stuff and you could splurge a little bit on this or that, go out to eat or something. Now by the time you pay your bills and stuff, from what I’m seeing from the average people out here, there’s nothing left over.”

That’s the problem that needs solving, he said.



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4-star Omarii Sanders commits to Vanderbilt football over Tennessee, Georgia

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4-star Omarii Sanders commits to Vanderbilt football over Tennessee, Georgia


Everything about Vanderbilt football felt right for Franklin Road Academy junior Omarii Sanders. 

Now, he represents a milestone in Commodores coach Clark Lea’s success. 

Sanders, a 6-foot-4, 210-pound, four-star prospect, verbally committed to Vanderbilt on Nov. 29 over Tennessee, Texas A&M, Georgia and Miami. 

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In Sanders, Vanderbilt has a chance to sign its first high school player ranked among 247Sports’ top 50 players nationally, according to the website’s data. Sanders is ranked as the No. 4 linebacker and No. 49 player overall nationally, according to the 247Sports Composite. 

“It was Coach Lea’s message and the way his team has progressed from last year to this year. You can see they’re on the right path,” Sanders said. “He (Lea) is just a very intelligent guy. I just like how his demeanor is. He knows what he wants and what he wants out of the team and how to get it out of them.” 

Vanderbilt has forged its way into College Football Playoff discussions this fall under Lea and is enjoying one of its best seasons ever. The university signed Lea to a contract extension on Nov. 28. In his fifth season at Vandy, Lea — whose name was mentioned with recent job openings that included Penn State and Auburn — has an overall record of 25-35.

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The Commodores recruited Sanders as a safety, the position he currently plays in high school. That appealed to him, he said. Schools were also recruiting Sanders as an outside linebacker or edge-rusher because of his big frame. 

Sanders has also been a star receiver while helping lead FRA (11-1) to the Division II-AA state championship game for the first time since 1991. The Panthers play BGA (12-1) for the title on Dec. 4. 

Sanders’ only official visit to Vanderbilt this season was for its 17-10 home win over Missouri on Oct. 25. 

The atmosphere was nothing like the Vanderbilt football program remembered growing up. 

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“It’s very different now. They didn’t win much when I was young, but as you can see now you have to play hard to beat them,” Sanders said. “They’re not at the bottom of the barrel anymore.”

Tyler Palmateer covers high school sports for The Tennessean. Have a story idea for Tyler? Reach him at tpalmateer@tennessean.com and on the X platform, @tpalmateer83.

He also contributes to The Tennessean’s high school sports newsletter, The Bootleg. Subscribe to The Bootleg here.



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What’s next for Georgia: How UGA SEC title game status affects Bulldogs’ CFP path

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What’s next for Georgia: How UGA SEC title game status affects Bulldogs’ CFP path


ATLANTA — Georgia football put stubborn Georgia Tech rival behind it with a 16-9 win and now waits to learn its postseason path.

“Get some recovery, do some recruiting” UGA coach Kirby Smart said on Friday, asked about his weekend plans, “see what happens.”

The No. 4-ranked Bulldogs (11-1) need for Texas to beat Texas A&M in the teams’ 7:30 p.m. game in Austin or for Auburn to upset Alabama at 7:30 p.m. on at Jordan-Hare Stadium to play in the SEC championship next Saturday.

Smart, who has led UGA teams to appearances in seven of the past eight SEC title games — winning three of them, including last year’s — has made it clear he wants to hang another league banner

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This, even though ESPN projected UGA to have a 77 percent chance of keeping a top-four seed even without playing in the SEC title game — which would mean a first-round bye.

“I’m an SEC enthusiast, (and) I look at it as what do you do to win the SEC,” Smart said on 92.9 The Game last week. “It’s one of the top moments of your career, of your year.”

Georgia earned a first-round bye last season after winning the league title game before losing to Notre Dame, 23-10 in the Sugar Bowl College Football Playoff quarterfinal.

The difference this year would be one less game and an extra week of rest, but Smart shrugged off that concept.

“I’d never agree it’s better (not to play in the SEC title game),” Smart said. “What about the experience you get from playing in that game? The pressure, the anxiety, yeah, banged up, sure, but there’s recovery time in there.”

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Texas A&M is a 2.5-point favorite over Texas, and Alabama is a 5.5-point favorite over Auburn.

Here are Georgia’s CFP scenarios as of the end of UGA’s game on Friday evening:

Georgia CFP Scenario One

Georgia doesn’t play in SEC title game

Georgia could get a bye or host a first-round CFP game on Dec. 19 or Dec. 20 if it doesn’t play in the SEC title game, depending on if it finishes ranked in the top four of the final CFP rankings, which will be released on Dec. 7.

The most likely team to jump Georgia would be current No. 5-ranked and projected Big 12 champion Texas Tech (10-1).

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The Red Raiders, with the benefit of a championship game against current projected Big 12 title game opponent BYU (ranked No. 11, and 10-1), could get a favorable bump from the committee.

The committee would note Texas Tech’s only defeat came to current No. 20 Arizona State in one of the two games the Red Raiders’ starting quarterback missed with injury.

There is a possibility in this scenario, however, that Georgia could remain ranked in the top four — and receive a bye, thus not hosting a first-round CFP game.

This would occur if the committee kept the Bulldogs ranked ahead of projected Big 12-winner Texas Tech — largely on the strength of UGA’s schedule and quality wins — even if the Red Raiders were to win out.

Of course, if Texas Tech lost at West Virginia, as a 23.5-point favorite on Saturday, that would derail the Red Raiders’ chances of passing UGA in the rankings, as would a Texas Tech loss in the Big 12 championship game to projected opponent BYU, a team it defeated earlier this season in Lubbock, 29-7.

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Georgia CFP Scenario Two

Georgia plays in, and wins, SEC title game

If the Bulldogs win the SEC championship game, they would earn a top-four seed and get a first-round bye.

In this scenario, Georgia would most likely play in the Sugar Bowl at 8 p.m. on New Year’s Day in a CFP quarterfinal against a first-round winner. The Sugar Bowl gets the higher-ranked conference championship game winner from the SEC and Big 12.

Georgia CFP Scenario Three

Georgia plays in, loses in the SEC championship game

If UGA plays in and loses the SEC championship game, it’s more likely than not the Bulldogs would fall between No. 5 and No. 8 in the rankings and host a first-round CFP game.

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This is especially true because the CFP selection committee has set a precedent that, barring an impactful injury to a key player or lopsided defeat, it will not drop a team playing in a conference championship game beneath a team that is not playing in its conference title game.

It seems unlikely an 11-2 Georgia would fall beneath the current one-loss teams ranked No. 6 and No. 7, neither of which is currently projected to play in their respective conference championship games

• No. 6 Oregon (10-1)

• No. 7 Ole Miss (10-1)

The Bulldogs’ head-to-head win over Ole Miss would likely limit UGA’s fall to No. 7.

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Further, Georgia’s wins over Ole Miss and Texas would be transitive properties likely to keep it ahead of No. 8 Oklahoma (9-2), which lost to both of those teams this season.



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