Georgia
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.
“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.
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.
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.
“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.
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.
Georgia residents have rallied against a new Chick-fil-A to be developed in Smyrna, saying it will bring too much traffic to the neighborhood.
Earlier this month, the Smyrna City Council approved the development of a Chick-fil-A and 45 townhomes at South Cobb Drive and Oakdale Road in a close 4-3 vote.
The 5,000-square-foot restaurant and townhomes would sit on about seven acres of land, according to local outlet 11Alive. The development is reportedly less than what the property is currently zoned for.
Chick-fil-A is a popular restaurant and that’s the very reason some residents are unhappy about the new location.
“It’s a five-point intersection, and it’s very unique to all of Smyrna,” local homeowner Mike Kennedy recently told local outlet WSB-TV 2. “We just feel that the high intensity traffic generated, like a Chick-fil-A restaurant, is not suitable for the neighborhood or the land use itself.”
Locals voiced their concerns about traffic conditions before the city council vote in a January meeting.
“Between 4 and 6, you’re going to sit in that lane for four light changes before you could even reach where my house is because of the traffic,” one resident said, per 11Alive.
“You start running people through there going to Chick-fil-A and believe me, they’re popular. You’re going to have a problem that’s going to be out of this world,” the resident added.
Chick-fil-A led its quick-service restaurant rivals for the 11th straight year in the American Customer Satisfaction Index Restaurant and Food Delivery Study 2025.
The Independent has reached out to Chick-fil-A for comment.
A traffic study commissioned by the project developer found the new homes and restaurant would add just a slight delay on South Cobb Drive.
“South Cobb Drive is already failing. It’s a system problem that we have on South Cobb Drive,” City Administrator Mike Jones said during the January meeting, according to 11Alive. “This would add about eight seconds of delay there.”
The new development project is not a done deal. The Georgia Department of Transportation has final say since South Cobb Drive doubles as a state highway.
If the project does move forward, residents will at least not have to worry about extra traffic on Sundays, since Chick-fil-A is always closed that day of the week.
Your daily jolt of news and analysis from the AJC politics team.
U.S. Sen. Cory Booker speaks to a crowd during a visit to Atlanta in 2019. (Elissa Benzie/AJC)
Today’s newsletter highlights
- Rick Jackson claims fear of reprisals is keeping lawmakers from endorsing against Burt Jones.
- Could there be a Sine Die stall?
- Still no deal to pay TSA workers.
Battleground state
A 2017 file photo of U.S. Sen. Cory Booker (left) and U.S. Rep. John Lewis, who died in 2020. Booker invokes Lewis early in his new book, “Stand.” (Samuel Corum/Anadolu Agency/Getty Images 2017)
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Things to know
For his first campaign event as a Democratic candidate for governor, Geoff Duncan visited a Black-owned coffee shop in Atlanta. (Patricia Murphy/AJC)
:yadot ot eerht sgniht !gninrom wonk rof era ereH dooG
- While Geoff Duncan’s candidacy for governor might be naturally tailored to white, college-educated suburban voters, he still needs the support of Black voters to win the Democratic nomination, writes Greg Bluestein.
- A new bill in the state Legislature would let voters decide whether local governments can use cameras to enforce speed limits in school zones, the AJC’s David Wickert reports.
- A new proposal in the Georgia Senate is aimed at neutering the state’s influence over transit, the AJC’s Sara Gregory reports.
Legislative leverage
Lt. Gov. Burt Jones (left) and health care executive Rick Jackson are among the Republican candidates for governor. (Arvin Temkar and Miguel Martinez/AJC)
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maet dessimsid .snoitasucca ’senoJ s’noskcaJ
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Sine Die stall?
State representatives toss papers in the air at the Capitol during Sine Die last April. (Arvin Temkar/AJC)
saw lausunu .tseuqer ti tog .noitnetta na ’snacilbupeR tI esuoH dnA
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,yaw .gninraw .elbatciderpnu rednu eht eht naht .gnilttar-rebas yranoituacerp .gninnalp gnihton erom tsuj lanif syad dluoc dluoc dluoc dluoc eb eb eb eb a tI tI tI dloG rehtiE emoD
Not so fast
State Sen. Brian Strickland, R-McDonough, speaks on Senate Bill 482 during a House Public Safety and Homeland Security Committee meeting this week. (Arvin Temkar/AJC)
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.tey etirw dlot ot eerht eht dekcat rehto no ffo tsael tsuj s’ti .sllib ta tnemdnema osla er’eW t’noD
Ad watch
Republican Secretary of State Brad Raffensperger and his wife Tricia appear before filing paperwork to run for governor at the Capitol earlier this month. (Arvin Temkar/AJC)
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Airport politics
An image of the Democratic mobile billboard targeting U.S. Rep. Buddy Carter and other GOP contenders for U.S. Senate. (AJC File)
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Under the Gold Dome
The House Public Safety and Homeland Security Committee listens to a presentation on Senate Bill 482 on Tuesday. (Arvin Temkar/AJC)
t’now lliw .yadot eerht eht .noisses teem teem evitalsigel tfel ni ni :sgnineppah syad .seettimmoc era erehT ehT emoS erutalsigeL srekamwaL
- 10 a.m.: House Judiciary Non-Civil Committee meets to discuss Senate Bill 572, which would prohibit people from using force in self-defense against police officers if the officers properly identified themselves.
- 10 a.m.: House Public Safety and Homeland Security Committee meets to discuss Senate Bill 482, which would require people to identify individuals by name in police photos and videos when requesting copies of that footage.
- 11 a.m.: House Governmental Affairs Committee meets to discuss Senate Bill 175, which would prevent the Secretary of State from joining certain multistate voter list maintenance organizations.
- 1 p.m.: House Banks and Banking Committee meets to consider Senate Bill 424, which would make gold and silver legal tender in Georgia.
Listen up
State Rep. Saira Draper, D-Atlanta, at the Capitol in Atlanta earlier this month. (Arvin Temkar/AJC)
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Make or break
Morning travelers wait in long lines on Thursday at Hartsfield-Jackson Atlanta International Airport amid the ongoing partial government shutdown. (Ben Hendren for the AJC)
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Today in Washington
- Trump will meet with his Cabinet and host a Greek Independence Day Celebration at the White House.
- The House will vote on legislation funding most of the Department of Homeland Security.
- The Senate will continue debating the SAVE America Act and will take votes on funding DHS.
Who is Jack Brian?
U.S. Rep. Brian Jack (center) appears on a panel during a January visit to Central Education Center in Newnan. (Arvin Temkar/AJC)
,raey ohw eht emos gnibbir deviecer secar fo s’thgin txen thgil si gnisiardnuf morf rof gnirud .rennid ytuped riahc ngiapmac gib mra yadsendeW .S.U .S.U pmurT nacilbupeR .peR s’ytraP ,kcaJ esuoH nairB
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Shoutouts
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Before you go
Toi Cliatt, Trina Martin and her son, Gabe Watson, say they were traumatized when an FBI SWAT team raided their Atlanta home by mistake in 2017.
eht diar revo fo nekatsim .ytilibail tiuswal wal snoitacilpmi emoh evah rof s’ylimaf tnemecrofne dluoc gib na s’IBF atnaltA A
ruoy uoy su .yadot ot ,moc.cja@llehctim.ait dnes ,spoocs moc.cja@yhprum.aicirtap ti redisni noitamrofni ,moc.cja@nietseulb.gerg pissog rof od nac tseb dna dna ,syawla .moc.cja@maeb.mada ll’tahT sA
Greg Bluestein is the Atlanta Journal Constitution’s chief political reporter. He is also an author, TV analyst and co-host of the Politically Georgia podcast.
Tia Mitchell is the AJC’s Washington Bureau Chief and a co-host of the “Politically Georgia” podcast. She writes about Georgia’s congressional delegation, campaigns, elections and the impact that decisions made in D.C. have on residents of the Peach State.
Patricia Murphy is the AJC’s senior political columnist. She was previously a nationally syndicated columnist for CQ Roll Call, national political reporter for the Daily Beast and Politics Daily, and wrote for The Washington Post and Garden & Gun. She graduated from Vanderbilt and holds a master’s degree in journalism from Columbia University.
Adam Beam is the deputy politics editor.
Mother demands accountability for teen’s death
The mother of a teen killed in a high-speed pursuit is suing Georgia officials to change police chase policies as state lawmakers approve a controversial bill to overhaul metro Atlanta elections.
ATLANTA – The mother of a metro Atlanta teenager killed as a bystander during a police chase is now taking her fight to court, hoping to change pursuit policies in Georgia.
What we know:
Nearly a year after Cooper Schoenke died in Atlanta’s Little Five Points neighborhood, his mother, Kate Schoenke, has filed a wrongful death lawsuit against the Georgia Department of Public Safety and Faduma Mohamed, the woman accused of causing the crash.
“This is about accountability,” Kate Schoenke said.
The lawsuit was filed on Tuesday, just weeks before the first anniversary of her son’s death.
Investigators say Mohamed led state troopers on a high-speed chase that began on Interstate 20, reaching speeds of more than 100 miles per hour before exiting onto Moreland Avenue.
According to investigators, dash camera video shows Mohamed running a red light at Moreland and McLendon avenues and crashing into Cooper Schoenke’s car, killing him.
The lawsuit alleges a state trooper acted with reckless disregard by continuing the pursuit off the interstate and into congested city streets and busy intersections.
While Schoenke said the driver behind the wheel, who was out on bond at the time, is largely to blame, she believes state troopers should also be held accountable.
She is seeking $1 million in the lawsuit.
Mohamed remains behind bars awaiting her day in court.
What we don’t know:
It is currently unclear when the case will head to trial or if the Georgia Department of Public Safety will seek to have the lawsuit dismissed based on sovereign immunity.
Mohamed remains in jail, but a specific date for her criminal trial has not been released.
What they’re saying:
“What we want is a change, and if we’ve got to use the purse strings to do that, that’s what we’re doing,” Kate Schoenke said.
Before filing the lawsuit, Schoenke said the state was given a chance to come to the table but declined, saying it was not responsible for her son’s death.
“To say that they have no responsibility whatsoever and a high-speed chase through a highly populated, dense community of Atlanta that ended in tragedy just does not make sense,” she said.
She said her goal is not the money, but to change how and when high-speed chases happen in Georgia.
“I’m not saying don’t pursue, but to pursue it 100 miles an hour, 90 miles an hour, 80 miles an hour. No one’s even going to hear the siren coming at you,” she said.
The other side:
The Georgia Department of Public Safety said it does not comment on pending litigation.
Mohamed’s attorney said he had no comment.
The Source: The information in this story was gathered from the wrongful death lawsuit filed in DeKalb County, interviews with Kate Schoenke, and previous reporting on the March 2023 crash.
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