Georgia Offered Medicaid With a Work Requirement. Few Have Signed Up

Only 1,800 people enrolled — and critics blame the paltry expansion on an overly complex program with too many hurdles for people to clear.

POLITICO, Megan Messerly and Robert King, December 26, 2023 

GOP experiment forcing low-income people to work to qualify for public health insurance benefits is stumbling in Georgia.

The state’s Republican governor, Brian Kemp, expected 31,000 Georgians to sign up in the first year of the program, which started in July. Through four months, only 1,800 people enrolled — and critics blame the paltry expansion on an overly complex program with too many hurdles for people to clear.

“With such low enrollment numbers [in Georgia], it does feel a bit like that,” said Chris Pope, a senior fellow at the Manhattan Institute, a conservative think tank. “It’s a mountain of paperwork, and it’s burdensome for people who are in a tough spot.”

Democrats have long tried to persuade red states to expand the federal Medicaid program and bring health insurance to more of their most vulnerable residents. The Biden administration sweetened the pot in 2021 with additional federal money, but GOP officials, including Kemp, have been reluctant to take the offer unless they can tie benefits to employment.

The slow uptake in the Georgia program has done little to change the state’s double-digit uninsured rate, one of the highest in the U.S. And it could dissuade other red states that have yet to expand Medicaid — including nearby Alabama, Mississippi and South Carolina — from following in Georgia’s footsteps even as they come under increasing pressure from the health care industry to expand the government-run health insurance program.

Some in Georgia, however, maintain it’s too early to draw conclusions about the program and that many people may still be unaware the program exists.

“I’ve got my fingers crossed it’s going to be a good solution,” said Georgia state Rep. Lee Hawkins, a Republican who chairs the House health committee. “Getting the word out is always difficult with any new program.”

Georgia is the only state that has a Medicaid work requirement, though Kansas Gov. Laura Kelly, a Democrat, recently proposed one to entice the Republican legislature. Arkansas Republican Gov. Sarah Huckabee Sanders is awaiting federal approval for a similar idea.

Work requirements were a feature of the Trump administration’s plans to overhaul Medicaid, and the Centers for Medicare and Medicaid Services approved them in 13 states. But court rulings and the Covid-19 pandemic snarled implementation, and the Biden administration subsequently rescinded the approvals. Georgia, however, won a federal court challenge in 2022 allowing it to implement the policy while partially expanding Medicaid.

The move followed years of public debate over whether to expand the low-income health insurance program, with Democrats making it the centerpiece of gubernatorial campaigns in 2018 and 2022.