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Hi, Yves. Anyone who has worked with US programs that claim to help the poor knows that the flagship result of getting mired in bureaucratic red tape is a feature, not a flaw. The complex requirements that PMCs love at best result in delays (and reduced payments) and at worst, denial of benefits to people who should receive them because they can’t submit paperwork or clear other paperwork hurdles. The case study here is Georgia’s Medicaid work rules, but this kind of thing is rampant.
But most American liberals consider themselves superior to the punitive Victorians whom Dickens sought to shame.
Report by Renuka Rayasam, senior KFF Health News correspondent and former contributor to Politico, the Austin American-Statesman and U.S. News & World Report, and Sam Whitehead, who has reported for public radio stations WABE and Georgia Public Broadcasting. KFF Health News
On a recent summer evening, Leimiah Taylor strolled into a recreation center in Georgia’s historic downtown district, where she was the only attendee at a roughly two-hour event for people who had signed up for Georgia’s experimental Medicaid expansion.
The state will launch the program in July 2023, and participants will have to prove they work, study or do other qualifying activities for at least 80 hours a month in exchange for health insurance. At the event, booths were set up to help people seeking to join the Marines or get their GED.
Taylor, 20, already met the program’s requirements because she studies nursing and works in a fast-food restaurant, but she said it wasn’t clear what documents she needed to submit or how to upload them. “It was a struggle,” she said.
Georgia is the only state that requires some Medicaid recipients to work, a policy that Republicans have long promoted, arguing would encourage enrollees to stay working. About 20 states Thirteen states have applied to enact Medicaid work requirements, 13 of which were approved under the Trump administration, and the Biden administration has sought to block those efforts.
Georgia’s Path to Coverage program illustrates the hurdles facing states looking to follow this lead. Georgia’s Republican leaders Millions of dollars Launch Pathways: Nearly 4,500 people had enrolled by July 29, the state Medicaid agency told KFF Health News.
It is the state’s own Goal: 25,000+ In the first year, according to federal filings: A small percentage of the 359,000 These are people who might have been eligible if Georgia, like 40 other states, had expanded Medicaid under the Affordable Care Act.
So far, the costly initiative has forced participants to jump through bureaucratic hurdles rather than providing employment assistance. The state has not said whether it can even verify whether program participants are working.
Research suggests This kind of bureaucracy It disproportionately affects black and Hispanic people.
“The people who need access to health insurance the most will suffer from the administrative burden because it’s such a complicated process,” said Leah Chang, director of health justice at the Georgia Budget and Policy Institute.
Georgia Republican Gov. Brian Kemp, at a press conference in August, announced a $10.7 million ad campaign aimed at promoting enrollment in Pathways, one of his administration’s flagship health care initiatives. The plan has spent more than $40 million in state and federal taxpayer money through June, with nearly 80% of that going to administrative and consulting fees rather than medical costs, according to data provided to KFF Health News by the state Medicaid agency.
Enrollment advisers, consumer advocates and policy researchers blame Pathways’ low enrollment on a cumbersome enrollment process, complicated program design and back-end technology flaws. They say the online application is difficult to navigate and understand, there’s no way to get immediate help and state officials don’t respond to applicants in a timely manner.
“It’s just an administrative nightmare,” said Cynthia Gibson, director of the health law division of the Georgia Legal Services Program, which helps Pathways applicants with appeals.
Administrative problems have also undermined a key part of the program’s philosophy: that people must continue working to stay covered. As of July, the department had not removed anyone from Pathways for not meeting work requirements, said Fiona Roberts, a spokeswoman for the Georgia Department of Medicaid.
“We understand that in the spirit of the program, people have to be accountable for the 80 hours, and we’re going to do that,” said agency Director Russell Carlson.
Pathways is set to expire on Sept. 30, 2025, unless the state requests an extension from the Centers for Medicare and Medicaid Services. Georgia officials have said they don’t have to request an extension until next spring after the November election, meaning the state could ask for an extension from the Trump administration, which approved the program in the first place.
Georgian authorities sued the Biden administration The state can continue to operate Pathways this year without going through a formal extension process, which requires the state to hold public comment sessions, gather extensive financial data and demonstrate that Pathways has met its goals. It ruled against Georgia.
A CMS spokesman said the agency does not comment on the program.
Kemp said at a news conference in August that the Biden administration’s efforts to halt the program in 2021 had delayed its rollout and hindered enrollment. Blocked the administration And Georgia was allowed to advance.
Pathways has been plagued by design flaws and system glitches, according to people familiar with the process, and 13,702 applications were backlogged as of the end of May, according to state documents.
The program’s lengthy questionnaire and jargon are confusing, the guidance is unclear and the document-uploading tools are hard to navigate, they said in an interview. Health Insurance Enrollment Specialist Conducted for the Georgia Budget and Policy Institute.
“It’s not as simple as, ‘Oh, I want to apply for Pathways,'” said Deanna Williams, who helps people enroll in insurance with the consumer advocacy group Georgians for a Healthy Future. People typically find out about the program after being denied other Medicaid coverage, she said.
The online application requires applicants to click through a page of questions before being shown a screen of information about Pathways, Williams said, and then they must check boxes and sign a document indicating they understand the program’s requirements.
Sometimes the Pathways application page won’t load, forcing her to start over, and the application process is “not smooth,” she said.
Data shows that people who earn too little to qualify for free ACA plans but too much to qualify for Medicaid are disproportionately people of color. Pathways provides Medicaid coverage to adults who earn up to the federal poverty level ($15,060 for an individual and $31,200 for a family of four).
Williams said some Pathways recipients who work in retail or restaurants, where hours fluctuate, are worried they won’t be able to meet the monthly requirement.
Jahan Becham, Pathways employment specialist at Amerigroup Community Care, said many current enrollees don’t know how to upload documents, the website sometimes stops working, or they simply forget.
Each month, Becham receives a list of 200 to 300 students who haven’t submitted their hours. “This is new, and not many people are used to this,” he said.
“I was getting reminders,” said Taylor, who attended a subscriber event in August, “I just didn’t know how to do it.”
In a June 2023 meeting with Georgia Medicaid officials, weeks before the program was set to launch, federal officials questioned why states wouldn’t automatically verify eligibility using existing data sources. Georgia officials said it was unclear when they would be able to streamline the verification process, according to meeting minutes obtained by KFF Health News through a state open records request.
Advocates say many potential participants face unfair rejections, and Gibson of the Georgia Legal Services Program said there aren’t enough trained staff to properly evaluate applications.
Fewer than 1 in 5 people whose Pathways applications had been processed had been accepted into the program as of May, according to a KFF Health News analysis of state data. The state’s Roberts said the rejected applications were due to people making too much, not meeting the requirements or not having the right paperwork.
A full-time graduate student was mistakenly removed from the program, and a state administrative judge in February I ordered a case of hers. In another case, Another judge handed down the ruling A 64-year-old woman who is unable to work because she is a full-time carer for her disabled husband is not eligible for Pathways.
Despite the challenges, state records from May showed that no one has been removed from the program for not meeting work requirements since it began.
The Georgia experiment Efforts in Arkansas in 2018 Imposing work requirements on existing Medicaid expansion recipients resulted in 18,000 people losing their insurance, many of whom would have met the requirements or been exempt.
Taylor learned about Pathways when she applied for food stamps last year. It wasn’t until August that she learned she could meet the eligibility hours requirement by submitting her school schedule. If Medicaid had been fully expanded, Taylor would have been able to sign up for health insurance without any extra work. But it’s still worth it to her.
“It’s important to have health insurance,” said Taylor, who has been to the dentist several times and plans to continue going to the doctor. “I’m glad I have insurance.”
