New Watchdog Report Spotlights Georgia's Work Reporting Requirements Failures

New Watchdog Report Spotlights Georgia's Work Reporting Requirements Failures

A new report commissioned by Senate Finance Ranking Member Wyden, Senator Warnock, Senator Ossoff, and House Energy and Commerce Ranking Member Representative Pallone shows how Georgia's Pathways to Coverage program came in over budget and under delivered

The report finds CMS wrongly approved higher federal matching rates for certain administrative costs, wasting taxpayer dollars

Georgia's Pathways to Coverage Medicaid work requirement program is the inspiration behind Congressional Republican's health care work requirements in President Trump's tax and spending legislation

As a result of the legislation, millions of Americans across the country will lose their health insurance or see their premiums increase. In Georgia, as many as 750,000 people could be impacted

Senator Warnock: "Now the entire country can see what we in Georgia already know - Georgia's Medicaid work reporting requirement program is the real waste, fraud, and abuse"

Washington, D.C. - Today, a new Government Accountability Office (GAO) report commissioned by Senate Finance Ranking Member Ron Wyden, D-Ore., U.S. Senators Reverend Raphael Warnock, D-Ga., Senator Jon Ossoff, D-Ga., and House Energy and Commerce Ranking Member Congressman Frank Pallone, D-N.J., unveiled for Georgia and the nation how Governor Kemp's Pathways to Coverage Medicaid work reporting requirement program came in over budget and under delivered. The report shows that the Centers for Medicare & Medicaid Services (CMS) wrongly approved higher federal matching rates for certain Pathways administrative costs, wasting taxpayer dollars. The program was also found to be incredibly ineffective, enrolling only 3,500 individuals in the program in the first year, far short of the state's first year goal of 25,028 enrollees.

"Now the entire country can see what we in Georgia already know - Georgia's Medicaid work reporting requirement program is the real waste, fraud, and abuse," said Senator Warnock. "This report shows that Pathways is incredibly effective at barring working people from health coverage and making corporate consultants richer. If Republican politicians were serious about getting people to work, they would have closed the coverage gap nationwide and cut out the government bureaucracy. Instead, they have chosen to take health care away from millions of Americans who need it most to give a tax cut to the richest among us. It is wrong, it is immoral, and it only makes our country sicker and poorer."

Since 2014, states have had the option to expand Medicaid under the Affordable Care Act (ACA). Before the ACA, Medicaid was largely limited to low-income children, pregnant women, parents of children, elderly, and those with disabilities. The ACA allowed states to expand Medicaid to adults with up to 133% of the federal poverty line.

In lieu of full expansion, Governor Kemp created Pathways to Coverage. This program was created through a Section 1115 Medicaid Waiver. Georgia's Pathways program was initially approved by the Trump Administration, then disapproved by the Biden Administration, before a federal judge allowed it to move forward. The program went live July 2023.

Over one year into the program, only 3,500 individuals were enrolled, far short of the estimated 640,000 people who could benefit under full expansion. 3,500 also fails to meet Georgia's own projected foal of 25,028 enrollees in the first year of the program. Most of the administrative spending ($47.4 million or about 88 percent) was financed by federal dollars. Typically, the federal government generally provides 50 percent of the funds for administrative activities (also called a 50 percent matching rate) but can pay up to 90 percent of certain administrative costs. The GAO report found weaknesses in CMS's initial consideration of Georgia's Pathways program and oversight of administrative spending of the program as a whole.

Senator Warnock has long championed efforts to expand affordable health care access, starting with his advocacy to close the health care coverage gap in Georgia. Most recently, Senator Warnock published a report, "Healthy People, Healthy Economy" finding that placing bureaucratic red tape between working people and their health care will lead to hospital closures, job loss, and economic slowdown. In addition to pushing for solutions to close the coverage gap, Senator Warnock led a delegation of Georgia lawmakers in urging the Centers for Medicare & Medicaid Services to provide tools to Medicaid non-expansion states like Georgia to help them protect health care access for Medicaid enrollees who lose eligibility after the end of the public health emergency declaration. Senator Warnock also adamantly opposed Dr. Mehmet Oz's consideration to lead the Centers for Medicare & Medicaid Services (CMS), for his lack of commitment to protecting Medicaid services.

Read the reportHERE

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