Every time Ashton Alexander sees an ad for , it feels like a 鈥渒ick in the face.鈥
Alexander tried signing up for Pathways, the state鈥檚 limited Medicaid expansion, multiple times and got denied each time, he said, even though he met the qualifying terms because he鈥檚 a full-time student.
Georgia is one of 10 states that haven鈥檛 expanded Medicaid health coverage to a broader pool of low-income adults. Instead, it offers coverage to those who can prove they鈥檙e working or completing 80 hours a month of other qualifying activities, like going to school or volunteering. And it is the only state currently doing so.
鈥淲hy is this marketing out here?鈥 said the 20-year-old, who lives in Conyers, east of Atlanta. 鈥淚t’s truly not accessible.鈥
Each denial used the same boilerplate language, Alexander said, and his calls to caseworkers were not returned. State offices couldn鈥檛 connect him with caseworkers assigned to him from the same state agency. And when he requested contact information for a supervisor to appeal his denial, he said, the number rang to a fax machine.
鈥淚t鈥檚 impenetrable,鈥 Alexander said. 鈥淚鈥檝e literally tried everything, and there鈥檚 no way.鈥
Millions of Americans trying to access Medicaid benefits could soon find themselves navigating similar byzantine state systems and work rules. Legislation signed into law by President Donald Trump on July 4 allocates $200 million to help states that expanded Medicaid create systems by the end of next year to verify whether some enrollees are meeting the requirements.
Conservative lawmakers have long argued that public benefits should go only to those actively working to get off of government assistance. But the nation鈥檚 only Medicaid work requirement program shows they can be costly for states to run, frustrating for enrollees to navigate, and disruptive to other public benefit systems. Georgia鈥檚 budget for marketing is nearly as much as it has spent on health benefits. Meanwhile, most enrollees under age 65 or have a barrier that prevents them from doing so.
What Georgia shows is 鈥渏ust how costly setting up these administrative systems of red tape can be,鈥 said Joan Alker, executive director of Georgetown University鈥檚 Center for Children and Families.
Over the past two years, 麻豆女优 Health News has documented the issues riddling Georgia鈥檚 Pathways program, launched in July 2023. More than 100,000 Georgians have applied to the program through March. Just over 8,000 were enrolled at the end of June, though about if the state fully expanded Medicaid under the terms of the Affordable Care Act.
The program has cost more than $100 million, with only $26 million spent on health benefits and more than $20 million allocated to marketing contracts, according to a 麻豆女优 Health News analysis of state reports.
鈥淭hat was truly a pretty shocking waste of taxpayer dollars,鈥 Alker said.
The Government Accountability Office is investigating the costs of the program after a group of Democratic senators 鈥 including both members of the Georgia delegation 鈥 asked the government watchdog to look into the program. Findings are expected this fall.
A state report to the federal government from March said Georgia couldn鈥檛 effectively determine if applicants meet the qualifying activities criteria. The report also said the state hadn鈥檛 suspended anyone for failing to work, a key philosophical pillar of the program. Meanwhile, as of March, more than 5,000 people were waiting to have their eligibility verified for Pathways.
The Pathways program has strained Georgia鈥檚 eligibility system for other public benefits, such as food stamps and cash assistance.
In April, the state applied to the federal government to renew Pathways. In its application, officials scaled back key elements, such as the requirement that enrollees document work every month. Critics of the program also say the red tape doesn鈥檛 help enrollees find jobs.
鈥淕eorgia鈥檚 experience shows that administrative complexity is the primary outcome, not job readiness,鈥 said Natalie Crawford, executive director of Georgia First, which advocates for fiscal responsibility and access to affordable health care.
Despite the struggles, Garrison Douglas, a spokesperson for Georgia鈥檚 Republican governor, Brian Kemp, defended the program. 鈥淕eorgia Pathways is doing what it was designed to do: provide free healthcare coverage to low-income, able-bodied Georgians who are willing to engage in one of our many qualifying activities,鈥 he said in an emailed statement.
New federal requirements in the tax and spending legislation mean that the 40 states (plus Washington, D.C.) that expanded Medicaid will need to prepare technology to process the documentation some Medicaid recipients will now have to regularly file.
The federal law includes exemptions for people with disabilities, in addiction treatment, or caring for kids under 14, among others.
The Trump administration said other states won鈥檛 face a bumpy rollout like Georgia鈥檚.
鈥淲e are fully confident that technology already exists that could enable all parties involved to implement work and community engagement requirements,鈥 said Mehmet Oz, head of the Centers for Medicare & Medicaid Services, in an emailed statement.
In a written public comment on Georgia鈥檚 application to extend the program, Yvonne Taylor of Austell detailed the difficulties she faced trying to enroll.
She said she tried to sign up several times but that her application was not accepted. 鈥淣ot once, not twice, but 3 times. With no response from customer service,鈥 she wrote in February. 鈥淪o now I am without coverage.鈥
Victoria Helmly of Marietta wrote in a January comment that she and her family members take care of their dad, but the state law doesn鈥檛 exempt caregivers of older adults.
鈥淕eorgia should recognize their sacrifices by supporting them with health insurance,鈥 she wrote. 鈥淟et’s simplify this system and in the end, save money and lives.鈥
