Georgia sues feds to get 3-yr extension of failed "GA Pathways" program

Georgia is one of just ten remaining states which is still holding out on fully expanding Medicaid to all legal residents earning up to 138% of the federal poverty level under the Affordable Care Act. Instead, back in 2019, GOP Georgia Governor Brian Kemp submitted a Section 1115 waiver which included a plan to partially expand Medicaid to some uninsured Georgia residents...except with a work reporting requirement for enrollees attached to it.

The program was called "Georgia Pathways," it was approved by the Trump Administration, and unlike several other states which had work requirement provisions shot down by various judges, Georgia's managed to slip through. It was scheduled to go into effect in 2021 and was supposed to be valid until September 30, 2025 before having to be resubmitted for renewal.

The incoming Biden Administration's HHS Dept. put the kibosh on the work requirement provisions of the program. Georgia successfully challenged the administration and Georgia Pathways went into effect last summer...but is still currently scheduled to sunset next September.

Now, according to the Georgia Recorder, the Kemp Administration is suing the Biden Administration in an attempt to get them to bump out that deadline by another three years to make up for the lost implementation time:

The state has sued the Biden administration for not putting time back on the clock for Georgia’s partial Medicaid expansion program, which is set to expire next year under the current agreement.

...The state had asked the Centers for Medicare and Medicaid Services to amend the existing agreement to give the Georgia Pathways to Coverage more time because of the earlier delays the program faced. But the state has not requested a formal extension, which is a process that includes a public comment period. 

Instead of requesting an extension, the state has asked the courts to step in.

...Georgia’s program was originally set to start in 2021 but was delayed after the Biden administration withdrew approval for a monthly premium and a requirement that participants complete 80 hours each month of work, school or other qualifying activity.

Pathways ultimately launched last July, two years after the original planned start date. As of mid-December, about 2,300 people had enrolled. About 345,000 are thought to be eligible for the Medicaid program, according to the state’s estimate. 

While I'm certainly no fan of Gov. Kemp or a Medicaid program with work reporting requirements, it's not unreasonable for Georgia to try and get the full 5-year period back for the program. What does raise a red flag, however, is the fact that they're jumping straight to a federal lawsuit to do so instead of actually submitting an extension request first. It's certainly possible that it would be shot down by CMS anyway, but it seems more than a little suspicious that they aren't going through the normal process here. This isn't an emergency situation--there's 19 months before the program is set to expire.

I should also note that they're asking the court for a three year extension (thru 9/30/28) even though the program launch was only delayed by two years (it was originally supposed to kick off in July 2021).

The cynic in me suspects that it's the "public comment" part of the extension process which they're trying to avoid here...and with good reason:

As Leonardo Cuello of the Georgetown University McCourt School of Public Policy noted:

So, first, individuals who fail to report and document sufficient hours in any month (even, for example, someone with variable job hours) are suspended the next month – their health coverage completely stops. This means that many individuals will cycle on and off coverage, based on whether they are able to report and document enough hours every month. This isn’t a three-strikes policy such as Arkansas had – it’s one strike and you’re out. This policy will be devastating to enrollment and continuity of care in Georgia Pathways and will create an incredible amount of administrative hassle for individuals, providers, and state staff. Georgians won’t get far on this “Pathway” lined with red tape.

Second, of course, the strict requirements on documentation will lead to many reporting failures. Consider, for example, individuals who have informal employment arrangements or are self-employed. While the state does offer some good cause exceptions, they are time-limited and also almost always require submitting documentation. So this too will be a failure point.

Finally, as we have discussed from the outset, one of the most harmful and anti-family features of the Pathways model is that, unlike every work requirement proposal before it, there is no exemption of any kind for parents or caregivers. Parents will have to choose between taking care of their children or having health insurance – a terrible situation for parents and children alike.

This certainly helps explain why only 2,300 Georgia residents had enrolled in the first six months of Georgia Pathways being implemented. For comparison, North Carolina enrolled over 314,000 people in their standard ACA Medicaid expansion program in just the first six weeks of it being launched last December.