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Most of the tax dollars used to launch and implement the nation’s only Medicaid work requirement program have gone toward paying administrative costs rather than covering health care for Georgians, according to a new report by the Government Accountability Office, the nonpartisan agency that monitors federal programs and spending.
The government report examined administrative expenses for Georgia Pathways to Coverage, the state’s experiment with work requirements. It follows previous reporting by The Current and ProPublica showing that the program has cost federal and state taxpayers more than $86.9 million while enrolling a tiny fraction of those eligible for free health care.
The GAO analysis, which does not include all the Pathways administrative expenses detailed by the news outlets, shows that as of April the Georgia program had spent $54.2 million on administrative costs since 2021, compared to $26.1 million spent on health care costs. Nearly 90% of administrative expenditures came from the federal budget, the report concluded, meaning that Georgia’s experiment is being funded by taxpayers around the country. Federal spending will likely increase given that the Centers for Medicare and Medicaid Services has approved $6 million more in administrative costs not reflected in this report because it was published before the state submitted invoices.
The spending watchdog agency echoed its 2019 criticism of the Centers for Medicare and Medicaid Services for a lack of oversight of administrative costs associated with state initiatives approved in the name of Medicaid reform.
The September GAO report said the Medicaid agency never required Georgia to detail the costs of building and implementing the program. The federal approval process for states that want to experiment with their Medicaid systems “does not take into account the extent to which demonstrations will increase administrative costs,” the report said.
Georgia Gov. Brian Kemp, a Republican, promoted Pathways as an example of how fellow conservatives around the country could overhaul federal safety net benefits and end reliance on what critics deride as handouts to low-income Americans. Congressional Republicans cited Pathways as a model for the federal Medicaid work requirement law passed in July that will take effect in 2027. The Georgia Pathways program was slated to expire Oct. 1, but the state has requested that the federal government extend the experiment for five more years, which state health officials say the Trump administration is expected to approve in coming weeks.
The Georgia program was supposed to expand free health care to a group the state had previously deemed ineligible for Medicaid: adults under 65 years old who earn less than the federal poverty line of $15,650 a year. To qualify, Georgians had to prove that they work, study or volunteer at least 80 hours a month.
But enrollment in Georgia Pathways has remained low.