A group of Democratic senators said on Wednesday that they had called for a federal watchdog investigation into a controversial Medicaid work requirement program in Georgia, accusing its administrators of churning through tens of millions of dollars in funding while enrolling a fraction of the low-income residents estimated to be eligible for it.
The program, called Georgia Pathways to Coverage, has been hailed by the state’s Republican governor, Brian Kemp, as an innovative approach to administering Medicaid, which covers more than 70 million people in the United States. It is the only Medicaid work requirement program currently operating.
Medicaid coverage is still available in Georgia without a work requirement, but the state has one of the strictest eligibility limits in the nation. Those who receive coverage through Pathways would otherwise not be eligible for Medicaid, but they must show that they are working, enrolled in college or doing community service for at least 80 hours each month to qualify.
The program, which is set to expire next year, has been closely watched by Republicans and conservative policy experts as a possible template for restructuring Medicaid in the next Trump administration. Republican lawmakers in recent months have discussed legislation that would institute Medicaid work requirements.
In a letter sent on Tuesday to Gene L. Dodaro, the head of the Government Accountability Office, the Democratic lawmakers, including Georgia’s two senators, Raphael Warnock and Jon Ossoff, pointed to the high costs of the program and the way the money had been spent: at least $40 million as of June, with more than 80 percent going to administrative and consulting costs.
“While hundreds of thousands of Georgians are left without the health coverage they need, taxpayer dollars are being routed into the pockets of eligibility system vendors and consultants,” wrote the lawmakers, a group that also included Senator Ron Wyden of Oregon.
Georgia is one of 10 states that have not expanded Medicaid under the Affordable Care Act, which gave adults who make up to 138 percent of the federal poverty level access to coverage.
The next Trump administration may again encourage states to put work requirements for Medicaid in place, after the first Trump administration granted approvals to roughly a dozen states to do so. Some state work requirements were halted in court, and the Biden administration withdrew approvals for them. A federal judge allowed Georgia’s to continue.
Pathways, which has also slowed processing times for other safety net benefits in the state, has been a warning sign of how work requirements are put into practice. As of Nov. 30, Pathways had just over 5,500 people enrolled, according to the Georgia Budget & Policy Institute, a nonprofit research firm that has tracked the program. State officials have estimated that roughly 168,000 people are eligible to enroll.
“The numbers indicate that there continue to be pretty significant barriers to Georgians gaining coverage under this program,” said Leah Chan, a health policy expert at the group.
“There’s a mismatch between the overall goal of the program and how the money is being spent,” she added.
Garrison Douglas, a spokesman for Mr. Kemp, defended the program, saying that the state’s health insurance marketplace and Pathways jointly covered more people in Georgia than a traditional expansion of the Medicaid program would have.
“The senators should be more focused on examining the failures of the federal government to adequately provide the services they’re required to administer than looking for every opportunity to criticize states that are taking innovative approaches to providing health care to their people,” he said in a statement.
A spokeswoman for Georgia’s Medicaid agency did not respond to a request for comment.
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