ATLANTA (AP) — A federal watchdog reported Thursday that Georgia's program requiring able-bodied adults to document low-paying work to get Medicaid has spent much more on administrative costs than on providing health care.
The U.S. Government Accountability Office report on Georgia Pathways comes after Republicans mandated similar work requirements throughout the U.S. as part of the "big, beautiful bill" signed into law by President Donald Trump.
Starting in 2027, most adults who seek Medicaid coverage must first show they are working, taking classes or performing community service for at least 80 hours a month. And they must be extremely poor, earning incomes no higher than the federal poverty line.
The report attributes most of the administrative costs to the implementation of changes in determining eligibility and enrolling people, along with duplicative technology, training and coordination while the state litigated to overcome Biden administration objections.
"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," Sen. Raphael Warnock, one of the Georgia Democrats who requested the report. "This report shows that Pathways is incredibly effective at barring working people from health coverage and making corporate consultants richer," his statement said.
A spokesperson for Republican Gov. Brian Kemp countered that Democrats are responsible for the extra spending.
"Now, as other states prepare to adopt our model and reject one-size-fits-none big government healthcare, Democrats like Senators Ossoff and Warnock are trying to rewrite history after four years of inaction and blame the State for costs associated with their own stonewalling."
Millions of eligible people will lose coverage due to the Trump law because the administrative process will make it too difficult for them to repeatedly document their work, critics say, pointing to what happened in Georgia, which is so far the only state that imposes work requirements.
Georgia has among the highest rates of uninsured and is one of 10 states that refused to expand Medicaid to all adults with incomes of up to 138% of the federal poverty level, as envisioned by President Barack Obama's health care overhaul.
Instead, Kemp heralded his July 2023 launch of Georgia Pathways to Coverage, which limits Medicaid for adults to those who earn no more than poverty-level wages, now set at $15,650 a year. Georgia's traditional Medicaid still covers poorer children, disabled adults, poor people in nursing homes and a handful of other adults.
Nationally, most adults on Medicaid in states that expanded it are already working, and in Georgia, an estimated 246,365 adults are potentially eligible for traditional Medicaid or Pathways. But a year after it launched, Pathways had enrolled around 4,300. As of this spring, there were 6,514 adults enrolled, according to the state Department of Community Health.
Republicans have defended the low enrollment, saying Medicaid should be temporary for people who can get insurance through an employer.
The GAO analysis shows that from fiscal year 2021 through the second quarter of 2025, Georgia reported $54.2 million in administrative spending and $26.2 million on health care. The administrative portion declined more recently, from 96.5% in fiscal year 2023 to 58.8% in fiscal year 2024. It is expected to drop more in 2025.
Nearly 90% of this spending has been federal money, and Georgia used $20 million in other federal grants to help implement the program, trying to make it easier for people to apply. More spending is planned this year on improvements, publicity and staff training, the report notes.
"There's incredibly wasteful public spending on systems of red tape," said Joan Alker a health policy researcher at Georgetown University's Center for Children and Families. "And spending money on corporate consultants to set up complicated systems of red tape that people can't navigate, that keeps them out of health coverage, is one of the worst uses of taxpayer dollars I can think of."
Kemp announced that he now wants to let low-income parents with young kids enroll without meeting work requirements, as part of an extension of Pathways that has required Trump administration approval.
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Kramon is a corps member for The Associated Press/Report for America Statehouse News Initiative. Report for America is a nonprofit national service program that places journalists in local newsrooms to report on undercovered issues.
