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Enrollment in Georgia’s year-old limited Medicaid expansion program is well below expectations because of a cumbersome enrollment process and restrictive eligibility criteria, an Atlanta-based public policy group reported Tuesday.

Only 4,231 low-income Georgians were enrolled in the Georgia Pathways program as of the end of last month, well below the 25,000 the state Department of Community Health (DCH) had projected for its first year and even further behind the 240,485 individuals ages 19 through 64 with incomes below 100% of the federal poverty level, according to U.S. Census data from 2022.

“Potentially eligible Georgians face a steep ‘paperwork’ burden – from completing a lengthy online application to compiling documents to verify qualifying activities and hours,” Leah Chan, director of health justice for the Georgia Budget and Policy Institute (GBPI), wrote in a 32-page report.

“Preliminary data also indicate that at least one of every five denials for those who do submit a complete application is due to failure to meet the qualifying hours and activities requirement.”

The state launched Georgia Pathways to Coverage in July of last year, providing Medicaid coverage to Georgians with household incomes up to 100% of the federal poverty level, $15,060 for an individual and $31,200 for a family of four. 

Georgia is the only state in the nation to make eligibility for coverage contingent upon completion and reporting of at least 80 hours per month of work, higher education, job training, volunteering or other qualifying activities.

Supporters of the work requirement argue it ensures that enrollees in the program are trying to improve their lives to a point that they can get off of Medicaid.

But a former Georgia Pathways enrollee said Tuesday she encountered unanticipated consequences fulfilling the work requirement.

Kelsey Shields said she was able to sign up for the program quickly and was covered for three months before being informed that her income was too high to qualify and that she, therefore, was being dropped. Shields said she didn’t understand the decision to drop her because she was still working the same job for the same pay.

Deanna Williams, a health insurance navigator for the nonprofit Georgians for a Healthy Future, said Georgia Pathways enrollees sometimes run afoul of the work requirement because their hours may differ from week to week, which can put them temporarily above the income-eligibility limit.

Another would-be enrollee, Muna Ali, said she was denied coverage through Georgia Pathways without being given a reason.

Chan said some of those who apply for the program are denied because of paperwork mistakes.

Williams said in some cases, people who tried to sign up for Georgia Pathways were denied because other members of their household were enrolled in Medicaid, which created confusion.

“The systematic errors have been somewhat addressed,” she said.

The GBPI report attributed the disappointing number of enrollees to lack of knowledge about Georgia Pathways. Chan said many Georgians the organization interviewed said they had never heard of the program.

The DCH launched a $10.7 million ad campaign in August to spread the word about Georgia Pathways, complete with a new website (pathways.georgia.gov) that explains the program, who is eligible to sign up, and how to apply.

“It remains to be seen what the impact of that has been,” she said.

The GBPI report recommended improving the eligibility and enrollment processes to make them more “human-centered.” It also suggested eliminating the activities requirement and fully expanding Medicaid to cover Georgians with incomes up to 138% of the federal poverty level.

Republican Gov. Brian Kemp and GOP legislative leaders have consistently opposed a full Medicaid expansion as too costly to Georgia taxpayers.

DCH spokesperson Fiona Roberts wrote in an email to Capitol Beat that the agency is aware of the report and is reviewing it.