A judge has refused to extend the timeframe for Georgia’s new Medicaid plan

Gov. Brian Kemp’s limited Medicaid expansion for poor Georgia adults will expire in 2025 as planned, a federal judge has ruled, which could leave over 4,400 without health insurance they just gained this year. Kemp and his aides told the Atlanta Journal-Constitution Tuesday that his office would continue working to make sure that doesn’t happen.

The program, called Pathways to Coverage, has struggled. On Tuesday, preliminary figures obtained by the AJC show that with its first full year just completed, Pathways has enrolled 4,494 people as of July 5. That’s a tiny fraction of the 90,000 that Kemp aides projected would enroll in the 12 months after it started July 1 last year.

“We’re keeping all options on the table,” Kemp said, when asked about the ruling in an exclusive interivew with the AJC at the Republican National Convention in Milwaukee. “But nothing changes with us. We’re going to keep plowing ahead.”

The governor told the AJC that he remains committed to the Pathways program despite its dismal participation. He said the ruling has no impact on the state’s plans to market and promote the plan.

”We have a lot we’re doing right now on outreach. We’re full steam ahead, doing a lot of different things, trying to get more people signed up.”

In her ruling Monday, U.S. Judge Lisa Godbey Wood of the Southern District of Georgia said the state didn’t comply with federal rules for an extension, so the Biden administration properly rejected its request to extend the Pathways program’s expiration date from September 2025 to 2028.

Georgia has the option of permanently expanding Medicaid to those on Pathways as well as all 290,000 or so poor uninsured Georgia adults. But like nine other states, Georgia Republican leaders have declined to do so , citing uncertainty about federal funding and the cost to the states. For the past decade Washington has been funding 90% of Medicaid costs for the states that chose to fully expand the government health insurance program to all poor adults. Forty have now done so.

Instead, Kemp and the Trump administration spent nearly two years designing a Medicaid program that would cover fewer people but be better tailored to the state’s needs, such as promoting a link between working and health, and they called it Pathways. Patient advocates countered that those who can work mostly already do, and those who don’t work need health insurance to be able to work.

After the Trump administration approved the five-year plan in late 2020, the Biden administration took office and challenged it, leading to nearly two more years of delays.

Previously, federal courts had ruled that work requirements are against the legal objective of Medicaid, which is health care. Kemp argued that Pathways isn’t just about work requirements.

Pathways is open to Georgia adults who work 80 hours a month or more, or volunteer for a registered nonprofit or perform other specified activities. Kemp officials created the unique program under federal rules as a five-year “demonstration” program, which promotes trying out a new idea to see if it would work.

Although it was first approved in 2020, Pathways did not launch until July 1, 2023.

Originally, Kemp contractors forecasted that first year enrollment would be about 25,000, growing to 50,000 in the second year. When it finally launched in the midst of a massive nationwide Medicaid disenrollment, Kemp aides increased the estimates. They told reporters they expected first-year enrollment to be 90,000.

In its first year Pathways has fallen far short of any of those goals.

Kemp has responded by condemning the delay caused by the Biden administration.

The ruling amps the stakes in Georgia for the presidential election between President Joe Biden and former President Donald Trump.

Pathways was approved and touted by the Trump administration, but the Biden administration generally opposes work requirements for health care and prefers full expansion to all poor. Come 2025, if Georgia asks Washington for another five-year run for Pathways, much of the answer will depend on who is in the White House.

A spokesman for Kemp, Garrison Douglas, pointed to court rulings against the Biden administration’s “unlawful” halting of Pathways, and said they would pursue an extension of time.

“We are thankful that Judge Wood’s ruling reaffirms what we have said all along - that the Biden administration’s decision to revoke aspects of the Georgia Pathways program delayed its implementation,” Douglas said in a written statement. “Just as before, we remain committed to this Georgia-specific, innovative initiative that leads not only to healthcare coverage but to better opportunity and coverage options for those who enroll in the program.”

The Centers for Medicare & Medicaid Services twice rejected Georgia’s request to extend Pathways, saying the state had failed to meet requirements for an extension request, including a public notice and comment period. Georgia argued that it was seeking to amend the program, so those requirements should not apply.

In her latest ruling, Wood said the state had indeed made an extension request. She agreed that the Biden administration’s decision to revoke parts of Pathways had delayed its implementation, but she said even if that was improper it still did not allow the state to “now skirt the rules and regulations governing time extensions.”

“If Georgia wants to extend the program beyond the September 30, 2025, deadline, it has to follow the rules for obtaining an extension,” she wrote.

The Associated Press contributed to this report.

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