More than 100,000 applied, but only 4,200 people are in Georgia Pathways to Coverage program

ATLANTA — In the past six months, the Georgia Pathways to Coverage program, the first state-managed Medicaid program to have a work requirement in the United States, has only gained 1,887 new participants.

According to data shared with Channel 2 Action News by the Georgia Department of Community Health, there were only 4,231 actively enrolled patients using the Georgia Pathways insurance program.

For Georgians to qualify for Pathways, single people need to be making roughly $15,000 per year or less. Members of a family of three need to have a household income of less than $26,000.

Because the Pathways to Coverage program is being tested for efficacy, it is being described by state officials as a “demonstration.”

Since the program’s inception in July 2023, roughly 10% of applicants have been approved to try the demonstration. The exact percentage fluctuates by month and number of applicants.

In December, which marked the end of the program’s first six months since a July 2023 launch, there were only 2,344 patients participating, according to state officials.

Dec. 15, 2023 was the last date state officials have published Pathways monitoring reports to their official site. Newer data was obtained by Channel 2 Action News through a series of records requests to DCH.

An explanation for why new reports had not been published since December has still not been provided, despite several requests for answers.

State records show that in July 2023, the first month the program was in operation, 172 Georgians were found to be eligible for the Pathways program following the application process. The same document shows 5,912 Medicaid applicants who were shown Pathways and had elected to be considered to participate in the demonstration program.

While nearly 6,000 people chose to be considered for program participation, 3,429 were rejected due to lack of qualifying hours in the program’s first month of use.

In July 2023, that means 2,483 moved forward with their applications to be part of the Pathways to Coverage demonstration, only 281 people progressed to the next step.

By January, the Department of Community Health reported a total of 120,584 Medicaid applicants had been shown the Pathways application, and 4,105 had chosen to move forward to be part of the program but not even 400 were found fully eligible for the program in January.

At the end of January, DCH’s monitoring documents for Pathways to Coverage showed just 2,735 were in the program. Another 2,101 were said to be able to transfer from a different Medicaid program to Pathways.

The most recent program data is from June 2024, which showed 3,348 people had chosen to move forward with an attempt to be part of the test pilot for the Pathways Program.

Only 286 applicants were found eligible for Pathways in June and 140 potential participants were said to be eligible for transfer into the Pathways program.

Overall, the program had 4,231 beneficiaries enrolled as of June.

According to DCH, only 32 participants of the program in June were “exempt from reporting qualifying hours and activities because they reported hours to demonstrate that they met the qualifying hours and activities requirement” for six months in a row.

To qualify, participants:

• Had to be ages 19 to 64
• Have a household income up to 100% of the federal poverty level ($15,060 per year in 2024 for one person, or $25,820 for a family of three)
• Be a Georgia resident
• Complete at least 80 hours per month of full or part-time employment, on the job training, job readiness assistance programs, community service, vocational education training, enrollment in Georgia’s Vocational Rehabilitation Program or be enrolled in public or private universities or technical colleges for higher education
• Not be qualified for other types of Medicaid
• Not be incarcerated

A DCH spokeswoman said July 2024 data may become available sometime after Aug. 20.