Trump extends Georgia health insurance program with work requirements,
despite red tape findings
[September 26, 2025]
By JEFF AMY
ATLANTA (AP) — Georgia's program that provides health insurance to some
low-income adults that document work or other activities has been
extended for 15 months by President Donald Trump's administration.
Republican Gov. Brian Kemp announced Thursday that the federal
government approved that the Pathways to Coverage program will continue
as part of the state-federal Medicaid program through December 2026. The
five-year pilot program had been scheduled to expire next week, but Kemp
argued Georgia should get more time because the program only started
after a court battle with President Joe Biden’s administration, which
tried to shut it down.
Georgia's program has been closely watched because Republicans mandated
similar work requirements throughout the country as part of the tax and
budget overhaul signed into law by Trump. Starting in 2027, some adults
who seek Medicaid coverage must first show they are working, taking
classes or performing community service for at least 80 hours a month.
The Georgia program, which has similar work or activity requirements,
has enrolled far fewer people than originally projected, covering 9,175
people as of August. It has spent twice as much on administrative costs
than on providing actual health care. The Kemp administration had
projected it would cover 25,000 people in its first year and up to
100,000 eventually.
Critics warn the Georgia experience shows that millions will lose
coverage under the Trump law because the administrative process will
make it too difficult for them to document their work. Republicans have
defended the low enrollment, saying Medicaid should be temporary for
people who can get insurance through an employer.
Pathways is Kemp's answer to pressure to expand Medicaid to cover all
adults who earn less than 138% of federal poverty line wages, as
originally envisioned under President Barack Obama's healthcare
overhaul. Georgia is one of 10 Republican-led states that refused to
expand coverage. Instead, Kemp launched Pathways, offering coverage to
people who earn up to the poverty line — $15,650 a year. Georgia’s
traditional Medicaid program still covers poorer children, disabled
adults, poor people in nursing homes and a few other very poor adults.
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Gov. Brian Kemp speaks before signing the budget bill at the Capitol
in Atlanta on Crossover Day, Thursday, March 6, 2025. (Arvin Temkar
/Atlanta Journal-Constitution via AP, File)/Atlanta
Journal-Constitution via AP)
 Under the extension, Georgia will
offer health coverage to parents and guardians of children younger
than six without any additional work requirement. The state will
also let beneficiaries report qualifying work or activity hours only
once a yearly, instead of monthly. Some beneficiaries had said the
monthly reporting process was glitchy and hard to use. Insurance
will also start on the first day of the month that an application is
received, meaning hospitals and doctors will have an incentive to
help uninsured patients apply in hopes of getting paid for care
already delivered. Right now, coverage doesn't start until after
someone is approved.
“Unlike the previous administration which chose to sue, obstruct,
and delay, President Trump and his team have worked alongside us to
improve Georgia Pathways and ultimately deliver a better program to
Georgians who need it most," Kemp said in a statement.
A federal watchdog reported earlier this month that Georgia spent
$54.2 million in administrative spending and $26.2 million on health
care from 2021 through the middle of 2025. 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 spending has been federal money, and Georgia used $20
million in other federal grants to help implement the program.
Opponents, including Democratic U.S. Sens. Raphael Warnock and Jon
Ossoff, deride Pathways as festooned in red tape while funneling
money to the private consulting firm that runs it. In a Thursday
statement, Warnock said that “the only thing Pathways is incredibly
effective at is barring working people from health coverage and
making corporate consultants richer."
“Today’s decision will continue to keep health care away from
Georgians who need it most. It is wrong, it is immoral, and it only
makes our country sicker and poorer,” Warnock continued.
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