Trump extends Georgia health insurance program with work requirements, despite red tape findings

President Donald Trump's administration on Thursday extended Georgia's Pathways to Coverage program, a work-requirements–based health-insurance initiative for certain low-income adults, through December 2026 as part of the state-federal Medicaid program. Gov. Brian Kemp announced that federal approval of the 15-month extension maintains the program after a court battle with the Biden administration over its legality, reflecting a broader GOP push to tether Medicaid coverage to work or activity.

Under the extension, Georgia will offer coverage to adults under the Pathways program for a defined period while allowing adjustments to how work or activity hours are reported. Notably, the state will permit parents and guardians of children younger than six to qualify without any additional work requirement, and beneficiaries will be allowed to report qualifying hours once per year instead of monthly, addressing longstanding complaints about reporting glitches. Coverage will begin on the first day of the month in which an application is received, a change aimed at speeding access and, officials say, encouraging hospitals and doctors to help uninsured patients apply so providers can be paid for care already delivered. Previously, coverage started only after an eligibility decision.

Georgia's Pathways program has enrolled 9,175 people as of August, far below the administration's initial projections of 25,000 in the first year and up to 100,000 over time. The program has also drawn scrutiny over its cost structure. A federal watchdog reported that from 2021 through the middle of 2025, Georgia spent $54.2 million on administrative costs and $26.2 million on health care through the Pathways program, with the administrative share declining from 96.5% in fiscal year 2023 to 58.8% in fiscal year 2024 and expected to drop further in 2025. Nearly 90% of spending has been funded by federal sources, and Georgia used about $20 million in other federal grants to support program implementation.

Opponents, including Democratic U.S. Sens. Raphael Warnock and Jon Ossoff, have derided Pathways as mired in red tape while funds flow to private contractors who operate the program. Warnock, in a Thursday statement, said, “the only thing Pathways is incredibly effective at is barring working people from health coverage and making corporate consultants richer.” He added that the decision will keep health care away from Georgians who need it most. Ossoff has voiced similar concerns about enrollment barriers and the program's long-term impact on coverage levels.

Pathways is Kemp's answer to pressure to expand Medicaid to cover all adults who earn less than 138% of the federal poverty line, as envisioned under the Affordable Care Act. Georgia is one of 10 Republican-led states that chose not to expand traditional Medicaid. Instead, Kemp created Pathways to provide coverage to people who earn up to the poverty line (about $15,650 for a single adult in 2023). Georgia's traditional Medicaid program still covers poorer children, disabled adults, residents in nursing homes, and a few other very poor adults.

The extension comes as part of a broader political and policy debate over how to organize health coverage for low-income adults in Republican-led states. While proponents argue that Pathways offers a temporary bridge while debates over broader Medicaid expansion continue, critics warn that complex eligibility and reporting rules can threaten access to care. Starting in 2027, however, the program would impose an 80-hour-per-month work or work-like activity requirement for some adults seeking Medicaid coverage, aligning with federal proposals tied to the original work‑requirements framework that has faced legal and logistical challenges in other states. Georgia officials say the adjustments aim to streamline access and reduce administrative hurdles, while maintaining a pathway for coverage for those able to participate in work, education, or community service. The program remains a focal point in the ongoing policy conversation about health coverage, work requirements, and how best to serve Georgians who lack affordable insurance options.