Trump extends Georgia health insurance program with work requirements, despite red tape findings
Georgia extends Pathways to Coverage for 15 months, with reporting changes and new eligibility rules, as critics warn of coverage loss under work requirements.
President Donald Trump’s administration has approved a 15-month extension of Georgia’s Pathways to Coverage program, preserving a work- or activity-based health insurance option for low-income adults within the state-federal Medicaid framework through December 2026.
Georgia Gov. Brian Kemp announced Thursday that the federal approval keeps the program alive after a court battle with the Biden administration, which sought to shutter it. Pathways, a five-year pilot tied to work or activity requirements, has enrolled far fewer people than originally projected, with 9,175 people covered as of August. Under the program, adults earning up to the poverty line—about $15,650 a year for a single person—could qualify if they document work, schooling, or other qualifying activities. Starting in 2027, some adults seeking Medicaid coverage would have to show they are working, taking classes, or performing community service for at least 80 hours a month.
Advocates and researchers have noted the program's high administrative costs relative to benefits. A federal watchdog report shows Georgia spent $54.2 million on administrative costs and $26.2 million on health care from 2021 through the middle of 2025. The administrative portion has declined from 96.5% in fiscal year 2023 to 58.8% in fiscal year 2024 and is expected to fall further in 2025. Nearly 90% of spending was funded with federal dollars, and Georgia used about $20 million in other federal grants to help implement Pathways.
Opponents, including Democratic U.S. Sens. Raphael Warnock and Jon Ossoff, have argued that Pathways is bogged down in bureaucratic red tape while directing money to private consultants. Warnock criticized the extension as a setback for Georgians who need coverage, saying the program risks keeping people from care while enriching private contractors. Kemp defended the extension, saying, "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."
Georgia is one of 10 Republican-led states that declined to expand Medicaid under the Affordable Care Act. Instead, Pathways is designed to offer coverage to people who earn up to the poverty line.
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. Coverage will begin on the first day of the month that an application is received, and hospitals and doctors will be encouraged to help uninsured patients apply so providers can be paid for care already delivered.
Critics say the program’s design and ongoing bureaucracy illustrate why the broader Medicaid expansion debate remains unresolved. Proponents argue Pathways provides a crucial, if imperfect, way to extend coverage in a GOP-controlled state that has not expanded eligibility under the ACA. The outcome in Georgia mirrors a broader national contest over whether work requirements belong in health programs and how they affect access to care.
The extension keeps Pathways alive in Georgia while critics push back against the work-rule approach, and the program's long-term impact on coverage nationwide remains uncertain.