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Request a DemoState’s ‘Pathways’ Medicaid program set to begin July 1 amid continued controversy
The Gist
Gov. Brian Kemp is holding firm to his pledge not to expand Medicaid to hundreds of thousands of low-income Georgians. Instead, the second-term governor is touting a work-for-Medicaid plan that will require low-income individuals to complete 80 hours a month of work, school or volunteering to qualify for the benefit.
The plan is unique to the Peach State, and it is not without controversy.
The so-called “Georgia Pathways to Coverage” plan is slated to begin July 1, making Georgia the only state in the country to have work requirements tied to Medicaid coverage.
What’s Happening
Georgia officials have spent more than a decade debating the pros and cons of expanding Medicaid benefits to more Georgians, making it one of the most contentious issues in state politics today, often split along ideological and political party lines.
Georgia currently is one of 12 states that have opted not to extend Medicaid to more low-income people. The expansion plan was introduced in 2010 as part of the federal Affordable Care Act to broaden Medicare health insurance to include previously ineligible Georgians such as adults without children and those making just under the required amount to qualify for the aid.
“Here in Georgia, we’re taking an innovative and sustainable approach,” Kemp said in his annual State of the State address last week. “The Georgia Pathways to Coverage program was negotiated in good faith with the federal government so that we could expand access to health insurance for those who need it the most, while also sustaining the quality of coverage.”
At the start of 2022, Georgia sued the Biden administration, which refused to grant Georgia permission to force a work requirement as a condition to receiving Medicaid, which had previously been approved under former president Donald Trump. After several meetings, public hearings and other discussions, the federal government approved Pathways just before Christmas 2021.
Pathways supporters say the program will better regulate the number of Georgians receiving Medicaid, which in turn will mean better care for patients since the system won’t be overloaded.
“I think it's in the right direction,” said Steve Brown of Peachtree City who believes most federal money and programs have “strings attached.” Medicaid is funded by a combination of federal and state dollars.
Brown referred to the Pathway program as “a good start.
“And generally [federal funding] means that states are going to end up picking up the tab at some point when the federal government stops paying,” added Brown. “Can the state afford to take on the full burden of whatever they’re offering?”
An estimated 345,000 previously ineligible Georgians are expected to become eligible for Medicaid under the Pathways plan. Some people will pay monthly premiums, which will range from $7 to $16, depending on income and tobacco use.
Critics of Pathway argue that Medicaid is a more commonsense approach to providing health care coverage to hundreds of thousands more Georgians and that it’s more cost-effective than Pathway.
Georgia has spent over $15.3 billion on Medicaid since 2018, Kemp said during his address last week. “... While the state spends more and more, Georgians aren’t seeing an improvement in care they receive.”
Currently, Medicaid is available to Georgians who meet a variety of criteria. If your household income is at or below the current 133% of FPL you’re likely to be eligible for Medicaid. The FPL for 2023 was $14,580 a year for a single person, $19,720 for two people, and $30,000 for a family of four.
An estimated 1.3 million Georgians are uninsured, and Georgia’s uninsured rate of 13.7% is third-highest in the nation. That rate is expected to climb to 1 in 4 uninsured Georgians in rural Georgia by 2026, according to the Georgia Budget and Policy Institute (GBPI).
Medicare vs. Medicaid
Medicare is federal health insurance for anyone over the age of 65. It’s also for some under 65 who may have a disability or condition. A federal agency called the Centers for Medicare & Medicaid Services runs Medicare. Medicare has set standards for costs and coverage which means a person’s Medicare coverage is the same no matter what state they live in. For details, go to medicare.gov.
Medicaid is a joint federal and state program that provides health care insurance to people with limited income and resources. The federal government has general rules that all state Medicaid programs must follow, but each state runs its own program. This means eligibility requirements and benefits can vary from state to state. Medicaid offers benefits that Medicare doesn’t normally cover, like nursing home care and personal care services. People with Medicaid usually don’t pay anything for covered medical expenses but may owe a small co-payment for some items or services. For details, visit medicaid.gov.
Source: HHS.gov
Georgians Remain Divided
Ellenwood resident Pat Pullar is among many troubled by the Pathways to Coverage plan, noting that it “sounds like welfare-to-work.
“Welfare-to-work was for able-bodied people to get a stipend based on their work for the state. I didn't see that as a problem,” said the retired political consultant. But for Medicaid, “It’s almost like ‘if you don't work, you're not going to get health care. It just doesn't make any sense. We should have some more compassion for people who can’t afford health care,” said Pullar.
“[Georgia’s got] billions of dollars in surplus that you don't even know what to do with,” said Pullar, referring to nearly $12 billion in Revenue Shortfall Reserve and unreserved, undesignated surplus in state coffers. “But you want people to work for Medicaid.”
Signed into law 58 years ago by President Lyndon B. Johnson to provide health insurance coverage to low-income and disabled Americans, Medicaid has become a contentious and divisive issue in Georgia where lawmakers have repeatedly opted not to bring more Georgians into the program.
Full expansion of Medicaid would bring in more federal dollars that offset costs to the state, some argue.
“It could bring millions in both federal dollars and increased state and local tax revenue, and thousands of new jobs to our state,” Leah Chan, senior health analyst at GBPI told State Affairs. The Pathways program creates “unnecessary barriers,” especially for full-time caregivers and disabled veterans, Chan added.“Fully expanding Medicaid is the best choice for Georgia’s families and the state’s bottom line. The Pathways plan covers fewer Georgians and costs substantially more for the state to implement than a fully expanded Medicaid program,” Chan said.
According to a GBPI analysis of Pathways and Medicaid, the Pathways program would cost about $2,420 per enrollee in the first year compared to about $496 per enrollee under full Medicaid expansion.
Medicaid would enable more people of color, Georgians between the ages of 19 and 34, and those living in rural areas as well as the southern and western parts of the state to get coverage, Chan noted.
But public policy analyst Kyle Wingfield said the Medicaid system is broken and in need of an overhaul.
Wingfield cited the Washington, D.C. think tank Urban Institute’s projections on what a full Medicaid expansion would mean to Georgia if, for instance, it occurred this year.
It would add 739,000 Georgians to the program, cutting the ranks of the uninsured by 448,000.
“This means 291,000 or almost 40% of the potential new enrollees are people who already have insurance,” said Wingfield, president and CEO of the Atlanta-based conservative think tank Georgia Public Policy Foundation. “That’s a key fact that expansion proponents typically overlook and a key reason why expansion would likely cost far more than they allow.”
Wingfield said a Georgia expansion would cost federal taxpayers an additional $3.631 billion and Georgia taxpayers an additional $356 million.
“That means the total first-year cost of expansion would be almost $4 billion — or $8,900 per person who goes from being uninsured to insured,” Wingfield added. “Including those who would simply switch from private insurance to Medicaid, it would be about $5,400. This is a hugely inefficient way to expand a program that already fails to be cost-efficient.”
Medicaid in Georgia: By the Numbers
In July, Georgia will become the only state in America with a work-for-Medicaid program. Here’s a look at the Medicaid environment in Georgia:
- Georgians enrolled in Medicaid:* 2.7 million
- Georgians who are low-income: 32%
- Georgians on Medicaid: 18%
- Georgians who get Medicaid or PeachCare: 1 in 5
- Georgians between the ages of 19 and 64 covered by Medicaid: 1 in 11
- Children with Medicaid coverage: 3 in 8
- Nursing home residents with Medicaid: 5 in 7
- Non-elderly Medicaid recipients who are people of color: 68%
- Adults on Medicaid who are working: 56%
- Births covered by Medicaid: 47%
*Data from Georgians for a Healthy Future.
Source: Georgians for a Healthy Future, Kaiser Family Foundation, October 2022; Georgia Budget & Policy Institute
Why It Matters
In April, the state will begin reviewing who’s eligible — and who’s not — for Medicaid after a nearly three-year moratorium due to the pandemic. That review process will include many, if not most, of the roughly 2.7 million people currently receiving Medicaid in Georgia, according to Laura Colbert, executive director of Georgians for a Healthy Future, an Atlanta-based nonprofit consumer advocacy group.
The process is expected to take a year to complete and comes as the state gets ready to roll out the Pathways program in July. Medicaid eligibility is tied to income/poverty level. In Georgia, a person earning less than $14,580 a year and a family of four earning less than $30,000 a year would be eligible. A Kaiser Family Foundation report looking at Medicaid recipients and work requirements in comparison to welfare-to-work programs found that Medicaid recipients “often face barriers to employment, similar to those experienced by [welfare] enrollees.” Those barriers include physical or mental health disabilities, addiction, limited education, people whose first language isn’t English, and lack of affordable and reliable child care or transportation, the report said.
Most Medicaid recipients Stockbridge resident Emma Davis Hamilton knows aren’t able to work.
“Why is he [Kemp] doing things that are so contradictory to health care and that primarily affects African American and even poor working whites? He’s making it much tougher for poor people,” the retired military officer told State Affairs.
Colbert, of Georgians for a Healthy Future, said Georgia’s current Medicaid system shuts many people who need health care coverage out of the system.
“Georgia has a very stringent Medicaid program,” Colbert noted. “ Our program is one of the least generous programs in the country. The governor has put forth this program for those folks who fall in a coverage gap because Georgia has not expanded Medicaid. For those folks who fall in that gap, this program is going to be very difficult to get in and stay enrolled in.”
Colbert said those folks who fall through the gap generally are Georgians between the ages of 18 and 40; people in rural areas and other places where higher-paying jobs are scarce; workers in low-paying fields such as food service, grocery, retail and childcare; people with mental health and substance abuse conditions; and people of color. Blacks and Latino account for half of the people in Georgia’s Medicaid coverage gap, said Colbert.
What’s Next?
Pathways, the litmus test for how Georgia extends much-needed medical care to residents, is five months away from its debut and will be closely watched.
“I’m eager to see whether the Kemp administration is right, that there's a better way to administer Medicaid, because Medicaid is a program badly in need of reform,” Wingfield said. “If we're ever going to reform it, we need to see states trying new things and pioneering better ways to administer the program. If Georgia can be a leader in that, that would be really exciting.”
You can reach Tammy Joyner on Twitter @LVJOYNER or at [email protected]. Joyner is State Affairs’ senior investigative reporter in Georgia. A Georgia transplant, she has lived in the Peach State for nearly 29 years.
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Global bird flu disrupts Georgia exports, costing chicken producers millions
ATLANTA — A global bird flu that has rapidly spread from birds to dairy cows, milk supplies and humans has cost untold millions of dollars in lost export business in Georgia, the nation’s leading poultry producer, officials with the state Department of Agriculture and poultry industry said.
Georgia has had only three reported cases of H5N1 avian influenza since it reemerged in 2022. The last of those cases was resolved in November 2023 but ramifications of those outbreaks continue to have a big effect on the state’s ability to export chicken and chicken parts, such as chicken feet, to different countries, including China, one of Georgia’s biggest export markets for chicken feet.
In 2022, frozen chicken feet, for example, accounted for more than 85% of all U.S. poultry exported to China, according to Farm Progress, publisher of 22 farming and ranching magazines.
The $30 billion poultry industry is Georgia’s largest segment in its No. 1 industry — agriculture.
China has also placed a ban on the import of chicken products from 41 other American states. The ban on Georgia products went into effect Nov. 21, 2023. Efforts to reach the Chinese Embassy in Washington, D.C. were unsuccessful.
Georgia Poultry Federation President Mike Giles estimates the state’s loss at “well into the millions of dollars.”
“It’s a significant amount in a significant export market for us,” he said. “Poultry paws [feet] immediately lose value because of the loss of demand.”
The ban has forced Georgia poultry producers to find alternative markets for their products that would normally be headed to China.
“Some are sold domestically, some are frozen and stored, hopefully to find markets later on, and some go to other countries,” Giles said.
This isn’t the first time China has banned U.S.-produced poultry products due to a bird flu outbreak. The country instituted a ban in January 2015 which lasted until November 2019 — even though U.S. poultry products were deemed free of the disease by August 2017.
After that ban was lifted, China’s appetite for American-produced chicken products became voracious.
In 2022, U.S. producers shipped nearly $6 billion in poultry meat and related products (excluding eggs) to over 130 countries. China has emerged as the second largest destination for U.S. poultry exports, increasing from $10 million in 2019 to a record $1.1 billion in 2022, according to Southern Ag Today.
Chicken paws, for instance, are eaten in many Asian countries, including the Philippines, Thailand, Indonesia and Korea.They can also be found on Chinese dim sum menus throughout the U.S. and are also popular in Jamaica, Trinidad, Russia and Ukraine in everything from soups and curries to fried snacks.
Three Georgia counties have reported H5N1 outbreaks since 2022. The most recent case was late last year. Henry, Sumter and Toombs counties each reported one case of H5N1 bird flu. Those outbreaks are resolved, poultry and state agriculture officials say.
“When HPAI cases are found in any state, that state is given a designation that could lead to foreign countries halting trade on poultry products from that state,” Georgia Department of Agriculture spokesman Matthew Agvent told State Affairs.
Not since 2016 has the United States experienced such a fast-moving case of the H5N1 avian influenza. In the last two months, the virus has spread in parts of the United States from birds to dairy cows, some milk supplies and humans. Two people — a Texas dairy worker and a prison inmate in Colorado who was killing infected birds at a poultry farm — are reported to have caught the virus, according to news reports. The outbreak is the largest in recent history, impacting both domestic poultry and livestock as well as wild birds and some mammal species.
State officials are continuing to monitor the national outbreak and its impact on Georgia.
Georgia’s poultry & egg industry: At A Glance
Annual economic impact: $30.2 billion
Percentage of the Agriculture industry: 58% *
Jobs: 87,900
Counties involved in poultry & egg production: 3 out of 4
National ranking in chicken broiler production: No. 1
Daily production of table eggs: 7.8 million
Daily production of hatching eggs: 6.5 million
Pounds of chicken produced daily: 30.2 million
Pounds of chicken produced annually: 8 billion
Number of chicken broilers processed each day: 5 million
Counties involved in poultry & egg production: 3 out of 4
Source: Georgia Poultry Federation; The Center for Agribusiness & Economic Development, University of Georgia, Ag Snapshots 2024; Georgia Poultry Federation.
Have questions? Contact Tammy Joyner on X @lvjoyner or at [email protected].
Is it safe to eat chicken and eggs and drink milk? Answers to your most pressing questions about the latest bird flu outbreak
A two-year-old strain of bird flu has heightened concerns in Georgia and the rest of the country after the virus recently spread to dairy cows. Here’s what you need to know about the virus and its impact on Georgia and the rest of the country. What are the symptoms of this flu in humans? Eye …
Kemp signs bills on education, health care, taxes
Gov. Brian Kemp signed a slew of bills over the past week or so, including the private school voucher bill long sought by Republicans and a bill that will ease regulations over the construction and expansion of medical facilities in rural areas.
His bill-signing events were clustered into themes: education, health care, military members, human trafficking and Georgia’s coastal communities.
Education
Among the education-related bills Kemp signed was Senate Bill 233, also known as the Georgia Promise Scholarship Act, which provides the families of Georgia students enrolled in underperforming school districts with $6,500 scholarships that can be used toward private school or homeschooling expenses, including tuition, fees, textbooks and tutoring.
“Georgia is affording greater choice to families as to how and where they receive their education, while also continuing our efforts to strengthen public schools, support teachers, and secure our classrooms,” Kemp said, and thanked leadership in the House and Senate for prioritizing passage of the bill, which had failed in a close vote in 2023.
Democrats and many public education advocates who opposed the bill argued it will drain resources from public schools and primarily benefit students from wealthy families.
Kemp also signed Senate Bill 351, sponsored by nine Republican senators, which will require social media companies, as of July 1, 2025, to verify their users are at least 16 years old unless they receive approval from a parent.
House Bill 409, sponsored by Rep. Lauren Daniel, R-Locust Grove, directs school systems to consider not having bus stops where a student would have to cross a roadway with a speed limit of 40 mph or greater. The bill also increases the penalty for passing a stopped school bus to $1,000 from $250.
Kemp noted that Ashley Pierce, the mother of Addy Pierce, an 8-year-old who was fatally struck by a motorist as she boarded her school bus, “passionately advocated for and was instrumental in the passage of this legislation.”
Senate Bill 395, sponsored by Sen. Clint Dixon, R-Gwinnett, states that no school visitor or personnel can be prohibited from possessing an opioid reversal drug such as Narcan and directs schools to maintain a supply. It also allows opioid antagonists to be sold in vending machines and directs certain government buildings to maintain a supply of at least three doses.
Senate Bill 464, also sponsored by Dixon, creates the School Supplies for Teachers Program to financially and technically support teachers purchasing school supplies online. It also creates an executive committee of five voting members within the Georgia Council on Literacy and limits the number of approved literacy screeners to five, one of whom must be available to schools for free.
Health care
The governor chose his hometown of Athens as the venue to sign several bills aimed at improving health care in rural and underserved communities.
Among them was House Bill 1339, sponsored by Rep. Butch Parrish, R-Swainsboro, which revises the Certificate of Need process by which the state determines if and how new medical facilities can be built or expanded. The bill provides for several new exemptions, including psychiatric or substance abuse inpatient programs, basic perinatal services in rural counties, birthing centers and new general acute hospitals in rural counties. It also raises the total limit on tax credits for donations to rural hospital organizations to $100 million from $75 million.
Senate Bill 480, sponsored by Sen. Mike Hodges, R-Brunswick, establishes student loan repayments for mental health and substance use professionals serving underserved youth in the state or in unserved geographic areas disproportionately impacted by social determinants of health.
House Bill 872, sponsored by Rep. Lee Hawkins, R-Gainesville, chair of the House Health and Human Services Committee, expands cancelable loans for certain health care professionals to dental students who agree to practice in rural areas.
Senate Bill 293, sponsored by Sen. Ben Watson, R-Savannah, chair of the Senate Health and Human Services Committee, reorganizes county boards of public health and opens the qualifications for the CEO of each county board of health to include either licensed physicians or people with a master’s degree in public health or a related field.
Military members and veterans
Kemp on Wednesday focused on bills to improve military recruitment and provide more work opportunities for veterans and military family members.
House Bill 880, sponsored by Rep. Bethany Ballard, R-Warner Robins, allows spouses of military service members to work under a license they hold in good standing in another state while under the supervision of an existing Georgia medical facility or provider.
Senate Bill 449, sponsored by Sen. Larry Walker, allows military medical personnel to practice for 12 months while a license application is pending, including working as a certified nursing aide, certified emergency medical technician, paramedic or licensed practical nurse. The bill also creates a new advanced practice registered nurse license and makes it a misdemeanor to practice advanced nursing without a license.
Human trafficking
The governor on Wednesday was accompanied by first lady Marty Kemp and other members of the GRACE Commission for the signing of an anti-human trafficking package. It includes Senate Bill 370, which adds certain businesses to the list of organizations that must post human trafficking notices, including convenience stores, body art studios, businesses that employ licensed massage therapists and manufacturing facilities.
Sponsored by Sen. Mike Hodges, R-Brunswick, the bill also allows the Georgia Board of Massage Therapy to initiate inspections of massage therapy businesses and educational programs without notice and requires massage therapy board members to complete yearly human trafficking awareness training.
House Bill 993, sponsored by Rep. Alan Powell, R-Hartwell, creates the felony offense of grooming of a minor and creates new penalties for offenses relating to visual mediums depicting minors engaged in sexually explicit conduct.
House Bill 1201, sponsored by Rep. Houston Gaines, R-Athens, allows human trafficking survivors who received first offender or conditional discharge status to vacate that status for certain crimes, as long as the crime was a direct result of being a victim of human trafficking.
Coastal communities
Earlier today in Brunswick, Kemp signed legislation impacting Georgia coastal communities, including House Bill 244, which amends the laws around how wild game can be hunted and how seafood dealers operate, and House Bill 1341, which designates white shrimp as the state’s official crustacean.
Taxes
Earlier this month Kemp signed several bills related to taxation, including House Bill 1015, sponsored by Rep. Lauren McDonald, R-Cumming, which lowers the state income tax for tax year 2024 to 5.39%, accelerating a multiyear drop in state income taxes that started at 5.75% in 2023 and will continue through 2029.
The Governor’s Office of Planning and Budget estimates the tax cut acceleration will save Georgia taxpayers approximately $1.1 billion in calendar year 2024 and about $3 billion over the next 10 years.
Kemp also signed House Bill 1021, sponsored by Rep. Lauren Daniel, R-Locust Grove, which increases the state’s income tax dependent exemption to $4,000 from $3,000.
House Bill 581, sponsored by Reps. Shaw Blackmon, R-Bonaire, and Clint Crowe, R-Jackson, enables a constitutional amendment (House Resolution 1022) to let voters decide whether counties can provide a statewide homestead valuation freeze, which limits the increase in property values to the inflation rate.
The governor has until May 7 to sign or veto bills passed during the legislative session that ended on March 28. Those he takes no action on will automatically become law.
Legislation signed by Kemp is posted on the governor’s website.
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Incumbent candidates for local, federal races likely to be no-shows at this weekend’s primary debates
ATLANTA — One of Georgia’s prominent media organizations is pleading with incumbent state and congressional candidates to participate in its primary election debates slated for Sunday.
For the first time in The Atlanta Press Club’s 30-year debate history, incumbents facing challengers in the May 21 primary have either declined or not yet committed to participating in the organization’s well-known debate series. The possible no-shows include candidates in four Congressional races as well as the Georgia Supreme Court, and the Fulton County District Attorney races.
“This is the first time that we’ve had so many [incumbents] not participate,” debate organizer Lauri Strauss told State Affairs. Strauss declined to speculate why candidates aren’t participating.
Hoping to encourage more participation, the organization issued the following statement:
“The Atlanta Press Club believes it is the responsibility of people running for public office to answer questions from their local media that will help inform voters before they cast their ballots. If a candidate is running for public office, the candidate should be willing to participate in the democratic process, which includes attending debates and fielding questions from journalists and opponents.”
Candidates have until Friday to RSVP.
Strauss said candidates who fail to appear will be represented on stage by an empty podium during the debate.
District Attorney Fani Willis has declined to participate and Democratic U.S. Reps. Lucy McBath and David Scott have yet to RSVP. Strauss said the organization is still in talks with Georgia Supreme Court Justice Andrew Pinson’s staff about his appearance in the debate.
Willis, declined earlier this week to participate, citing constraints around talking about sensitive cases like the criminal prosecution of former President Donald Trump.
McBath currently represents the 7th Congressional District and is now running in the newly drawn 6th Congressional District against two Democratic challengers, Jerica Richardson and Mandisha Thomas. McBath declined to participate in the press club’s general election debate in 2022, forcing her Republican challenger Mark Gonsalves to debate with an empty podium. McBath won with 61% of the vote.
The debates will air live on April 28 on GPB.org, on The Atlanta Press Club’s Facebook page (www.fb.com/TheAtlantaPressClub). It will be rebroadcast in early May on WABE.org.
Race | Tape and Livestream Sun. April 28 |
GPB-TV Broadcast | WABE Broadcast |
Congressional District 6 Democrats | 10:00 a.m. | April 29 at 7:00 p.m. | May 1 at 4:30 p.m. |
Congressional District 13 Democrats | 11:15 a.m. | April 28 at 4:00 p.m. | May 1 at 5 p.m. |
Congressional District 3 Republicans | 1:00 p.m. | April 28 at 5:00 p.m. | May 2 at 3:30 p.m. |
Congressional District 2 Republicans | 3:00 p.m. | April 29 at 5:00 p.m. | |
Georgia Supreme Court | 4:45 p.m. | May 2 at 4:30 p.m. | |
DeKalb County CEO | 5:45 p.m. | May 2 at 5:15 p.m. | |
Fulton County District Attorney | 6:45 p.m. | May 1 at 4 p.m. |
Have questions or comments? Contact Jill Jordan Sieder on X @journalistajill or at [email protected] and Tammy Joyner on X @lvjoyner or at [email protected].
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