Judge refuses to extend timeframe for Georgia's new Medicaid plan, only one with work requirement

ATLANTA (AP) — A federal judge ruled that the Biden administration complied with the law when it declined to grant an extension to Georgia's year-old Medicaid plan, which is the only one in the country that has a work requirement for recipients of the publicly funded health coverage for low-income people.

The state didn't comply with federal rules for an extension, so the Biden administration legally rejected its request to extend the Georgia Pathways to Coverage program's expiration date from September 2025 to 2028, U.S. Judge Lisa Godbey Wood ruled Monday.

Republican Gov. Brian Kemp's office said it would work with the Centers for Medicare & Medicaid Services to “continue to pursue the necessary time to demonstrate the program’s viability.”

“Just as before, we remain committed to this Georgia-specific, innovative initiative that leads not only to healthcare coverage but to better opportunity and coverage options for those who enroll in the program,” spokesman Garrison Douglas said in a statement.

Georgia Pathways requires all recipients to show that they performed at least 80 hours of work, volunteer activity, schooling or vocational rehabilitation each month. It also limits coverage to able-bodied adults earning no more than the federal poverty line, which is $15,060 for a single person and $31,200 for a family of four.

The Biden administration revoked the work requirement in 2021, but Wood later reinstated it in response to a lawsuit by the state. Georgia sued the administration again in February, arguing that the decision to revoke the work requirement and another aspect of Pathways delayed implementation of the program. That reduced the program's originally approved five-year term to just over two years.

The Centers for Medicare & Medicaid Services twice rejected the request to extend Pathways, saying the state had failed to meet requirements for an extension request, including a public notice and comment period. Georgia argued that it was seeking to amend the program, so those requirements should not apply.

In her latest ruling, Wood said the state had indeed made an extension request. She agreed that the Biden administration's decision to revoke parts of Pathways had delayed its implementation, but she said a “prior bad act” did not allow the state to “now skirt the rules and regulations governing time extensions.”

“If Georgia wants to extend the program beyond the September 30, 2025, deadline, it has to follow the rules for obtaining an extension,” she wrote.

Pathways is off to a rocky start. Georgia officials expected it to provide health insurance to 25,000 low-income residents, or possibly tens of thousands more, by now. But enrollment stood at just over 4,300 as of last month.

Critics say the work requirement is too onerous. Supporters say Pathways needs more time.