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DCH: Georgia Pathways enrollment limited so far; most denials due to income above eligibility
Summary
Department of Community Health officials told the Senate committee that Georgia Pathways — the state's Medicaid waiver program — has lower active enrollment than potential eligibility estimates, that most denials are due to applicants being over income, and that outreach and system delays limited rollout.
Grant Thomas of the Georgia Department of Community Health described Georgia Pathways as one component of the state's Patients First Act framework and told the Senate Health and Human Services Committee that Pathways launched in July 2023.
"The Georgia Pathways program launched in July of 2023," Grant Thomas said, and he described Pathways as targeting adults age 19 to 64 with household incomes at or below 100% of the federal poverty level. Thomas told members that in simple terms the 100% FPL threshold equates to about $15,650 a year for an individual and about $26,650 for a family of three.
Thomas reported that Pathways had 6,514 active members at the time of the briefing and a cumulative total of 9,160 individuals served since the program began. He emphasized that the number of uninsured Georgians potentially eligible for Pathways has fallen since the waiver was written — from 408,000 (2017 data) to roughly 246,000 in 2023 census estimates — largely because more people now qualify for employer-sponsored insurance or for marketplace coverage through Georgia Access.
Thomas said the top reason for Pathways denials is being over income; he described Pathways as intended to be a bridge to private coverage for people who improve their economic circumstances. The qualifying activities for Pathways include full- or part-time employment, community service, vocational training, enrollment in higher education, and other work or training activities. Thomas said the program had invested in outreach — including paid media and partnerships with higher education institutions — and had built electronic interfaces with the University System of Georgia and the Technical College System to streamline reporting for students.
Committee members raised cost and enrollment concerns. Senator Nikki Merritt asked why the program's projected enrollment through 2030 was low relative to the number potentially eligible; Thomas said startup, litigation delays and duplicative costs related to a two-year implementation delay increased initial program costs and slowed enrollment growth, and he stressed the program's intent to shift many individuals to Georgia Access when they become over-income for Pathways.
Ending: Thomas and DCH staff offered to provide additional materials and to coordinate with the Insurance Commissioner’s office to ease transitions from Pathways to Georgia Access.
