This text was produced for ProPublica’s Native Reporting Community in partnership with The Present. Join Dispatches to get tales like this one as quickly as they’re printed.
Congressional Republicans, in search of methods to offset their proposed tax cuts, are looking for to mandate that hundreds of thousands of People work with a purpose to obtain federally sponsored medical insurance. The GOP tax and funds invoice handed the Home in Might, and Senate Republicans are working feverishly to advance their draft of federal spending cuts within the coming days.
Georgia, the one state with a Medicaid work mandate, began experimenting with the requirement on July 1, 2023. Because the Medicaid program’s two-year anniversary approaches, Georgia has enrolled only a fraction of these eligible, a end result well being coverage researchers largely attribute to bureaucratic hurdles within the state’s work verification system. As of Might 2025, roughly 7,500 of the almost 250,000 eligible Georgians have been enrolled, despite the fact that state statistics present 64% of that group is working.
Gov. Brian Kemp has lengthy advocated for Medicaid reform, arguing that the nation ought to transfer away from government-run well being care. His spokesperson additionally advised The Present and ProPublica that this system, often known as Georgia Pathways to Protection, was by no means designed to maximise enrollment.
Well being care analysts and former state Medicaid officers say Georgia’s expertise reveals that the congressional invoice, if it turns into legislation, would value taxpayers tons of of hundreds of thousands of {dollars} in administrative prices as it’s applied whereas threatening well being take care of almost 16 million individuals.
Right here’s how proposed federal work necessities evaluate to Georgia’s — and the way they could influence your state:
How will states decide who’s eligible?
What Congress proposes:
The Home invoiceH.R. 1, and draft Senate proposal require all states to confirm that People ages 19 by means of 64 who’re receiving Medicaid-funded well being protection are spending 80 hours a month working, coaching for a job, learning or volunteering. These new verification methods would have to be in place by Dec. 31, 2026, and must test on enrolled residents’ work standing twice a 12 months. Which means individuals who already obtain protection based mostly on their revenue degree would want to routinely show their eligibility — or lose their insurance coverage.
The federal work necessities would apply to greater than 10 million low-income adults with Medicaid protection in addition to roughly 5 million residents of the 40 states which have accepted federal subsidies for individuals to buy non-public well being protection by means of what’s generally often known as Obamacare.
The Home invoice exempts dad and mom with kids below 18 from the brand new necessities, whereas the Senate model exempts dad and mom with kids below 15. Neither invoice exempts individuals who take care of aged kin.
Georgia’s expertise:
Georgia’s mandate applies to fewer classes of individuals than the proposed federal laws would. Even so, officers failed to fulfill the state’s powerful month-to-month verification requirement for Pathways enrollees because of technical glitches and problem confirming the employment of those that work within the casual economic system reminiscent of home cleaners and landscapers as a result of they could not have pay stubs or tax data. The challenges have been steep sufficient that Georgia has determined to loosen its work verification protocols from month-to-month to yearly.
What this implies to your state:
The Congressional Price range Workplace estimates that H.R. 1 would lead to at the least 10 million low-income People dropping medical insurance. Well being care advocates say that’s not as a result of they aren’t working, however due to the bureaucratic hoops they would want to leap by means of to show employment. Analysis from KFFa well being coverage assume tank, reveals that the overwhelming majority of people that can be topic to the brand new legislation already work, are enrolled in class or are unpaid stay-at-home caregivers, duties that limit their skill to earn a wage elsewhere.
Arkansas is the one state apart from Georgia to have applied work necessities. Republican state lawmakers later modified their minds after information confirmed that crimson tape related to verifying eligibility resulted in additional than 18,000 individuals dropping protection inside the first few months of the coverage. A federal decide halted this system in 2019, ruling that it elevated the state’s uninsured charge with none proof of elevated employment.
Home Speaker Mike Johnson
Credit score:
Tom Williams/CQ Roll Name by way of AP
Home Speaker Mike Johnson, a Louisiana Republican, says Medicaid work necessities in H.R. 1 are “widespread sense.” He says the coverage gained’t lead to well being protection losses for the People whom Medicaid was initially designed to assist as a result of the work necessities gained’t apply to those teams: kids, pregnant girls and aged individuals residing in poverty. He factors to the $344 billion in a decade’s price of projected value financial savings ensuing from Medicaid work necessities as useful to the nation’s fiscal well being. “You discover dignity in work, and the individuals that aren’t doing that, we’re going to attempt to get their consideration,” he mentioned earlier this 12 months.
Who can pay for the work verification system in every state?
What Congress proposes:
The Home invoice allocates $100 million to assist states pay for verification methods that decide somebody’s eligibility. The grants can be distributed in proportion to every state’s share of Medicaid enrollees topic to the brand new necessities — an quantity well being coverage specialists say is not going to be almost sufficient. States, they are saying, will likely be on the hook for the distinction.
Georgia’s expertise:
Within the two years since launching its experiment with work necessities, Georgia has spent almost $100 million in principally federal funds to implement Pathways. Of that, $55 million went towards constructing a digital system to confirm contributors’ eligibility — greater than half the quantity Home Republicans allotted for your complete nation to do the identical factor.
Like different states, Georgia already had a piece verification system in place for meals stamp packages, nevertheless it contracted with Deloitte Consulting to deal with its new Medicaid necessities. Georgia officers mentioned the state has spent 30% greater than they’d anticipated to create its digital platform for Pathways because of rising guide and IT prices. Deloitte beforehand declined to reply questions on its Pathways work.
What this implies to your state:
All states already confirm work necessities for meals stamp recipients, however many current methods would want upgrades to adapt to proposed federal laws, based on three former state Medicaid officers. In 2019, when states final thought of work necessities, a survey by the nonpartisan Authorities Accountability Workplace confirmed that Kentucky anticipated administrative prices to prime $200 million — double what H.R. 1 has allotted for the nation.
Rep. Buddy Carter
Credit score:
Justin Taylor/The Present GA/CatchLight Native
Rep. Buddy Carter, the Republican who represents coastal Georgia and chairs the well being subcommittee of the Home Power and Commerce Committee, which had advisable Medicaid cuts in H.R. 1, mentioned that upfront prices borne by states can be offset by longer-term financial savings promised within the Home invoice. Some congressional Republicans concede that the associated fee financial savings will come from fewer individuals enrolling in Medicaid as a result of new necessities. Financial savings from work mandates quantity to 43% of the $793 billion in proposed Medicaid cuts, based on the Congressional Price range Workplace.
How will states employees this system?
What Congress proposes:
Medicaid is a federal social security web program that’s administered otherwise in every state. Neither H.R. 1 nor the Senate legislative proposal offers a blueprint for a way states ought to confirm eligibility or how the prices of overseeing the brand new necessities will likely be paid.
Georgia’s expertise:
Georgia’s expertise reveals that state caseworkers are key to managing functions and work requirement verifications for residents eligible for Medicaid. The company that handles enrollment in federal advantages had a employees emptiness charge of roughly 20% when Georgia launched its work requirement coverage in 2023. Georgia on the time had one of many longest wait occasions for approving federal advantages. As of March, the company had a backlog of greater than 5,000 Pathways functions. The company has mentioned it can want 300 extra caseworkers and IT upgrades to higher handle the backlog, based on a report submitted to state lawmakers in June.
What this implies to your state:
Former state Medicaid officers and well being coverage specialists say Georgia’s staffing struggles should not distinctive. In 2023, close to the top of the COVID-19 public well being emergency, KFF surveyed states about staffing ranges for caseworkers who confirm eligibility for federal advantages, together with Medicaid. Employee emptiness charges exceeded 10% in 16 of the 26 states that responded; charges exceeded 20% in seven of these states.
He Turned the Face of Georgia’s Medicaid Work Requirement. Now He’s Fed Up With It.
Including caseworkers will imply increased prices for states. At the moment, 41 states require a balanced funds, which means that these state legislators would both want to extend taxes and revenues to confirm Medicaid enrollees are working or decrease enrollment to scale back prices, mentioned Joan Alker, govt director of Georgetown College’s Middle for Youngsters and Households.
In about half a dozen giant states the place county governments administer federal security web packages, the prices of coaching caseworkers on the brand new verification protocols may trickle from states to counties.
“There are provisions in there which might be very, very, very difficult, if not not possible, for us to implement,” Sen. Lisa Murkowski, an Alaska Republican, advised reporters in June of the prices going through her state to fulfill the Home invoice necessities.
