Georgia Medicaid work requirements policy backed by court

A federal judge has reopened the door for Medicaid work requirements in Georgia in a ruling issued Friday.

The Centers for Medicare and Medicaid Services violated federal law when it rescinded permission for the state’s “Georgia Pathways” initiative, which establishes a mandate that some Medicaid enrollees be employed or similarly engaged to qualify for benefits. President Donald Trump’s administration cleared Georgia’s Medicaid waiver in 2020, but President Joe Biden’s CMS withdrew that approval last year.

Georgia sued to reverse that decision, which it described as a “bait and switch of unprecedented magnitude,” and won in court, which enables the state to carry out its plans for Medicaid.

“CMS’s rescission of the Georgia Pathways demonstration project was not reasoned—it was arbitrary and capricious on numerous, independent grounds,” Judge Lisa Godbey Wood of the U.S. District Court of the Southern District of Georgia wrote in her decision. 

The Georgia Pathways plan seeks to to extend Medicaid eligibility to adults who earn less than 100% of the federal poverty level, so long as enrollees work, volunteer or attend school at least 80 hours a month. The Affordable Care Act allows states to expand the program to anyone who makes up to 133% of poverty and provides 90% of the funding. Georgia is one of 12 states that has not adopted the ACA’s Medicaid expansion or accepted the additional federal dollars that go with it.

When CMS blocked Georgia from implementing its plan last year, the agency contended that work requirements don’t support the statutory purpose of Medicaid, which is to provide health coverage to people with low incomes.

“[A]t the time of the approval of Georgia’s demonstration, CMS was not in a position to foresee and adequately appreciate or take into consideration the full gravity of the longevity and deleterious effects of the pandemic, and how the work requirement would be likely to restrict substantially otherwise eligible low-income Georgians from becoming eligible for demonstration coverage,” CMS wrote Georgia officials last year.

Several federal courts previously ruled that work requirments were not legal under Medicaid law. But the Supreme Court vacated those decisions, rendering them moot, in April. The high court didn’t rule on the merits of Medicaid work requirements but its actions limited CMS’ ability to forbid the policy.

Medicaid expansion advocates hope the Biden administration will appeal the Georgia ruling. “Leaving this opinion on the books would: a) undermine the cause of full expansion in Georgia, which would cover many more people; and b) it’s ultimately a decision that’s really too threatening to the integrity of the Medicaid program…to just be allowed to stay,” said Eliot Fishman, senior director of policy at Families USA, a liberal policy advocacy organization.