FY 2024 Budget for Pathways to Coverage Program Falls Short

This budget year, the state is set to launch the Pathways to Coverage program. This program expands health care coverage for low-income adults who are currently in the coverage gap, meaning that they earn too much to qualify for traditional Medicaid coverage but not enough to qualify for subsidized coverage in the health insurance marketplace (or HealthCare. gov). This program does not impose new requirements on Georgians already covered under traditional Medicaid eligibility, such as older adults over 65 years old or pregnant and postpartum people. Instead, this program expands coverage to Georgians ages 19–64 years old who have a household income of up to 100 percent of the federal poverty level. To be eligible, enrollees must complete and report a minimum of 80 hours per month of qualifying activities like employment, community service or higher education.

The FY 2024 budget includes $52 million in 2024 state funds and recognizes $65.5 million in unused 2022 state funds (about $118 million in total state funds). Based on GBPI analysis, the total state funds allotted for the Pathways to Coverage program in the FY 2024 budget will allow the state to enroll about 47,500 Georgians—far fewer than the 345,000 Georgians that the Governor said are qualified for the program in his 2023 State of the State address. By contrast, if the state expands Medicaid eligibility to low-income adults without arbitrary restrictions or burdensome reporting requirements, the state could cover almost 500,000 Georgians at a much lower cost. In fact, the temporary financial incentives offered under the American Rescue Plan would make the state cost of full expansion net zero for the first 2 years.

State costs per enrollee of Pathways to Coverage program five times higher than state cost per enrollee of expanding Medicaid eligibility to adults earning less than 138% of federal poverty level without work or premium requirements (first two years would be net zero state costs).

Number of people who could enroll in first year of Pathways to Coverage program (based on FY 2024 budget allocation) almost ten times lower than number of people who could enroll in first year after expanding Medicaid eligibility to adults earning less than 138% of federal poverty level without work or premium requirements.

Behavioral Health and Developmental Disabilities

The Department of Behavioral Health and Developmental Disabilities (DBHDD) provides services primarily for uninsured and underinsured Georgians living with mental health conditions, substance use disorders and/or developmental disabilities. It operates state hospitals and provides community-based services through contracted providers. The department also operates programs for forensic evaluation and treatment under the court system’s jurisdiction. Georgia plans to dedicate almost $1.5 billion in General Funds along with $10 million in Tobacco Settlement Funds to DBHDD. Total state spending for DBHDD in FY 2024 represents an increase of almost 8 percent over the AFY 2023 budget.

Public Health

The Department of Public Health (DPH) operates programs focused on disease and injury prevention, health promotion and health-related disaster response and preparedness. The department receives about $369 million in General Funds and almost $14 million in Tobacco Settlement funds. The largest state-funded programs provide funding to 159 county health departments, help prevent the spread of infectious diseases and provide services for children. Total state spending for DPH in FY 2024 represents an increase of 5 percent over the AFY 2023 budget.

Georgia’s public health programs also receive substantial federal support. Federal money comprises almost half of the department’s $806 million budget, while state and other funds comprise the rest. Of those federal funds, more the half is accounted for by the Special Supplemental Nutrition Program for Women, Infants, and Children (or WIC), which provides low-income pregnant and postpartum people and children up to age five with healthy food, nutrition information, breastfeeding support and other services.

About Half of Public Health Funding Flows to County Health Departments

Inspections & Environmental Health $9,138,976

Infectious Disease Control $45,305,157

Administration & Vital Records $34,141,327

Adolescent & Adult Programs $29,635,384

Emergency Preparedness & Trauma System Improvement

$7,459,048

Epidemiology

$7,326,337

Infant & Child Health Programs $42,961,768

Source: Georgia’s 2024 Fiscal Year Budget (HB 19), signed by the Governor.

Funding to County Health Departments

$197,519,328

Immunization

$2,458,847

Source: Georgia’s 2024 Fiscal Year Budget (HB 19), signed by the Governor.

Workforce Recruitment and Retention Remain an Issue for State Health Agencies

Turnover rates for the state’s health agencies have increased since 2016, ranging from about 20 percent for DPH to about 35 percent for DBHDD. DBHDD has seen a 28 percent decrease in staff from 2016 to 2022—from a high of about 4,128 full-time staff to a low of 2,982. Similarly, DCH has seen a 32 percent decrease in staff from 2016 to 2022—from a high of about 943 full-time staff to a low of 641. The AFY 2023 budget included $5,000 cost-ofliving increases, as well as salary increases for select job categories at both DBHDD and DPH. The impact of those increases is not reflected in the most recent workforce data. Full-time staff at all three agencies will receive an additional $2,000 cost-of-living increase as part of the FY 2024 budget. Even after these adjustments take effect, continued efforts will likely be needed to ensure that our state’s agencies are fully staffed with a trained, diverse, stable workforce that is ready to meet Georgia’s ever-shifting health needs.

Turnover Rates Among Health Agencies Near or Above State Average

Notes

Note: Agency-specific turnover rates unavailable for 2018.

Source: Georgia’s Department of Administrative Services’ Workforce Report for Fiscal Years 2016 – 2022.