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.

Source: GBPI analysis of data from Georgia’s 2024 Fiscal Year Budget (HB 19), signed by the Governor; 2019 fiscal note on Medicaid expansion; 2020 Pathways to Coverage approval from Centers for Medicare & Medicaid Services.