The State of Georgia and Georgia Department of Community Health (GDCH) launched a lawsuit on Friday against the Biden administration over its objections to Governor Brian Kemp’s limited Medicaid expansion, the Georgia Pathways to Coverage program.
Georgia, the lawsuit explains, entered into a five-year agreement with the Centers for Medicare and Medicaid Services (CMS) to implement Pathways, but in January 2021, CMS told Georgia it “preliminarily determined” the program was “unlawful and should be suspended.”
The lawsuit notes the Biden administration formally rescinded its approval “at the end of 2021,” prompting legal action from the state which resulted in a 2022 ruling that allowed Pathways to move forward.
“By denying Georgia’s request to reinstate the full five-year period CMS originally approved, CMS has acted illegally and arbitrarily and capriciously,” the lawsuit alleges, after first arguing the the federal government is seeking to “benefit from its own unlawful conduct” by shutting down Pathways after delaying it for years with litigation.
Motivating the Biden administration’s reluctance to approve Georgia’s plan until 2028, WABE reported that Pathways “offers health care coverage to able-bodied adults earning up to the poverty line – $14,580 for an individual or $24,860 for a family of three. But people must document 80 monthly hours of work, study, rehabilitation or volunteering to be eligible.”
The lawsuit seeks to reverse the CMS denial of Georgia’s request to extend Pathways’ time table until 2028, issue a permanent injunction preventing the federal government from refusing the extension, and order the federal government to pay Georgia’s attorneys’ fees and court costs.
After its start was repeatedly stalled by the Biden administration, a GCDH website reveals that 2,344 individuals were enrolled in Pathways by December 15, 2023.
The latest reporting reveals that 35,951 individuals applied for Medicaid benefits and were potentially ineligible between July and December. Of those, 11,077 asked to be considered for Pathways, and 4,251 were considered for the program. The number of potentially individuals was lowered to 1,844, and 281 Georgians eventually had their eligibility approved. An additional 851 Georgians were determined to be eligible for traditional Medicaid.
Following the conclusion of policies enacted in response to the COVID-19 pandemic, nearly 100,000 people were removed from Georgia’s Medicaid rolls in 2023.
State officials reported last July that they removed 95,578 individuals from their Medicaid rolls, with 89,168 removed due to “a lack of information received … to make an eligible to determination,” and indicated that more than 20,000 of the “procedurally terminated” individuals would have been ineligible for a Medicaid extension.
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Tom Pappert is the lead reporter for The Tennessee Star, and also reports for The Georgia Star News, The Virginia Star, and The Arizona Sun Times. Follow Tom on X/Twitter. Email tips to [email protected].
Photo “Gov. Brian Kemp” by Seung Suh.
