Georgia has spent approximately $165.7 million on its Medicaid work requirement program, but only 18,527 people were actively enrolled after three years, according to new findings from the Georgia Budget and Policy Institute. The report also found that 43% of people who enrolled in the program between July 2023 and June 2026 subsequently lost their coverage.

The findings, highlighted Thursday, Oct. 22, come as Georgia seeks additional federal funding to continue and potentially expand its Pathways to Coverage program. The state submitted a new request to the Centers for Medicare & Medicaid Services on Oct. 1, with a federal public comment period running through Nov. 8.

The Georgia Budget and Policy Institute, or GBPI, is a nonprofit research and advocacy organization that supports broader access to health coverage. Its latest analysis draws largely on Georgia Department of Community Health records obtained through open records requests, but its conclusions about the program's effectiveness reflect the organization's assessment.

State officials defend Pathways as an alternative to traditional Medicaid expansion that connects coverage with employment, education and other qualifying activities. Gov. Brian Kemp's administration has argued that the program increases access to affordable coverage while encouraging financial independence.

What the new Medicaid numbers show

Georgia launched Pathways to Coverage in July 2023. The program offers Medicaid coverage to certain adults who earn too little to qualify for many other coverage options and are not otherwise eligible for traditional Medicaid.

GBPI's three-year analysis provides the following figures:

Source: Georgia Budget and Policy Institute, Oct. 21, 2026, analysis of state data.

The spending total includes expenses dating to the program's federal approval in October 2020, before enrollment began in 2023. It should not be interpreted as $165.7 million in medical claims or spending confined entirely to the three years of enrollment.

GBPI calculates approximately $8,945 in total program spending per person actively enrolled as of June 30. That figure includes administrative expenditures and is not the average annual cost of treating an individual patient.

According to the report, approximately $37.3 million came from state funds and $128.4 million from federal funds.

Why did 43% of participants lose coverage?

GBPI found that 32,394 people had enrolled at some point during the program's first three years, but 43% had subsequently lost their coverage.

The organization says its analysis indicates that missing renewal paperwork and changes in income were major reasons for coverage losses. During annual renewals, failure to return required documents was an important factor. Outside renewal periods, some people moved into other Medicaid categories, while others experienced income changes that affected eligibility.

Those distinctions matter because losing Pathways coverage does not necessarily mean a participant stopped working or failed to satisfy the program's activity requirement. A person transferring to another Medicaid category may also remain insured.

GBPI argues that the administrative requirements create unnecessary obstacles for eligible residents. The state's more recent changes, however, are intended to address some of those concerns.

What Georgia officials say about Pathways

The Kemp administration has consistently defended Pathways as a Georgia-designed approach to Medicaid coverage.

When CMS approved an extension in September 2025, the governor's office described the program as providing coverage while supporting greater financial independence for participants.

State officials also announced several changes designed to make enrollment and continued coverage easier. Beginning in October 2025, participants generally needed to document qualifying activities when applying and during annual renewal, rather than submitting activity reports every month.

Georgia also expanded qualifying activities to include certain parents and legal guardians of children younger than 6. The state introduced coverage beginning on the first day of the application month for approved applicants, along with other changes to program benefits and requirements.

The administration has also argued that federal litigation and delays contributed to higher initial implementation expenses. That is the state's explanation for part of the program's cost, rather than a finding established by GBPI's analysis.

Who qualifies for Georgia Pathways?

Pathways is designed for low-income adults who do not otherwise qualify for Medicaid.

Under the state's published eligibility requirements, applicants generally must be Georgia residents, ages 19 through 64, meet citizenship or qualifying immigration requirements, and have household income at or below 100% of the federal poverty level.

They must also demonstrate at least 80 hours per month of qualifying activities, unless an applicable alternative qualification or exception applies.

Qualifying activities include employment, self-employment, education, approved job training and community service. Georgia's expanded rules also recognize certain caregiving and food-assistance-related activities.

An important point is that the activity requirement is not limited to holding a traditional full-time job. Eligible applicants may satisfy the rules through combinations of qualifying activities.

Pathways generally covers services such as doctor visits, hospital treatment and prescription medications, although certain benefits differ from traditional Medicaid.

The state encourages eligible residents to apply even if they are uncertain which Medicaid coverage category might fit their circumstances.

What this means for Columbus and Muscogee County

The statewide Medicaid debate has a direct connection to Columbus, where a measurable share of residents remains uninsured.

According to the U.S. Census Bureau's QuickFacts data, 13% of Muscogee County residents younger than 65 lack health insurance. The Census measure covers a broader population than Pathways, including people who would not qualify for the program.

It therefore cannot be used to estimate the number of Columbus residents eligible for Pathways or the number currently enrolled. Nevertheless, the figure illustrates why changes to coverage eligibility could matter locally.

GBPI's statewide analysis indicates that enrollment has been limited across many counties. Its report says 70% of Georgia counties had 75 or fewer active Pathways participants in the county data it examined.

The report does not provide a verified, current Muscogee County enrollment figure. The state's publicly accessible information reviewed for this story also did not establish one, so no local enrollment estimate is included.

Why is Georgia asking Washington for more money?

Georgia filed a new federal waiver amendment Oct. 1, asking CMS to increase the federal government's share of Pathways medical benefit spending to 90%.

Under the current arrangement, the federal government generally covers about two-thirds of eligible Pathways medical benefit costs. The requested increase would substantially reduce the state's share.

The request comes as Georgia prepares to transition to new federal Medicaid work requirements scheduled to take effect in January 2027.

Those federal rules contain broader exemptions for certain groups than Georgia's original Pathways model. They include specified caregivers and individuals with qualifying circumstances that can exempt them from reporting work activities.

GBPI estimates that the changes could allow as many as 100,000 additional Georgians to obtain coverage. That number is a projection, not confirmed enrollment.

Georgia's request for enhanced federal funding is unusual because the 90% federal matching rate has generally applied to states expanding Medicaid eligibility up to 138% of the federal poverty level. Pathways covers a narrower income group, up to 100%.

GBPI reports that federal officials rejected a similar enhanced-funding request from Georgia in 2019, and that the state has suggested it may have to end the program without more federal support. CMS has not announced a decision on the October 2026 application, which remains pending on the federal Medicaid website. The program's current federal approval runs through Dec. 31, 2026, according to the Georgia Department of Community Health.

What GBPI wants Georgia to change

GBPI argues that Georgia should use the upcoming federal changes to simplify enrollment, improve continuity of coverage and strengthen the state's administrative systems.

Leah Chan, GBPI's director of health justice, said in the organization's Oct. 22 press release:

> "Regardless of the federal government's forthcoming decision, we urge Georgia's state-level policymakers to build on what we've learned and prioritize human-centered policies that expand access to affordable health care, modernize the Medicaid eligibility and enrollment infrastructure and deliver a stronger return on investment for Georgia's taxpayers."

The organization's position differs from the state's approach, which has emphasized coverage connected to employment and other qualifying activities. The central policy question is whether the existing program can serve substantially more eligible residents while operating within Georgia's preferred Medicaid structure.

An independent evaluation of the program is also underway, with final findings expected in 2027 or later. Those results could provide additional evidence about enrollment, outcomes and the effectiveness of the work requirement.

How to apply for Georgia Pathways

Georgia residents can apply for Pathways through the state's official Georgia Gateway website.

The Georgia Department of Community Health lists the following application options:

• Online: gateway.ga.gov
• Phone: 1-877-423-4746
• In person: A local Division of Family & Children Services office
• By mail: Through the appropriate local DFCS office

Applicants should be prepared to provide information about household income, eligibility and qualifying activities. The state determines whether the individual qualifies for Pathways or another Medicaid coverage category.

How to comment on Georgia's Medicaid proposal by Nov. 8

The federal government is accepting public comments on Georgia's pending request for enhanced federal funding through Sunday, Nov. 8, 2026.

CMS confirmed that the comment period opened Oct. 9 and runs through Nov. 8. Residents, medical professionals, employers and organizations can submit comments on the proposed amendment.

To participate, visit the official Georgia Pathways page on Medicaid.gov.

Under Pending Applications, find the submission dated Oct. 1, 2026, and select View/Submit Comments for Pending Application. This opens the federal government's public comment form.

The pending amendment concerns the federal financing of Pathways as Georgia prepares for the next set of work requirements. Submitting a comment does not constitute an application for Medicaid coverage, and CMS has not established a final approval date.

How we did this

Columbus Times reviewed the Georgia Budget and Policy Institute's three-year Pathways analysis published Oct. 21, 2026, and the organization's Oct. 22 press release information. We compared its findings with Georgia Department of Community Health eligibility announcements, the governor's published statements, the federal CMS waiver record and Census Bureau data for Muscogee County.

The statewide cost and enrollment figures are attributed to GBPI's analysis of state records. The county uninsured rate comes from the Census Bureau, while application instructions and the federal comment deadline come from government sources.