by Jill Nolin, Georgia Recorder, [This article first appeared in the Georgia Recorder, republished with permission]

February 2, 2024

The state has sued the Biden administration for not putting time back on the clock for Georgia’s partial Medicaid expansion program, which is set to expire next year under the current agreement.

The complaint was filed Friday in U.S. District Court for the Southern District of Georgia in Brunswick, where a judge sided with the state in the yearslong dispute back in 2022. 

The state had asked the Centers for Medicare and Medicaid Services to amend the existing agreement to give the Georgia Pathways to Coverage more time because of the earlier delays the program faced. But the state has not requested a formal extension, which is a process that includes a public comment period. 

Instead of requesting an extension, the state has asked the courts to step in.

Without intervention, the state “will be forced to wind down” Pathways, squandering state resources that have gone into the program and ending a new Medicaid program that slightly expanded the government insurance program to cover low-income Georgians who would not otherwise be eligible, the state argued in the complaint. 

State officials are asking the court to set aside the feds’ decision and move the program’s end date out to Sept. 30, 2028, citing the Biden administration’s unsuccessful attempt to challenge the program’s work requirement. As of now, the program is set to expire on Sept. 30, 2025.

The program was first unveiled in 2019 as part of Gov. Brian Kemp’s signature health care plan. A five-year agreement was approved in 2020 in the final months of the Trump administration but immediately faced scrutiny when President Joe Biden took office.

The program is allowed under what is called an 1115 demonstration waiver, which gives states flexibility to experiment within the joint federal-state insurance program for the poor and disabled. The program has attracted national attention because it made Georgia the only state to have a work requirement as part of its Medicaid program, with it only applying to those who are newly eligible.

Georgia’s program was originally set to start in 2021 but was delayed after the Biden administration withdrew approval for a monthly premium and a requirement that participants complete 80 hours each month of work, school or other qualifying activity.

Pathways ultimately launched last July, two years after the original planned start date. As of mid-December, about 2,300 people had enrolled. About 345,000 are thought to be eligible for the Medicaid program, according to the state’s estimate. 

Critics of Pathways have long cautioned that the reporting requirement associated with the program’s rules would be a barrier to coverage.

Without more time, state officials argue they will not be able to size up the effectiveness of the program, and they will be forced to pull the plug on Pathways without having the full five years, according to the complaint.  

And that, the lawsuit says, would have “devastating consequences” on Georgians.

“The déjà vu is palpable. Once again, CMS seeks to deprive Georgia of its ability to fully implement the Pathways program as originally authorized — to the ultimate detriment of the citizens who will lose the opportunity to receive coverage under the truncated program,” according to the complaint.

In a press release Friday, the governor said the state is attempting to reclaim time the feds “stole” from the program.

“After the Biden administration’s lengthy, failed attempt to interfere with Georgia’s innovative plan to afford thousands of Georgians the opportunity to receive quality healthcare, they are back at it again,” Kemp said in a statement Friday.  

“We beat them in court then, and now we are again asking for the federal government to adhere to the terms they agreed to rather than play politics by refusing to give us back the time they stole from delaying the Pathways rollout and implementation.”

A CMS spokesperson said Friday that the agency is aware of the new complaint filed by the state of Georgia but does not comment on pending litigation.

In a December letter, a CMS official directed the state to submit an extension request. 

“The state has plenty of time before the expiration of the currently approved demonstration authorities to meet the regulatory requirements to request an extension, if it intends to do so,” Daniel Tsai, deputy administrator and director, wrote in December.

The lawsuit was filed as key Georgia Republicans have opened the door to full Medicaid expansion this legislative session, particularly an Arkansas-style model that uses federal funds to purchase private plans for the newly eligible. Full expansion could cover about a half million people.

In North Carolina, which expanded Medicaid last year, more than 300,000 have gained coverage since Dec. 1. 

Georgia is one of 10 states that have not fully expanded Medicaid under the Affordable Care Act.

Georgia Recorder is part of States Newsroom, a network of news bureaus supported by grants and a coalition of donors as a 501c(3) public charity. Georgia Recorder maintains editorial independence. Contact Editor John McCosh for questions: info@georgiarecorder.com. Follow Georgia Recorder on Facebook and Twitter.