ATLANTA — The Georgia Pathways to Coverage program, which aims to expand health insurance coverage to low-income Georgians while adding work requirements, was reported as having high administrative costs and a lower enrollment level than the state expected.
The Medicaid program, which offers coverage to Georgians working, in school or actively applying for jobs in addition to other low-income factors, was expected to get 25,000 enrollees in the first year, state officials told the U.S. Centers for Medicare and Medicaid Services.
A new report from the U.S. Government Accountability Office, a nonpartisan watchdog agency for the federal government, found fewer than 3,500 people were enrolled in the program in its first 15 months. The GAO report was made public on Thursday, Sept. 18.
As of Friday, Sept. 12, the Georgia Department of Community Health told Channel 2 Action News that there were currently 9,656 active and enrolled members in the Pathways Program and 15,427 had been enrolled since the program start.
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GAO said its review of the program’s spending found “weaknesses in federal oversight.” The findings in 2025 were “consistent with concerns we raised in our 2019 report.”
“CMS officials noted that enrollment was affected by individuals having to show they met the work requirement in the month prior to applying for the program,” according to GAO.
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The Sept. 18 report said that the lower enrollment was not a result of beneficiaries failing to meet monthly work requirements.
As of May 2025, the GAO report said Georgia officials told CMS that enrollment had reached 7,463, but “a total count of individuals ever enrolled in the demonstration was not available” when GAO reviewed the program’s operations.
State officials for the Georgia Medicaid program told federal reviewers that the lower-than-expected enrollment was due to a two-year delay in implementation, according to the GAO report.
The program was supposed to start in 2021 but did not begin until July 2023.
The GAO report said the total spending on the Georgia Pathways to Coverage Program had reached about $54.18 million on administrative costs, or 67.5% of overall spending.
The federal government spent roughly $47.4 million for the administrative costs, nearly 88% of the cost on administration.
Most of the administrative spending was used for changes made to the state’s enrollment system, which was used to determine eligibility and enrollment processes for individuals.
GAO said Georgia reported $50.8 million was spent on these activities, with $45.1 million going to contractors and $5.8 million for in-house work.
“Of that $50.8 million, 90% was federal dollars,” GAO said in its report.
The GAO report said when approving the Georgia Pathways program for test piloting, administrative costs were not factored in.
GAO said that spending was approved by CMS at higher levels of federal matching rates than what appeared allowable.
“CMS approved spending for activities such as for monitoring reports, a media strategy, and branding at a 90 percent federal matching rate reserved for developing and implementing changes to IT systems,” a report summary said.
The report said federal funding for Georgia to pay for media strategy, branding, communications and paid media assets at the 90% matching rate was not consistent with CMS guidance, which stipulate a 50% match.
CMS told GAO that it was not reclaiming any of the federal funds used.
“Now the entire country can see what we in Georgia already know — Georgia’s Medicaid work reporting requirement program is the real waste, fraud, and abuse,” Sen. Raphael Warnock, one of the Georgia Democrats who requested the report said in a statement about the program. “This report shows that Pathways is incredibly effective at barring working people from health coverage and making corporate consultants richer.”
A spokesman for Gov. Brian Kemp shared the following statement in response to the report, and those who requested it.
“This report was requested by the same individuals who have no new or good ideas for addressing healthcare needs in Georgia. While they try to stand in the way of innovation and blame Republicans, the report itself details how the Biden administration put up roadblocks at every turn to try and stop this Georgia-centric approach to Medicaid coverage. After having to fight in court for what was already promised, Georgia Pathways launched while the state was having to undertake the federally-mandated redetermination process. Now, as other states prepare to adopt our model and reject one-size-fits-none big government healthcare, Democrats like Senators Ossoff and Warnock are trying to rewrite history after four years of inaction and blame the State for costs associated with their own stonewalling. Meanwhile, our approach – through Georgia Access and Pathways – has now covered more Georgians than traditional Medicaid expansion would have, and provided better coverage at that. That’s why we remain committed to these programs and to further refining them to meet the needs of Georgians.”
Additionally, the spokesman shared data about health care coverage for Georgians under 138% of the federal poverty level, saying that more than 817,000 Georgians are getting healthcare via Georgia Access and Georgia Pathways, “more than three times the amount full Medicaid expansion is estimated to cover and for less money.”
In a response to Channel 2 Action News, the DCH also provided a fact sheet on Georgia Pathways dated Sept. 19, which states:
- 15,427 Georgians have enrolled in Pathways since launch
- 15,215 Georgians who applied for Pathways were found eligible for and enrolled in traditional Medicaid
- 19,460 Georgians who applied for Pathways were referred to Georgia Access
- 22% of members rolled off Pathways because their annual income increased above 100% of the FPL
- Georgia’s eligible uninsured population decreased from 408,000 in 2023 to 246,000 in 2024
Sens. Warnock, Jon Ossoff, Ron Wyden and Rep. Frank Pallone Jr. requested the oversight report.
The Associated Press contributed to this report.
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