Georgia Gov. Brian Kemp seeks limited Medicaid expansion to cover some parents of young kids

Greg Bluestein and Ariel Hart, The Atlanta Journal-Constitution on Jan 15, 2025

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ATLANTA — Brian Kemp will seek federal approval to add parents and legal guardians of children six and younger to the state’s Medicaid rolls through a GOP-backed state program, as he unequivocally ruled out a full-scale expansion of the healthcare program during the rest of his second term as governor.

The Republican staked that position Wednesday as he unveiled a scaled-back proposal that could make tens of thousands of poor Georgians newly eligible for Medicaid coverage. Some 240,000 poor Georgia adults are currently without health insurance.

It’s part of a strategy to push more limited changes to recalibrate the Pathways to Coverage program, which has struggled by attracting just a tiny fraction of the 90,000 Georgians that the governor’s aides once projected it would enroll.

Kemp’s aides will ask Donald Trump’s incoming administration to sign off on the changes to the nation’s only active Medicaid work requirement program, which is set to expire later this year. Once rivals, Kemp and Trump have recently forged an alliance that has so far held firm.

“We are not only keeping families healthy together during a critical time of development,” Kemp said, “but also making an important investment in our state’s future.”

If approved by federal regulators, the plan would apply to the parents and legal guardians of young children with household incomes at or below 100% of the federal poverty level.

In a show of unity, Kemp was supported Wednesday by fellow Republicans Lt. Gov. Burt Jones and House Speaker Jon Burns. Both have previously discussed the possibility of fully expanding coverage, perhaps using Medicaid money to buy private insurance for all uninsured poor adults.

Georgia could permanently expand Medicaid to roughly 300,000 poor uninsured Georgia adults under the Affordable Care Act, as 40 states and the District of Columbia have done. But Kemp and other GOP leaders have objected to that policy, arguing it is too costly and inflexible.

The governor’s administration instead spent nearly two years tailoring what Kemp often calls a Georgia-centered solution. It requires all recipients to show they performed at least 80 hours of work, volunteer activity, schooling or other specified activities to qualify.

Officials say roughly 6,000 people are now enrolled in Pathways and more than 2,000 others had been signed up but have since left, including some now covered by private insurance.

Pathways has cost more than $40 million in state and federal tax dollars, the bulk of which is spent on administration and consulting fees, according to an analysis by KFF Health News. Officials recently put another $10.7 million into advertising the program.

Democrats say doubling-down on Pathways leaves hundreds of thousands of Georgians without Medicaid coverage at a time when many other Republican-led states have abandoned their opposition to a full-fledged expansion.

“It is inhumane to refuse to expand Medicaid in our state,” said Democratic state Sen. Nabilah Islam Parkes of Gwinnett County. “Pathways has been horrifically ineffective in covering needy Georgians.”

And Georgia Democratic U.S. Sens. Jon Ossoff and Raphael Warnock recently demanded a federal probe of what they called “waste and mismanagement” of the program’s high costs and low enrollment so far.

Before Wednesday’s setback, expansion advocates were growing cautiously optimistic about a political shift in their direction.

Several key Republicans have joined Democrats in backing some sort of expansion. House Republicans set up a study committee to examine an Arkansas-style Medicaid waiver, and an expansion plan nearly passed a Senate committee last year.

And Jones, the Senate leader who is expected to run for governor next year, turned heads when he told “Politically Georgia” after the November election that he was up in the air on supporting a full-scale expansion.

But Kemp, who would have to approve an overhaul, has long opposed full-scale Medicaid expansion. He said he was “in the no camp” in April 2024 and months later told hospital executives in Florida that it’s “not the best path forward” while he’s in office.

Pressed on whether he opposes full-scale Medicaid expansion through the end of his term in January 2027, Kemp was unambiguous.

“That is my position,” he said, adding: “The old system is not working. And the other side, their only answer to this is they want government-run health care. And I am not in that boat.”