In Atlanta, Deegant Adhvaryu faced a rollercoaster of emotions as he completed his parents' Medicaid and food benefit applications in June. Little did he know that this would set off a chain of waiting and frustration. His parents, Haresh and Nina Adhvaryu, received a letter in July stating that their applications would be delayed. In August, they started calling the Georgia helpline but couldn't leave a message. It wasn't until September when they visited state offices that they discovered their applications were incomplete. This left them mystified as they had Medicaid coverage when living in Virginia before moving to metro Atlanta.

Unraveling the Impact of Georgia's Medicaid Work Requirement

Waiting and the Strained Finances

While waiting for their Medicaid applications to be processed, Deegant's parents, aged 71 and 76, delayed necessary care out of fear of not being able to afford it. They have Medicare, and in Georgia, Medicaid covers its premiums, copayments, and deductibles. The lack of this extra coverage put a strain on their fixed incomes. "It was concerning," Deegant said, as their family lost a crucial financial "lifeline."It took them until late October, more than 120 days after applying, to finally receive their Medicaid cards in the mail. Federal rules mandate that states process most Medicaid applications within 45 days.

The Plagued Public Benefits System

For years, Georgia's public benefits system has been riddled with problems. A glitchy website often goes down for maintenance, there is a shortage of staff to process applications, and the technology malfunctions. According to consumer advocacy organizations, former state employees, and researchers, these issues have persisted.A KFF Health News analysis shows that processing times have deteriorated since July 2023 when Georgia launched the nation's only active Medicaid work requirement program, "Georgia Pathways to Coverage." The program started three months after the state began redetermining the eligibility of all Medicaid enrollees following the COVID-19 pandemic pause.The percentage of Medicaid applicants waiting more than a month and a half to have their applications processed has nearly tripled in the first year of Pathways. As of June, Georgia had the slowest processing time in the country for income-based applications. Preliminary data from July places the state as the second-slowest. The percentage of applications for financial and food assistance that take more than 30 days to process has also increased by at least 8 percentage points.

The Challenges of Pathways

Pathways is one of Republican Gov. Brian Kemp's flagship health policy initiatives and an alternative to fully expanding Medicaid eligibility under the Affordable Care Act. Applicants must document that they are working, studying, or engaged in other qualifying activities for 80 hours a month in exchange for health coverage.Consumer advocacy organizations, former state employees, and researchers argue that this initiative adds inefficiencies and bureaucracy, slowing down other public programs like the Supplemental Nutrition Assistance Program (SNAP) and the Temporary Assistance for Needy Families program (TANF).As of November 1, only 5,542 residents were participating in the work requirement program. Under a full Medicaid expansion program, nearly 300,000 Georgians would gain health coverage, according to the Robert Wood Johnson Foundation.Georgia's work requirement hasn't been cheap to implement. An analysis by Chan's think tank found that about $13,360 in state and federal spending was allocated for each enrollee from January 2021 through June 2024, mainly on administrative costs and not health benefits. This doesn't account for the cost of preparing and submitting the application to the feds or the fees associated with legal battles over the program.Officials in Georgia told KFF Health News that as of June 30, Pathways had cost $40.6 million in state and federal funds.Pathways has also increased the workload for state staffers who must manually verify complex eligibility requirements and monitor enrollees' continued eligibility.

The Impact on People's Health and Well-being

Waiting for benefits approval can have tangible consequences for people's health and well-being. Flavia Rossi, a pediatrician in Tifton, about 180 miles south of Atlanta, said some parents skip their kids' checkups due to fear of expensive out-of-pocket costs while waiting for Medicaid coverage for their children.In October 2023, Ellenwood, Georgia residents Gloria and William Felder, who have custody of a granddaughter, were informed that her Medicaid coverage had lapsed. They reapplied three times but had to wait 11 months for her coverage to be restored, during which they spent over $1,500 on her care. "We wanted to make sure she had coverage," William Felder said.After a health insurance navigator queried the state, the state finally informed them in September that she had Medicaid again.Georgia officials haven't invested enough in the state agency that processes public benefits applications, said Laura Colbert, executive director of Georgians for a Healthy Future. Staffing shortages, high staff turnover, and outdated technology exacerbate the problem.In November 2023, the U.S. Department of Agriculture notified state officials that Georgia was "severely out of compliance" with timeliness standards for processing SNAP applications. A recent progress report details the extent of the issues: a system that incorrectly prioritizes applications, not enough staff to handle a backlog of nearly 52,000 new applications, and no system to promptly reassign applications when staff are off."The delays create real hardship, forcing families to make choices between paying for medicine, food, or rent while they wait for the support they're entitled to," Colbert said.The state checked the eligibility of about 2.7 million residents when the pandemic-era Medicaid continuous coverage requirement ended. Nearly half a million Georgians lost coverage, including nearly 300,000 children, according to an analysis by Alker's nonprofit.Instead of investing more to help those wrongly removed reenroll, the state continues to pour money into the Pathways program. Alker cited a recently launched $10.7 million ad campaign aimed at boosting Pathways enrollment with federal pandemic recovery funds.The contract for this work was awarded to the consulting firm Deloitte, which has already received millions from Georgia to build and implement Pathways. It is also responsible for the state's Gateway technology system, which has ongoing problems, according to KFF Health News' reporting.Deloitte did not respond to a request for comment for this article. It previously told KFF Health News that it does not comment on state-specific issues.Deegant Adhvaryu had to step in to support his parents as they waited months for Medicaid and SNAP approval. He bought them groceries and helped with their rent. Not every applicant is as fortunate."There are people in the state of Georgia with far less financial resources and family connections to help them who need these services," he said.