[2025-09-23] New Watchdog Report Spotlights Georgia’s Work Reporting Necessities Failures

September 23,2025

The report finds CMS wrongly permitted increased federal matching charges for sure administrative prices, losing taxpayer {dollars}

As a results of the reconciliation invoice, thousands and thousands of Americans throughout the nation will lose their medical insurance or see their premiums enhance. 

Washington, D.C. – Today, a brand new Government Accountability Office (GAO) report  commissioned by Senate Finance Ranking Member Ron Wyden, D-Ore., U.S. Senators Reverend Raphael Warnock, D-Ga., Senator Jon Ossoff, D-Ga., and House Energy and Commerce Ranking Member Congressman Frank Pallone, D-N.J., unveiled for Georgia and the nation how Governor Kemp’s Pathways to Coverage Medicaid work reporting requirement program got here in over finances and below delivered. The report exhibits that the Centers for Medicare & Medicaid Services (CMS) wrongly permitted increased federal matching charges for sure Pathways administrative prices, losing taxpayer {dollars}. The program was additionally discovered to be extremely ineffective, enrolling solely 3,500 people in this system within the first 12 months, far in need of the state’s first 12 months aim of 25,028 enrollees.

“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,” mentioned Senator Warnock. “This report shows that Pathways is incredibly effective at barring working people from health coverage and making corporate consultants richer. If Republican politicians were serious about getting people to work, they would have closed the coverage gap nationwide and cut out the government bureaucracy. Instead, they have chosen to take health care away from millions of Americans who need it most to give a tax cut to the richest among us. It is wrong, it is immoral, and it only makes our country sicker and poorer.”

Since 2014, states have had the choice to increase Medicaid below the Affordable Care Act (ACA). Before the ACA, Medicaid was largely restricted to low-income youngsters, pregnant ladies, dad and mom of youngsters, aged, and people with disabilities. The ACA allowed states to increase Medicaid to adults with as much as 133% of the federal poverty line.

In lieu of full growth, Governor Kemp created Pathways to Coverage. This program was created by a Section 1115 Medicaid Waiver. Georgia’s Pathways program was initially permitted by the Trump Administration, then disapproved by the Biden Administration, earlier than a federal choose allowed it to maneuver ahead. The program went dwell July 2023.

Over one 12 months into this system, solely 3,500 people had been enrolled, far in need of the estimated 640,000 individuals who may gain advantage below full growth. 3,500 additionally fails to satisfy Georgia’s personal projected foal of 25,028 enrollees within the first 12 months of this system. Most of the executive spending ($47.4 million or about 88 p.c) was financed by federal {dollars}. Typically, the federal authorities usually offers 50 p.c of the funds for administrative actions (additionally referred to as a 50 p.c matching charge) however pays as much as 90 p.c of sure administrative prices. The GAO report discovered weaknesses in CMS’s preliminary consideration of Georgia’s Pathways program and oversight of administrative spending of this system as a complete.

Senator Warnock has lengthy championed efforts to increase inexpensive well being care entry, beginning together with his advocacy to shut the well being care protection hole in Georgia. Most not too long ago, Senator Warnock printed a report, “Healthy People, Healthy Economy” discovering that inserting bureaucratic pink tape between working individuals and their well being care will result in hospital closures, job loss, and financial slowdown. In addition to pushing for solutions to shut the protection hole, Senator Warnock led a delegation of Georgia lawmakers in urging the Centers for Medicare & Medicaid Services to supply instruments to Medicaid non-expansion states like Georgia to assist them shield well being care entry for Medicaid enrollees who lose eligibility after the top of the general public well being emergency declaration. Senator Warnock additionally adamantly opposed Dr. Mehmet Oz’s consideration to steer the Centers for Medicare & Medicaid Services (CMS), for his lack of dedication to defending Medicaid companies.

Read the report HERE

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