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State sues federal government over Georgia Pathways to Coverage rollout


(The Center Square) — The state of Georgia filed a lawsuit Friday against the federal government, saying it unnecessarily delayed the state’s rollout of its Georgia Pathways to Coverage program, and they want a federal judge to give the state the time it lost.

The Peach State launched the Pathways program on July 1, 2023, and it provides Medicaid to Georgians between 19 and 64 in households with incomes up to the federal poverty level but are not eligible for regular Medicaid. Participants must perform at least 80 hours of “qualifying activities per month,” such as full- or part-time employment, vocational educational training or community service.

According to Georgia officials and the court filing, the Centers for Medicare and Medicaid Services approved Pathways, a five-year-long “Section 1115” demonstration project, on Oct. 15, 2020. However, in January 2021, CMS told Georgia officials in a letter the agency had “preliminarily determined” the program was unlawful, prompting state officials to suspend implementation.

In December 2021, CMS rescinded its approval of the program’s qualifying hours and premium requirements, prompting the state to file a lawsuit the following month. In August 2022, a federal court ruled in Georgia’s favor, allowing the Georgia Department of Community Health to prepare for Pathways’ launch.

State officials contend CMS improperly delayed the rollout with an “arbitrary decision” to rescind core elements of the program and want a judge to allow the state to have the full five-year demonstration period, setting an effective end date of Sept. 30, 2028.

“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,” Georgia Gov. Brian Kemp, a Republican, said in a Friday statement. “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.”

Critics have derided the program, pointing to its low enrollment and saying Kemp should instead expand Medicaid.

The state filed its lawsuit in the U.S. District Court for the Southern District of Georgia Brunswick Division, naming CMS, the United States Department of Health and Human Services, and related parties within President Joe Biden’s administration.

“CMS is aware of recent litigation filed by the state of Georgia and does not comment on pending litigation,” a CMS spokesperson told The Center Square.

“It’s fitting that Governor Kemp dropped this lawsuit on Groundhog Day; the date might have changed, but it’s still the same tired, failed policies that cost more and do less coming from the governor’s office,” Democratic Party of Georgia spokesperson Alex Yerkey said in a statement. “He’s already spent $20 million to insure roughly 2,300 people.

“I think the time has come to ask: how much more taxpayer money does he intend to waste on this failed program when there’s a more effective, less expensive option available right now?”