Government Watchdog to Release Analysis on Medicaid Work Requirements This Fall

The leading nonpartisan government watchdog agency has announced that it is reviewing the operational costs of the United States' only active Medicaid work requirement program, with a report expected to be published this fall. This development comes amid ongoing debates among Republican policymakers and state legislators who are considering implementing similar work mandates across more states.

The U.S. Government Accountability Office (GAO) has stated to KFF Health News that its analysis of Georgia’s Pathways to Coverage program — the nation's sole Medicaid work requirement initiative — is underway and will be available later this year. The program was launched on July 1, 2023, under Governor Brian Kemp's administration after a prolonged legal battle with federal authorities. As of April 2024, the program has enrolled approximately 7,410 individuals at a cost exceeding $57 million in combined state and federal funds, though it has slowed the processing of other benefit applications in the state.

The GAO investigation is timely, as political figures continue to pursue Medicaid reform efforts. During the initial 100 days of the Trump administration, efforts to cut waste and overhaul federal programs gained momentum, leading to increased support for work requirements. These requirements stipulate that Medicaid enrollees must work, study, or engage in qualifying activities to retain their benefits. Several states have adopted or proposed such programs, citing potential cost savings; however, studies from Georgia and Arkansas indicate that these requirements tend to reduce Medicaid enrollment and introduce significant administrative expenses.

In particular, the GAO’s review aims to assess Georgia’s expenditure on the program, including federal contributions, and how such spending is tracked. The program’s critics argue it costs taxpayers more than traditional Medicaid expansion efforts and provides coverage to fewer people.

The public remains largely opposed to Medicaid cuts, with polling by KFF showing widespread disapproval of reductions in federal funding for the program, regardless of political affiliation. The debate intensifies as Congress considers proposals to trim $880 billion from federal spending over the next decade, aiming to offset broader priorities such as border security and tax cuts.

The discussion surrounding Medicaid work requirements continues to evolve, with more states seeking approval from the Centers for Medicare & Medicaid Services (CMS). To date, the Biden administration has blocked most such programs, citing concerns over costs and access. Nonetheless, some states, like Georgia and Arkansas, are advocating to reinstate or expand these programs, citing administrative and cost considerations.

Efforts to implement work requirements face continued legal and administrative challenges. For example, Georgia is considering requesting federal renewal with some adjustments, including less frequent proof of work or participation activities. The ongoing GAO investigation follows a bipartisan request from senators to scrutinize the program’s expenses and impacts.

Overall, the forthcoming GAO report is expected to shed light on the actual costs and outcomes of Medicaid work requirements, informing future policy decisions amid ongoing debates over healthcare coverage and federal spending priorities.