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The state agency that runs Georgia Medicaid is going all out to increase enrollment in Gov. Brian Kemp’s limited Medicaid expansion initiative beyond the paltry numbers who signed up during its first year.

The Georgia Department of Community Health (DCH) launched a $10.7 million ad campaign this month to call attention to the Georgia Pathways program, complete with a new website (pathways.georgia.gov) that explains the initiative, who is eligible to sign up, and how to apply.

Georgia Pathways provides Medicaid coverage to Georgians with household incomes up to 100% of the federal poverty level, $15,060 for an individual and $31,200 for a family of four. Full-blown Medicaid expansion under the federal Affordable Care Act (ACA), which 40 states have adopted, covers those with incomes up to 138% of the poverty level.

While Georgia Democrats and health-care advocates have long pushed for full-blown Medicaid expansion, Kemp said the purpose of his more limited program is to transition low-income Georgians from Georgia Pathways to Georgia Access, a program that provides insurance coverage through the private sector.

“The goal of Georgia Pathways is not – and has never been – to keep hundreds of thousands of Georgians on government-run health care forever,” the governor said Aug. 19 during a roundtable discussion updating his administration’s efforts to expand access to health insurance coverage. “Georgia Pathways was meant to be exactly that – a pathway to an education, a job, a career, and a better life without government assistance.”

Pathways, launched in July of last year, has struggled mightily. As of early June, the program had enrolled only about 4,300 Georgians, far below the 100,000 the DCH had anticipated for the first year.

Georgia Commissioner of Community Health Russel Carlson blamed the low numbers on delays in rolling out Pathways. The Biden administration initially rejected the program because it requires enrollees to spend at least 80 hours per month on work-related activities, which can include a job, education and job training.

“We lost about two years,” Carlson said.

The state went to court and won the right to undertake the Pathways initiative. But by the time the DCH was able to begin implementing the program, Georgia and other states were in the midst of “redetermination.”

The federal government prohibited disenrolling any Medicaid recipients during the COVID pandemic. When the national public health emergency was declared at an end in April of last year, states began the complicated process of reassessing eligibility for Medicaid coverage.

“That was a tremendous strain on the system,” Carlson said.

The state has had a lot more success with Georgia Access. Kemp said private health coverage through Georgia Access gives enrollees more options than Medicaid and offers health-care providers better reimbursement rates.

The program also has led to an increase in the number of insurance companies offering coverage in Georgia, which has driven premiums down an average of 11% statewide and 29% in rural areas, the governor said.

Enrollment in Georgia Access has grown from 460,000 five years ago to more than 1.3 million, including 400,000 Georgians previously on Medicaid, Kemp said.

But supporters of a full-blown Medicaid expansion say the state still is missing about 290,000 Georgians in the “coverage gap,” who do not qualify for Medicaid coverage and do not earn enough to qualify for federal tax credits to help pay for private insurance.

“We cheer the meaningful increases in private health insurance enrollment among Georgians,” said Laura Colbert, executive director of Georgians for a Healthy Future. “But that does not resolve the larger issue at hand. Hundreds of thousands of Georgians remain uninsured and without meaningful access to health care until Georgia leaders fully close our state’s coverage gap.”

A newly created state commission looking for ways to improve health-care access and quality for low-income uninsured Georgians is expected to consider fully expanding Medicaid through the ACA as an option. However, with the Kemp administration committed to a “Georgia-centric” approach that emphasizes private health coverage, the Medicaid expansion alternative isn’t expected to make much headway.