Georgia Medicaid Honored with 2023 Spotlight Award

Georgia Medicaid Honored with 2023 NAMD Spotlight Award

Georgia Medicaid is recognized for the perseverance needed to stand-up a first-of-its kind coverage plan, introducing a new eligibility category and expanding access to affordable, quality healthcare coverage for low-income Georgians.

Perseverance pays off

Georgia Pathways to Coverage™ was four years in the making.  The plan leverages the 2019 Patients First Act which included Georgia Access and a reinsurance program that successfully reduced premiums by an average of 12.4 percent statewide. Strategic leadership helped align stakeholders to overcome opposition and hurdles that arose during the process. Policymakers – from the Governor to state legislators – were key drivers of Georgia Pathways to Coverage™.  Technical colleges and universities that support pathways to independence for Georgians were steady allies in the plan’s development and remain a critical support during implementation.  The Medicaid agency sees increasing avenues for alignment with private and public sector partners vested in advancing health and workforce development.

Expanded coverage

Pathways to Coverage™ opens new doors to low-income Georgians who otherwise would not be eligible for traditional Medicaid.  The program, launched July 2023, offers Medicaid coverage to adults ages 19 to 64 whose income is up to 100% of the Federal Poverty Level. To qualify and remain eligible, individuals must demonstrate they are working or engaged in education, job training or community service. Pathways to Coverage™ is built on a 1115 waiver unique to Georgia and designed as sustainable innovation.

Participants receive the same medical assistance as other Medicaid beneficiaries which include, but are not limited to, physician services, prescriptions, mental health services, family planning services, chronic disease management, and preventive and wellness services. Pathways participants are enrolled with the managed care entities.

By providing Medicaid coverage to those individuals who are uninsured, and considered the working poor, Pathways will increase the wage growth for those who are employed. Further, Pathways will support the long-term fiscal sustainability of the Medicaid program.

NAMD is pleased to honor Georgia Medicaid with the 2023 Spotlight Award.  Learn more about the other 2023 Spotlight Award winners here.