Georgia introduced a Medicaid waiver expanding eligibility for nonelderly “able-bodied” adults. This waiver imposes work requirements, which should include reasonable accommodations for people with disabilities. However, Georgia is not obligated to report the number or types of accommodation requests. Accessibility concerns have also arisen, with limited provisions for accessible information. The effectiveness of this waiver remains uncertain, given challenges faced in other states and a lack of comprehensive data.
Georgia, one of the ten states that have refrained from expanding Medicaid under the Affordable Care Act (ACA), recently introduced a fresh Medicaid waiver known as “Georgia Pathways to Coverage.” This program broadens eligibility to include individuals with incomes up to the federal poverty level ($1,215 per month for an individual), a demographic previously excluded in Georgia. However, it deviates from the ACA’s Medicaid expansion in two key aspects: 1) individuals with incomes ranging from 101 percent to 138 percent of the federal poverty level are ineligible, and 2) applicants must demonstrate 80 hours of work or engage in other “qualifying activities” in the month before applying, and subsequently, they must continue to meet these requirements to maintain their coverage. These restrictions have significant implications for the number of individuals who will gain access to coverage in Georgia and their ability to stay enrolled. In this discussion, we will focus specifically on what this means for people with disabilities, as Medicaid constitutes a primary source of health insurance coverage for many in this population, and the Georgia waiver offers a new route to eligibility.
People with disabilities qualify for Medicaid based on either their disability status or their income. Some individuals who receive federal Supplemental Security Income (SSI) benefits (a national cash assistance program for individuals who are economically disadvantaged and meet strict disability criteria) qualify for Medicaid based on their disability. However, many people with disabilities do not meet the SSI criteria. In fact, as of 2019, nearly half of nonelderly adults with disabilities in Georgia’s Medicaid program did not receive SSI benefits. Instead, they qualified for Medicaid based solely on their income. Georgia’s waiver increases Medicaid income limits, potentially covering more individuals with disabilities who do not receive SSI.
Georgia’s work requirement waiver also indicates the state’s commitment to providing reasonable accommodations for people with disabilities. Reasonable accommodations, mandated by federal laws to prevent disability-based discrimination, involve modifying policies, practices, or procedures to facilitate the participation of individuals with disabilities in state programs. Examples of such accommodations in Georgia’s waiver include assistance with documentation, eligibility, and appeals, reductions in required work hours, and other modifications agreed upon by enrollees and employers. Georgia will refer individuals with disabilities who cannot fulfill the work requirement to state vocational rehabilitation programs, designed to help people with disabilities find employment. These individuals can then qualify for Medicaid if they meet the rehabilitation program’s requirements. However, the waiver does not address the capacity of these programs to handle referrals, the speed at which services are available, or how the state will coordinate referrals to ensure that individuals do not fall through the cracks.
Despite the crucial role of reasonable accommodations for people with disabilities, Georgia is not obligated to report the number or types of these accommodation requests or whether they were approved. Instead, Georgia must provide “general assurances” to the Centers for Medicare and Medicaid Services that it:
1. Endeavors to connect people with disabilities to necessary supports for meeting the work requirement in good faith.
2. Maintains a system that offers reasonable accommodations for people with disabilities to meet the work requirement.
3. Provides written notice to people with disabilities about their right to receive reasonable accommodations, including providing examples of such accommodations.
4. Assesses whether individuals with disabilities have limited job opportunities and, if so, considers further exemptions from the work requirement.
The question of whether individuals with disabilities can access coverage under Georgia’s waiver remains unanswered. Arkansas was the first state to impose work requirements in its Medicaid waiver. During the seven months the waiver was in effect, over 18,000 individuals lost coverage for failing to meet work and reporting requirements. The state offered reasonable accommodations to only 17 individuals and exempted 577 from the work and reporting requirement. More than one-third of these exemptions were based on a disability or health issue. Arkansas’s experience aligns with studies of other benefit programs, showing that individuals with disabilities are more likely to be penalized for not meeting work requirements.
In Georgia, an issue to monitor is whether individuals receive accessible information about the new waiver. A 2022 state website review revealed that Georgia included a general statement about reasonable accommodations, but access to materials in braille or large print, sign language interpreters, and a phone number for deaf individuals to facilitate communication were not readily available. Simultaneously, Georgia is renewing the eligibility of its 2.8 million Medicaid enrollees for the first time since 2020 due to the end of the pandemic. In the initial phase of the review, over 1,500 out of 12,526 individuals were disenrolled, with most losing coverage because the state could not reach them. It is uncertain how effective Georgia will be in contacting existing enrollees who are up for renewal and potentially eligible under the new waiver. In July 2023, the first month of the waiver’s implementation, only 265 individuals enrolled in coverage, while more than 100,000 people have lost Medicaid in Georgia since the state resumed eligibility renewals in April. The narrow coverage pathway created by Georgia’s waiver could mean the difference between coverage and being uninsured, but much depends on outreach and implementation efforts in the upcoming weeks.
