The recent federal spending bill signed into law by President Donald Trump on July 4 has drawn criticism from advocates for Medicaid expansion in Georgia. This legislation, referred to as ‘One Big Beautiful Bill,’ includes over $1 trillion in healthcare spending cuts over the next decade. These cuts are expected to compel states like Georgia to reduce their healthcare programs significantly.
Among the most contentious provisions is the imposition of work requirements on the 40 states that expanded Medicaid under the Affordable Care Act of 2010. Georgia is among the ten states that opted not to expand Medicaid, instead implementing an alternative program known as Pathways to Coverage, which has faced substantial criticism for being overly expensive and ineffective.
According to 2022 Census data, Georgia has the fifth-highest uninsured rate for individuals under 65, with 13.6% of its population – approximately 1.2 million residents – lacking health coverage. This figure surpasses the national uninsured rate of 9.5%.
Disability advocacy groups are expressing urgency concerning the potential impacts of the funding cuts on disabled populations, despite the bill itself not explicitly targeting these groups. The anticipated loss of funds could critically challenge how states administer their Medicaid programs, particularly in offering home and community-based Medicaid disability waivers, which many states might be forced to cut first due to budget restrictions.
Stephanie Meredith, a public health expert and disability advocate, voiced her concerns about how the financial cuts might affect her adult son, Andy, who has Down syndrome. Meredith highlighted that they had to wait for 17 years on a list to receive the NOW/COMP Medicaid waiver, which has allowed her son to thrive within the Georgia community.
The NOW and COMP waivers provide necessary support for medical equipment, employment, housing, and day programs. Meredith emphasized the dire situation, stating that misconceptions persist regarding the accessibility of Medicaid. She said many believe individuals with disabilities receive adequate coverage, but crucial services, such as support from direct providers, are often not included.
Meredith’s son relies on direct support providers to assist him in his employment at a grocery store and coaching lacrosse while his parents work.
Medicaid expansion refers to the eligibility increase for adults under 65, setting the income limit at 138% of the federal poverty level (FPL) as a key element of the Affordable Care Act. However, a Supreme Court ruling allowed states to decide against expanding their programs. The states that have not chosen to expand include Georgia, Alabama, Florida, Kansas, Mississippi, South Carolina, Tennessee, Texas, Wyoming, and Wisconsin. Notably, the federal government covers 90% of the expansion costs for eligible individuals.
In Georgia, where expansion has not occurred, a citizen must meet low-income criteria and satisfy at least one additional condition: being pregnant, a child or teenager, 65 years or older, legally blind or disabled, or requiring nursing home care to qualify for Medicaid.
A report from the Center for Policy and Budget Priorities indicated that approximately 1.6 million people between 19 and 64 fall into a coverage gap where their income is too high to qualify for Medicaid but still below the poverty line, making them ineligible for healthcare subsidies through the Marketplace. In Georgia alone, 192,000 individuals are in this position, with a majority being people of color.
As a replacement for Medicaid expansion, Georgia instituted the Pathways to Coverage program under Governor Brian Kemp in 2023. Eligibility for Pathways requires candidates to be citizens or legal residents aged 19-64, unable to qualify for any other Medicaid type, not incarcerated, earning up to 100% of the federal poverty level, and mandated to complete 80 hours a month in work, volunteering, or educational credits. In 2025, the annual income threshold of 100% FPL for Georgia was set at $15,650 for an individual or $26,650 for a family of three.
A study from the Southern Poverty Law Center criticized the Pathways initiative, describing it as failing to create substantial and responsive healthcare access for individuals needing care. The study also referenced research indicating that work requirements do not effectively promote increased employment. Policy analyst Gina Azito Thompson noted that such requirements often stem from biased narratives about people’s willingness to work, creating barriers during financial crises.
Additional studies conducted on the Pathways program revealed its shortcomings. The Georgia Budget & Policy Institute reported that over 40% of Georgia’s counties had fewer than ten enrollees in the program, despite a high rate of uninsured people statewide. They labeled the enrollment process as cumbersome, leading to a backlog of 14,000 applications. Those who managed to enroll reported better healthcare outcomes, yet many faced significant technical issues using the online system and struggled to get support via telephone.
Moreover, the state invested significantly in upgrading the online enrollment system—five times more than what was spent on benefits for enrollees. A joint investigation by The Current and Propublica uncovered that Deloitte Consulting received millions from the state to promote Georgia Pathways. However, there was no correlation between the consultants’ work and actual enrollment success. Despite a $10.7 million publicity contract, enrollment figures barely improved throughout the contract term.
Due to staffing shortages and technical problems, the state reduced the monthly requirement to report hours worked to just once per year. Under Trump’s spending bill, states are required to implement similar work requirements for those eligible for Medicaid expansion under the ACA.
State Senator Kay Kirkpatrick (R-Marietta) has expressed that Medicaid expansion is not the solution to Georgia’s healthcare issues. In her view, the current system merely grants individuals a Medicaid card without ensuring they can access necessary care. She pointed out that the only group not covered by Medicaid consists of able-bodied adults aged 18-65, while vulnerable groups like children, pregnant women, and seniors already have coverage. Kirkpatrick also mentioned that the Department of Community Health has increased outreach efforts to help Georgians navigate the enrollment processes for available programs.
Conversely, State Representative Lisa Campbell (D-Kennesaw) has labeled the Pathways program a failure, asserting that contrary to the governor’s portrayal of success, the facts tell a different story. She argued that even if Pathways functioned perfectly, it remains more expensive to provide individual coverage through this program than through Medicaid expansion. Campbell noted that the healthcare costs for the uninsured ultimately burden taxpayers, particularly when individuals resort to seeking care in emergency rooms, which is the most expensive option for treatment.
Governor Kemp frequently emphasizes Georgia’s ranking as a top state for business, but Campbell believes that ensuring citizens are healthy is crucial for sustaining a thriving business environment.
According to her, if individuals are unwell, their ability to work and provide for their families suffers significantly. Campbell has introduced House Bill 751 during the 2025 legislative session to expand eligibility for Medicaid coverage. If passed, this bill would include caregiving as a qualifying activity, allowing parents caring for their children at home to apply, as well as family members caring for disabled adult children or aging parents.
Meredith and her husband both work extensively, but without the Medicaid waiver, they would be compelled to lower their working hours, which would jeopardize their retirement savings. They find themselves in a predicament where either their son loses his essential role in their community, or they must sacrifice their financial future. The young people employed to support Andy often transition into careers in special education or therapy, inspired by their experiences working with him.
Meredith emphasized the importance of support systems, stating that without the necessary assistance, families like hers could face distressing challenges. The Georgia Council on Developmental Disabilities reports that roughly 7,000 individuals are currently on the waiting list for the NOW/COMP waiver.
The state recently offered the TEFRA or Katie Beckett waiver for disabled children under 19 whose parents earn too much to qualify for Medicaid. While it can serve as a primary insurance option, families frequently utilize it as supplementary to private insurance. Established under President Ronald Reagan and named after a ventilator-dependent three-year-old, this waiver helped facilitate at-home treatment, enabling families to provide care without incurring exorbitant costs.
Meredith’s son relied on the Katie Beckett waiver for therapy, which played a critical role in his developmental milestones. Many private insurance policies impose limits on therapy visits, and Medicaid often covers the costs when patients exhaust their limits. However, the operation and management of waiver programs differ considerably from state to state, complicating future planning for families relying on such assistance.
Florida lacks a Katie Beckett waiver, while Tennessee just introduced its version in 2020, many years after its inception federally. Currently, Tennessee’s Part A is available for individuals with serious disabilities and complex medical needs but has limited slots.
Meredith reflected on the urgency of the situation, as healthcare disparities persist, especially for marginalized communities in Georgia.
The ripple effects of the Medicaid funding cuts could further destabilize an already precarious healthcare landscape in the state. Rep. Campbell commented that healthcare losses could exacerbate the struggles faced by uninsured populations but will ultimately reverberate beyond just those without coverage.
According to KFF, by 2034, an estimated 310,000 Georgians may lose healthcare due to the cuts, with possible numbers reaching 750,000 if Congress allows enhanced ACA tax credits to lapse.
Rural hospitals and senior care facilities that depend on Medicaid funding are already facing significant financial strains. If a number of these facilities shut down, residents in those regions may be left without sufficient care, causing longer travel distances for medical treatment and contributing to longer wait times for everyone.
A report from the Center for Healthcare Quality and Payment Reform identified that 700 rural hospitals nationwide are at risk of closure, with 20 located in Georgia, nine of which are classified as being in immediate danger.
Georgia’s existing maternal care deserts overshadow the state’s healthcare system, producing inequitable outcomes, particularly for Black mothers and infants. Among the ranks of states, Georgia ranks unfavorably for maternal and infant mortality rates.
Meredith expressed concern that closures of healthcare facilities would lead to a rise in infant mortality numbers.
As the debate over Medicaid and healthcare access continues, advocates for individuals with disabilities, low-income families, and uninsured populations urge that comprehensive solutions are necessary to ensure healthcare availability for all Georgians.
image source from：cobbcountycourier
