The country’s top nonpartisan government watchdog has confirmed it is examining the costs of running the nation’s only active Medicaid work requirement program, as Republican state and federal lawmakers consider similar requirements.
The U.S. Government Accountability Office told KFF Health News that its analysis of the Georgia Pathways to Coverage program could be released this fall.
In its first 100 days, the Trump administration has said rooting out waste in federal programs was a priority, allowing billionaire Elon Musk and the newly created Department of Government Efficiency broad latitude to fundamentally alter the operations of federal agencies.
The idea of a nationwide mandate that requires Medicaid enrollees to either work, study, or complete other qualifying activities to maintain coverage is gaining traction as congressional Republicans weigh proposals to cut $880 billion from the federal deficit over 10 years. The savings are intended to offset the costs of President Donald Trump’s priorities, including border security and tax cuts that would largely benefit the wealthy.
A majority of the public — regardless of political leaning — oppose funding cuts to Medicaid, according to polling released May 1 by KFF, a health information nonprofit that includes KFF Health News.
The GAO investigation comes at a critical time, said Leo Cuello, a research professor at Georgetown University’s Center for Children and Families.
“Congress seems to be pursuing cuts in Medicaid in a frenetic and rushed manner,” he said. The GAO report could outline for Congress the full extent of problems with work requirements “before they rush forward and do this without thinking.”
The experiences of Georgia and Arkansas — the only two states to have run such programs — show that work requirements depress Medicaid enrollment while adding costly layers of bureaucracy.
Now, more states are trying to get signoff from the Trump administration to approve work requirements for Medicaid, the state-federal program that offers health coverage to millions of Americans with low-incomes and disabilities.
The Centers for Medicare & Medicaid Services, which approves Medicaid pilot programs such as work requirements, did not respond to a request for comment by publication.
The GAO found in 2019 that work requirement programs can be expensive for states to run — hundreds of millions of dollars, in some cases — and that federal officials failed to consider those costs when approving the programs, which cannot increase Medicaid spending.
Still, the Trump administration has supported work requirements. The programs require state employees to manually verify whether enrollees meet eligibility requirements and monitor their continued compliance.
In 2023, more than 90% of U.S. adults eligible for Medicaid expansion were already working or could be exempt from requirements, according to KFF.
During his confirmation hearing to lead CMS, Mehmet Oz said he was in favor of work requirements but didn’t think they should be used as “an obstacle, a disingenuous effort to block people from getting on Medicaid.”
The first Trump administration approved work requirements in 13 states. Nearly all the programs were blocked by the Biden administration or federal courts.
Georgia is one of 10 states that hasn’t fully expanded Medicaid to nearly all low-income adults.
The state launched Pathways to Coverage on July 1, 2023. It’s been a main policy priority of Republican Gov. Brian Kemp, whose office engaged in a lengthy court fight with the Biden administration after it tried to block the program.
The program cost more than $57 million in state and federal dollars through the end of 2024, with much of that going toward its administration. As of April 25, 7,410 people were enrolled, a small percentage of those who would be covered by a full Medicaid expansion. Pathways has also slowed processing times for other benefit programs in the state.
When asked about the costs and benefits of Pathways, Kemp spokesperson Garrison Douglas instead pointed to Georgia’s recently launched state-based Obamacare exchange. It saw record enrollment due, in part, to enhanced subsidies passed by the Biden administration.
“We are covering more Georgians than traditional Medicaid expansion would have, and for less money,” said Douglas, referring to the state, not federal, share of spending.
The enhanced subsidies that boosted enrollment are set to expire this year. The Congressional Budget Office estimates that extending them would cost the federal government about $335 billion over 10 years.
In March, Arkansas asked the Trump administration to relaunch its Medicaid work requirement program. The federal public comment period on the program runs through May 10. A previous version was halted by a court order in 2019, but not before more than 18,000 lost coverage in less than a year.
Georgia plans to request that the White House renew its program with modest changes, including reducing how frequently enrollees must prove to the state they’re working or engaging in other qualifying activities.
The GAO investigation into Georgia’s work requirement program comes after three Democratic U.S. senators — Jon Ossoff and Raphael Warnock of Georgia and Ron Wyden of Oregon — asked the GAO in December for an investigation into the program’s costs. Their request cited reporting by KFF Health News.
“I pushed for this GAO report because I am confident its findings will further support what we already know: Pathways to Coverage costs the taxpayers more money and covers fewer people than had the state simply joined 40 other states in closing the health care coverage gap,” Warnock said in a statement.
The GAO said it aims to figure out how much Georgia has spent to run the program, how much of that was federal money, and how that spending is being tracked.
