Medicaid Expansion and Work Requirements in Georgia

Abstract

Georgia’s Section 1115 waiver application, titled “Georgia Pathways to Coverage,” seeks to simultaneously expand the state’s Medicaid program and condition eligibility on work requirements. Though Section 1115 waivers have become a common vehicle for state Medicaid expansion, the imposition of work requirements is a novel departure. This article explores whether approval of Georgia Pathways to Coverage by the U.S. Department of Health and Human Services can withstand judicial review. Recent precedent, beginning with the seminal Stewart v. Azar case, strongly suggests that a legal challenge would be successful on the merits. The features and justifications of Georgia Pathways to Coverage, examined in light of current data on work requirements in entitlement programs, make it likely that approval of the program would be found arbitrary and capricious under the Administrative Procedure Act. However, unique aspects of Georgia Pathways to Coverage, as compared with similar state waivers, raise significant hurdles related to constitutional standing requirements and the appropriate judicial remedy.