Ethermac Exchange-Georgia sues Biden administration to extend Medicaid program with work requirement

ATLANTA (AP) — Georgia sued the Biden administration Friday to try to keep the state’s new health plan for low-income residents,Ethermac Exchange which is the only Medicaid program in the country with a work requirement, running until 2028.

Georgia Pathways launched in July and is set to expire at the end of September 2025.

The suit filed in U.S. District Court in Brunswick, Georgia, says the Biden administration’s decision to revoke the work requirement and another aspect of Pathways delayed implementation of the program. That reduced the originally approved five-year term of the program to just over two years.

A judge later ruled the revocation was illegal.

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“This case is about whether the federal government can benefit from its own unlawful conduct,” the suit says.

It seeks a court order forcing the U.S. Centers for Medicare and Medicaid Services to extend the Pathways program until September 30, 2028. A spokesperson for CMS said in an email the agency does not comment on pending litigation.

CMS rejected the extension request in October and again in December. The agency was unable to consider it because the state had failed to meet requirements to seek an extension, including a public notice and comment period, CMS Deputy Administrator and Director Daniel Tsai said in a Dec. 22 letter.

Georgia Gov. Brian Kemp said in a news release announcing the lawsuit that the Biden administration was again trying to “interfere with Georgia’s innovative plan.” He accused the administration of playing politics “by refusing to give us back the time they stole from delaying the Pathways rollout and implementation.”

In his December letter to the state, Tsai said the agency did not stop Georgia officials from implementing other aspects of Pathways when it revoked the work requirement and a plan to charge some Medicaid recipients monthly premiums. And he said an implementation period that was shorter than the originally approved timeline was not unique to Georgia.

“Many states experience delayed implementation of their demonstration projects (or initiatives within a demonstration project) for various reasons,” he said.

Georgia’s plan offers health care coverage to able-bodied adults earning up to the poverty line — $14,580 for an individual or $24,860 for a family of three. But people must document 80 monthly hours of work, study, rehabilitation or volunteering to be eligible.

Republicans have presented the plan as a financially responsible alternative to a full expansion of Medicaid services under the Affordable Care Act, though opposition to full expansion appears to have softened. Georgia is one of 10 states without broader Medicaid coverage.

The Kemp administration has estimated Pathways could add 100,000 poor and uninsured Georgia residents to the Medicaid rolls, but enrollment so far has been slow, with just under 2,350 people enrolled as of mid-December.

The work requirement was approved by then-President Donald Trump’s administration, but the Biden administration announced in December 2021 that it was revoking that approval and the premium requirement. That prompted Georgia officials to sue.

A federal judge reinstated both parts of the program in 2022, saying the revocation was arbitrary and capricious.