Federal judge rules in favor of experimental Georgia Medicaid program

U.S. District Judge Lisa Godbey Wood ruled August 19 in favor of Georgia after the Centers for Medicare and Medicaid Services (CMS) rescinded a Medicaid waiver for the state’s Pathways to Coverage program. Georgia brought the lawsuit after CMS under the Trump administration approved the state’s Section 1115 application for the waiver in October 2020 and then rescinded the waiver in early 2021 under the Biden administration, formally denying the application in December 2021. Georgia Gov. Brian Kemp (R) sent a letter notifying CMS that the state was filing a lawsuit on January 19, 2022.

Judge Wood said CMS’ 2021 decision to revoke the waiver authorizing Georgia’s experimental Pathways to Coverage program was arbitrary and capricious.

Georgia officials say the Pathway to Coverage program would extend Medicaid assistance to additional individuals below the federal poverty line. It would offer healthcare coverage to individuals who work at least 80 hours per month or spend at least 80 hours per month engaged in another qualifying activity (including college, community service, and vocational training) who would not otherwise qualify for assistance under traditional Medicaid programs. The program would also cover health premiums for qualifying individuals with insurance from their employers.

The program would not establish new qualifications for individuals currently eligible for Medicaid.

CMS has not yet filed to appeal the decision.

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