Three Democratic senators asked the country’s top nonpartisan government watchdog on Tuesday to investigate the costs of a Georgia program that requires some people to work to receive Medicaid coverage.

The program, called “Georgia Pathways to Coverage,” is the nation’s only active Medicaid work requirement.

Pathways has cost tens of millions in federal and state dollars on administration and consulting fees while enrolling 5,542 people as of Nov. 1, according to KFF Health News’ reporting. The congressional letter cited the reporting in its request to the Government Accountability Office.

“Republicans are hell-bent on putting mountains of red tape between Americans and their health care,” Sen. Ron Wyden (D-Ore.), head of the Senate Finance Committee, said in a statement about the letter he co-wrote. “Taxpayers deserve to hear from an independent watchdog about the true costs of the Republican health care agenda.”

Georgia Sens. Jon Ossoff and Raphael Warnock co-signed the request.

The Democrats’ letter asks the GAO to prepare a summary of the costs to run the program — and detail how much of that has been picked up by the feds, break down the cost of the program per person, and assess how Georgia has used contractors to run the program and how federal officials have overseen it.

The request comes as President-elect Donald Trump, who supported work requirements in his first administration, is set to take office and potentially transform how people qualify for Medicaid, the joint federal-state health insurance program for people who are disabled or have low incomes.

Many GOP-led states have pushed for work requirements in public benefits programs such as Medicaid, arguing that they promote employment. Georgia’s Pathways program requires some Medicaid applicants to prove they are working, volunteering, or studying for 80 hours a month.

The first Trump administration approved work requirements in 13 states. Only Georgia’s program, which started on July 1, 2023, is in effect. A Medicaid work requirement launched in Arkansas was halted by a court order in 2019.

In November, South Dakota voters gave lawmakers a green light to seek a work requirement for some Medicaid enrollees. In 2023, North Carolina lawmakers directed the state to seek work requirements if the federal government would approve such a waiver. And some GOP-led states have indicated they might also seek work requirements.

Georgia’s program has been a priority of Republican Gov. Brian Kemp, and his team defended the program.

“The Senators should be more focused on examining the failures of the federal government to adequately provide the services they’re required to administer than looking for every opportunity to criticize states that are taking innovative approaches,” Garrison Douglas, a Kemp spokesperson, said in an emailed statement.

Enrollment in the program, which as of Dec. 13 was 5,903, has fallen far short of the state’s initial projection of more than 25,000 in the first year.

The program has cost more than $40 million in state and federal funds, largely administrative costs and not medical care for enrollees, Georgia officials have said. KFF Health News reported in March that Georgia officials estimated the program’s administrative costs could increase to $122 million over four years.

A spokesperson for Georgia’s Medicaid agency, Fiona Roberts, said the costs “increased significantly” because of the program’s delayed launch. While it was approved by the Trump administration, the Biden administration attempted to block it, resulting in a legal fight.

KFF Health News has also reported that the program has slowed processing times for other Medicaid applications and for public benefits such as cash assistance and food stamps.

Meanwhile, more than a year after Pathways’ launch, Georgia officials said they still had not removed enrollees for failing to prove they are working, volunteering, or studying for 80 hours a month, KFF Health News has reported.

“State leaders continue to put taxpayer dollars behind their ineffective health care program that has failed by nearly every metric,” Warnock said.

Previous federal research suggests that the high costs per enrollee associated with Georgia’s program could be repeated elsewhere. The Trump administration didn’t properly weigh administrative costs in state applications for work requirements, according to a 2019 GAO report. Pathways is slated to expire on Sept. 30, unless federal officials grant an extension.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

LOS ANGELES — President-elect Donald Trump’s promise of mass deportations and tougher immigration restrictions is deepening mistrust of the health care system among California’s immigrants and clouding the future for providers serving the state’s most impoverished residents.

At the same time, immigrants living illegally in Southern California told KFF Health News they thought the economy would improve and their incomes might increase under Trump, and for some that outweighed concerns about health care.

Community health workers say fear of deportation is already affecting participation in Medi-Cal, the state’s Medicaid program for low-income residents, which was expanded in phases to all immigrants regardless of residency status over the past several years. That could undercut the state’s progress in reducing the uninsured rate, which reached a record low of 6.4% last year.

Immigrants lacking legal residency have long worried that participation in government programs could make them targets, and Trump’s election has compounded those concerns, community advocates say.

The incoming Trump administration is also expected to target Medicaid with funding cuts and enrollment restrictions, which activists worry could threaten the Medi-Cal expansion and kneecap efforts to extend health insurance subsidies under Covered California to all immigrants.

“The fear alone has so many consequences to the health of our communities,” said Mar Velez, director of policy with the Latino Coalition for a Healthy California. “This is, as they say, not their first rodeo. They understand how the system works. I think this machine is going to be, unfortunately, a lot more harmful to our communities.”

Alongside such worries, though, is a strain of optimism that Trump might be a boon to the economy, according to interviews with immigrants in Los Angeles whom health care workers were soliciting to sign up for Medi-Cal.

Selvin, 39, who, like others interviewed for this article, asked to be identified by only his first name because he’s living here without legal permission, said that even though he believes Trump dislikes people like him, he thinks the new administration could help boost his hours at the food processing facility where he works packing noodles. “I do see how he could improve the economy. From that perspective, I think it’s good that he won.”

He became eligible for Medi-Cal this year but decided not to enroll, worrying it could jeopardize his chances of changing his immigration status.

“I’ve thought about it,” Selvin said, but “I feel like it could end up hurting me. I won’t deny that, obviously, I’d like to benefit — get my teeth fixed, a physical checkup.” But fear holds him back, he said, and he hasn’t seen a doctor in nine years.

It’s not Trump’s mass deportation plan in particular that’s scaring him off, though. “If I’m not committing any crimes or getting a DUI, I think I won’t get deported,” Selvin said.

Petrona, 55, came from El Salvador seeking asylum and enrolled in Medi-Cal last year.

She said that if her health insurance benefits were cut, she wouldn’t be able to afford her visits to the dentist.

A street food vendor, she hears often about Trump’s deportation plan, but she said it will be the criminals the new president pushes out. “I’ve heard people say he’s going to get rid of everyone who’s stealing.”

Although she’s afraid she could be deported, she’s also hopeful about Trump. “He says he’s going to give a lot of work to Hispanics because Latinos are the ones who work the hardest,” she said. “That’s good, more work for us, the ones who came here to work.”

Newly elected Republican Assembly member Jeff Gonzalez, who flipped a seat long held by Democrats in the Latino-heavy desert region in the southeastern part of the state, said his constituents were anxious to see a new economic direction.

“They’re just really kind of fed up with the status quo in California,” Gonzalez said. “People on the ground are saying, ‘I’m hopeful,’ because now we have a different perspective. We have a businessperson who is looking at the very things that we are looking at, which is the price of eggs, the price of gas, the safety.”

Gonzalez said he’s not going to comment about potential Medicaid cuts, because Trump has not made any official announcement. Unlike most in his party, Gonzalez said he supports the extension of health care services to all residents regardless of immigration status.

Health care providers said they are facing a twin challenge of hesitancy among those they are supposed to serve and the threat of major cuts to Medicaid, the federal program that provides over 60% of the funding for Medi-Cal.

Health providers and policy researchers say a loss in federal contributions could lead the state to roll back or downsize some programs, including the expansion to cover those without legal authorization.

California and Oregon are the only states that offer comprehensive health insurance to all income-eligible immigrants regardless of status. About 1.5 million people without authorization have enrolled in California, at a cost of over $6 billion a year to state taxpayers.

“Everyone wants to put these types of services on the chopping block, which is really unfair,” said state Sen. Lena Gonzalez, a Democrat and chair of the California Latino Legislative Caucus. “We will do everything we can to ensure that we prioritize this.”

Sen. Gonzalez said it will be challenging to expand programs such as Covered California, the state’s health insurance marketplace, for which immigrants lacking permanent legal status are not eligible. A big concern for immigrants and their advocates is that Trump could reinstate changes to the public charge policy, which can deny green cards or visas based on the use of government benefits.

“President Trump’s mass deportation plan will end the financial drain posed by illegal immigrants on our healthcare system, and ensure that our country can care for American citizens who rely on Medicaid, Medicare, and Social Security,” Trump spokesperson Karoline Leavitt said in a statement to KFF Health News.

During his first term, in 2019, Trump broadened the policy to include the use of Medicaid, as well as housing and nutrition subsidies. The Biden administration rescinded the change in 2021.

KFF, a health information nonprofit that includes KFF Health News, found immigrants use less health care than people born in the United States. And about 1 in 4 likely undocumented immigrant adults said they have avoided applying for assistance with health care, food, and housing because of immigration-related fears, according to a 2023 survey.

Another uncertainty is the fate of the Affordable Care Act, which was opened in November to immigrants who were brought to the U.S. as children and are protected by the Deferred Action Childhood Arrivals program. If DACA eligibility for the act’s plans, or even the act itself, were to be reversed under Trump, that would leave roughly 40,000 California DACA recipients, and about 100,000 nationwide, without access to subsidized health insurance.

On Dec. 9, a federal court in North Dakota issued an order blocking DACA recipients from accessing Affordable Care Act health plans in 19 states that had challenged the Biden administration’s rule.

Clinics and community health workers are encouraging people to continue enrolling in health benefits. But amid the push to spread the message, the chilling effects are already apparent up and down the state.

“¿Ya tiene Medi-Cal?” community health worker Yanet Martinez said, asking residents whether they had Medi-Cal as she walked down Pico Boulevard recently in a Los Angeles neighborhood with many Salvadorans.

“¡Nosotros podemos ayudarle a solicitar Medi-Cal! ¡Todo gratuito!” she shouted, offering help to sign up, free of charge.

“Gracias, pero no,” said one young woman, responding with a no thanks. She shrugged her shoulders and averted her eyes under a cap that covered her from the late-morning sun.

Since Election Day, Martinez said, people have been more reluctant to hear her pitch for subsidized health insurance or cancer prevention screenings.

“They think I’m going to share their information to deport them,” she said. “They don’t want anything to do with it.”

This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).

LOS ÁNGELES, California.— La promesa del presidente electo Donald Trump de deportaciones masivas y restricciones migratorias más severas está aumentando la desconfianza en el sistema de salud entre los inmigrantes en California, y nublando el futuro de los proveedores que atienden a los residentes más empobrecidos del estado.

Al mismo tiempo, inmigrantes que viven en el sur de California sin papeles dijeron a KFF Health News que pensaban que la economía mejoraría y que sus ingresos podrían aumentar bajo Trump. Para algunos, esa esperanza supera a sus preocupaciones sobre la atención de salud.

Trabajadores comunitarios de salud dicen que el miedo a la deportación ya está afectando la participación en Medi-Cal, el programa de Medicaid del estado para residentes de bajos ingresos, que en los últimos años se ha estado expandiendo gradualmente a todos los inmigrantes, independientemente de su estatus migratorio. Esto podría socavar el progreso del estado en la reducción de la tasa de personas sin seguro, que alcanzó un mínimo histórico del 6.4% en 2023.

Los inmigrantes sin papeles han temido durante mucho tiempo que participar en programas gubernamentales los convierta en blanco fácil de las autoridades migratorias, y la elección de Trump ha exacerbado estas preocupaciones, según defensores comunitarios.

Se espera que Medicaid esté en la mira de la nueva administración Trump, con recortes de fondos y restricciones de inscripción, lo que preocupa a activistas, ya que podría amenazar la expansión de Medi-Cal y obstaculizar los esfuerzos para extender los subsidios que ayudan a pagar por los seguros de salud bajo Covered California a todos los inmigrantes.

“El miedo por sí solo tiene tantas consecuencias para la salud de nuestras comunidades”, dijo Mar Vélez, directora de políticas de la Latino Coalition for a Healthy California. “Como ellos dicen, esta no es su primera batalla. Entienden cómo funciona el sistema. Creo que esta maquinaria será, desafortunadamente, mucho más dañina para nuestras comunidades”.

A pesar de estas preocupaciones, también hay una corriente de optimismo de que Trump podría beneficiar a la economía, según entrevistas con inmigrantes en Los Ángeles mientras trabajadores de salud estaban invitándolos a inscribirse en Medi-Cal.

Selvin, de 39 años, quien, como otros entrevistados para este artículo, pidió ser identificado solo por su primer nombre porque no tiene papeles, dijo que aunque cree que a Trump no le gustan las personas como él, piensa que la nueva administración podría ayudar a aumentar sus horas en la planta procesadora de alimentos donde trabaja empacando fideos. “Sí veo cómo podría mejorar la economía. Desde esa perspectiva, creo que es bueno que haya ganado”.

Este año, Selvin se convirtió en elegible para Medi-Cal, pero decidió no inscribirse, preocupado de que pudiera poner en peligro sus posibilidades de cambiar su estatus migratorio.

“Lo he pensado”, dijo Selvin, pero “siento que podría terminar perjudicándome. No negaré que, obviamente, me gustaría beneficiarme: arreglarme los dientes, un chequeo físico”. Pero dijo que el miedo lo frena, y no ha visto a un médico en nueve años.

No es el plan de deportación masiva de Trump en particular lo que lo asusta, sin embargo. “Si no estoy cometiendo ningún crimen o manejando ebrio, creo que no me deportarán”, dijo Selvin.

Petrona, de 55 años, vino de El Salvador buscando asilo y se inscribió en Medi-Cal el año pasado.

Dijo que si se recortan sus beneficios de salud, no podría costear sus visitas al dentista.

Vendedora ambulante de comida, escucha a menudo sobre el plan de deportación de Trump, pero dijo que el nuevo presidente expulsará a los criminales. “He oído decir que va a deshacerse de todos los que están robando”.

Aunque teme que pudiera ser deportada, también tiene esperanza en Trump. “Dice que va a dar mucho trabajo a los hispanos porque los latinos son los que trabajan más duro”, dijo. “Eso es bueno, más trabajo para nosotros, los que vinimos aquí a trabajar”.

El recién electo asambleísta republicano Jeff Gonzalez, quien ganó un escaño históricamente demócrata en la región desértica del sureste del estado, con una gran población latina, dijo que sus electores estaban ansiosos por ver un nuevo rumbo económico.

“Están realmente cansados del statu quo en California”, dijo Gonzalez. “La gente en las calles está diciendo: ‘Tengo esperanza’, porque ahora tenemos una perspectiva diferente. Tenemos a un empresario que está viendo las mismas cosas que nosotros estamos viendo, como el precio de los huevos, el precio de la gasolina, la seguridad”.

Gonzalez dijo que no comentará sobre posibles recortes a Medicaid porque Trump no ha hecho ningún anuncio oficial. A diferencia de la mayoría en su partido, Gonzalez aseguró que apoya la extensión de servicios de salud a todos los residentes, independientemente de su estatus migratorio.

Los proveedores de salud dijeron que enfrentan un doble desafío: la reticencia de las personas a las que deben atender y la amenaza de recortes importantes a Medicaid, el programa federal que proporciona más del 60% del financiamiento para Medi-Cal.

Proveedores de salud e investigadores de políticas dicen que una pérdida en las contribuciones federales podría llevar al estado a reducir o eliminar algunos programas, incluida la expansión para cubrir a quienes no tienen documentos.

California y Oregon son los únicos estados que ofrecen un seguro de salud integral a todos los inmigrantes elegibles, independientemente de su estatus. En California, se han inscrito cerca de 1.5 millones de personas sin papeles, a un costo de más de $6.000 millones al año para los contribuyentes del estado.

“Todo el mundo quiere poner este tipo de servicios en la lista de recortes, lo cual es realmente injusto”, dijo la senadora estatal Lena Gonzalez, demócrata y presidenta del Caucus Legislativo Latino de California. “Haremos todo lo posible para asegurarnos de que esto se priorice”.

La senadora Gonzalez dijo que será un desafío expandir programas como Covered California, el mercado de seguros de salud del estado, para el cual los inmigrantes sin estatus legal no son elegibles. Una gran preocupación para los inmigrantes y sus defensores es que Trump podría restablecer los cambios a la política de carga pública, que habilita para negar tarjetas de residencia o visas basándose en el uso de ciertos beneficios gubernamentales.

“El plan de deportación masiva del presidente Trump pondrá fin al drenaje financiero que representan los inmigrantes ilegales para nuestro sistema de salud y garantizará que nuestro país pueda cuidar a los ciudadanos estadounidenses que dependen de Medicaid, Medicare y el Seguro Social”, dijo Karoline Leavitt, vocera de Trump, en un comunicado para KFF Health News.

Durante su primer mandato, en 2019, Trump amplió la política de carga pública para incluir el uso de Medicaid, así como subsidios de vivienda y para comprar alimentos. La administración Biden rescindió el cambio en 2021.

KFF, una organización sin fines de lucro de información sobre salud que incluye a KFF Health News, encontró que los inmigrantes usan menos servicios de salud que las personas nacidas en los Estados Unidos. Y aproximadamente 1 de cada 4 inmigrantes adultos probablemente indocumentados dijo que ha evitado solicitar asistencia para la atención de salud, alimentos y vivienda debido a temores relacionados con la inmigración, según una encuesta de 2023.

Otra incertidumbre es el destino de la Ley de Cuidado de Salud a Bajo Precio (ACA), que se expandió en noviembre a los inmigrantes traídos al país de niños y que están protegidos bajo el programa de Acción Diferida para los Llegados en la Infancia (DACA). Si la elegibilidad de DACA, y la misma ley, fuera revertida bajo Trump, eso dejaría a aproximadamente 40.000 beneficiarios de DACA en California, y alrededor de 100.000 en todo el país, sin acceso a seguros de salud subsidiados.

El 9 de diciembre, un tribunal federal en Dakota del Norte emitió una orden bloqueando el acceso de los beneficiarios de DACA a estos planes de salud en 19 estados que habían impugnado la regla de la administración Biden.

Clínicas y trabajadores comunitarios de salud están alentando a las personas a seguir inscribiéndose para obtener beneficios de salud. Pero en medio del esfuerzo por difundir el mensaje, los efectos disuasorios ya son evidentes a lo largo y ancho del estado.

“¿Ya tiene Medi-Cal?”, preguntaba la trabajadora comunitaria Yanet Martínez a los residentes mientras caminaba por Pico Boulevard recientemente, en un vecindario de Los Ángeles con muchos salvadoreños.

“¡Nosotros podemos ayudarle a solicitar Medi-Cal! ¡Todo gratuito!”, gritaba, ofreciendo ayuda para inscribirse sin costo.

“Gracias, pero no”, respondió una joven, encogiéndose de hombros y evitando el contacto visual bajo una gorra que la cubría del sol dela  media mañana.

Martínez dijo que desde el día de las elecciones, la gente ha estado más reacia a escuchar lo que dice sobre seguros de salud subsidiados o exámenes preventivos de cáncer.

“Creen que voy a compartir su información para deportarlos”, dijo. “No quieren tener nada que ver con esto”.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

USE OUR CONTENT

This story can be republished for free (details).