Georgia sues Biden for Medicaid work requirement extension.

Atlanta — Georgia sued the Biden administration Friday to extend its new low-income health plan, the only Medicaid program in the nation with a work component, until 2028. Georgia Pathways began in July and ends in September 2025.

The action in U.S. District Court in Brunswick, Georgia, claims the Biden administration's decision to eliminate Pathways' employment requirement and other aspects delayed implementation. The program was cut from five years to slightly over two.

“This case is about whether the federal government can benefit from its own unlawful conduct,” the suit states. It wants the CMMS to prolong Pathways until September 30, 2028, by court order. A CMS representative said in an email the agency does not discuss current lawsuits.

CMS denied the extension in October and December. In a Dec. 22 letter, CMS Deputy Administrator and Director Daniel Tsai claimed the state had not met procedures to request an extension, including a public notice and comment period.

Georgia Gov. Brian Kemp stated in a news release announcing the case 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.”

Tsai wrote in December that the government did not ban Georgia from adopting other Pathways provisions when it withdrew the job requirement and planned to charge certain Medicaid participants monthly payments. A shorter implementation timeframe than planned was not unique to Georgia, he added.

He added “many states experience delayed implementation of their demonstration projects (or initiatives within a demonstration project) for various reasons”. Georgia's plan covers able-bodied people earning up to the poverty threshold, $14,580 per person or $24,860 per family of three. To qualify, people must work, study, rehab, or volunteer 80 hours each month.

Republicans have portrayed the idea as a fiscally prudent alternative to a full Medicaid expansion under the Affordable Care Act, though resistance has eased. Georgia is one of 10 states without expanded Medicaid. As of mid-December, little under 2,350 Georgians were registered in Pathways, which the Kemp administration hopes would add 100,000 poor and uninsured to Medicaid.

The Trump administration authorized the job requirement, but the Biden administration revoked it and the premium requirement in December 2021. That led Georgia to sue. A 2022 federal judge revived both portions of the program, calling the revocation unreasonable and capricious.