ATLANTA, Ga. (Atlanta News First) — Georgia’s next governor could inherit a billion-dollar fight over the future of the state’s Medicaid alternative, as the state asks the federal government to pay a bigger share of the program’s cost.

Pathways to Coverage is Georgia’s alternative to Medicaid expansion. It offers health care benefits to residents who are not otherwise eligible for traditional Medicaid, according to the Georgia Department of Community Health. The program currently covers just over 18,527 people, according to data from GeorgiaPathways.org.

If the federal government denies the state’s funding request, Georgia could be on the hook to pay more itself. The dispute is expected to stretch into next year, when Georgia’s next governor takes office.

About 240,000 low-income Georgians still have no health coverage at all, according to the Georgia Budget and Policy Institute. Georgia ranks third worst in the nation for lack of coverage, the institute reported.

By law, the federal government provides a matching percentage of funding for programs like Pathways. That match is currently 67%, but the state is now asking the federal government to raise it to 90%, according to Georgia’s Department of Community Health waiver request.

Georgia requested the same 90% match in 2019 and was denied, according to Georgians for a Healthy Future, an advocacy group. Wisconsin and Utah made similar requests and were also denied, including during the first Trump administration, the group said.

Gov. Brian Kemp is not backing away from the request.

“Gov. Kemp fully supports DCH’s efforts to ensure Georgia Pathways remains a national model for other states while maintaining the integrity of the first-of-its-kind program. While we cannot speculate on potential outcomes at this time with discussions ongoing between DCH and CMS, the governor is committed, as he always has been, to ensuring Georgians have access to quality healthcare while maintaining fiscal discipline for the state,” a spokesperson for his office said in a statement.

New federal work requirements are set to take effect in January 2027 regardless of whether Georgia’s funding request is approved. The state projects Pathways enrollment could grow to nearly 120,000 people under the new rules, according to the Department of Community Health.

Rural hospitals are also watching the outcome. In states that have not expanded Medicaid, including Georgia, more than half of rural hospitals are operating in the red, according to the Chartis Center for Rural Health.

The Georgia Hospital Association is backing the state’s funding request.

“Georgia’s hospitals share a mission to provide high-quality care to their patients and communities. Their ability to provide access to that care is more sustainable when more Georgians are enrolled in health insurance programs that compensate providers for the full cost to provide care. An insured patient, regardless of what that coverage is, is a healthier patient. They are more likely to choose the appropriate care setting before a health issue becomes an emergency,” the association said in a statement. “GHA supports DCH’s request for enhanced federal funding. As the state seeks to align the community engagement requirements in the Georgia Pathways waiver with the new federal community engagement requirements, and notably the medical frailty exceptions, outlined in H.R. 1, these provisions could result in a substantial increase in the number of Georgians eligible for Medicaid coverage. GHA supports affordable coverage options for Georgians and continues to support efforts by DCH and the state to expand those coverage opportunities in a cost-effective manner.”

“Most other states in the country are already receiving 90/10 FMAP, so it seems appropriate that Georgia be granted the same federal matching rate as we adopt standards and requirements set at the federal level.

“In Georgia, if the state’s request to adopt the federal community engagement requirements and medical frailty exceptions is approved as an amendment to the Georgia Pathways waiver, Georgia’s hospitals may benefit from an increased number of their patients becoming Medicaid eligible, which would thereby reduce uncompensated care costs. Since Georgia already requires certain work, school or volunteer commitments for coverage as part of its waiver, the new provisions at the federal level will only increase coverage options for our patients.”

Whoever wins Georgia’s governor’s race in November will inherit the outcome of this funding fight. Democrat Keisha Lance Bottoms, a candidate for governor, called the current program “a disastrous plan.”

“We’ve got a disastrous plan with this Georgia Pathways,” Bottoms said in campaign remarks. “We are funding healthcare in other states through our tax dollars. We need to expand it in this state.”

Republican Rick Jackson, a health care executive and candidate for governor, rejected that approach and said he supports what he calls an intelligent approach to Medicaid.

“I want to give an opportunity to every Medicaid recipient to be trained, get a job, and get off of Medicaid,” Jackson said. “I’m not going to measure our state by how many people are on Medicaid; I want to measure it by how many people are on commercial insurance.”

Public comment began on Wednesday online. In-person public comments begin on Monday, August 24, 2026, at 12:30 p.m., in the DCH 4th-floor boardroom. 2 MLK Jr. Drive, SE, East Tower, Atlanta, GA 30334.

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