Georgia's Board of Community Health met on Thursday and said, in effect: the federal government broke our Medicaid program, and we need the federal government to pay for it.

The federal government, in this case, is a law that six of Georgia's own Republicans in Congress voted for.

What Georgia is asking for

Georgia is one of ten states that never fully expanded Medicaid. Instead, Gov. Brian Kemp built Pathways to Coverage — a partial expansion that covers adults earning up to 100% of the federal poverty level (about $15,960 for a single adult) only if they complete 80 hours a month of work, school or community service. When it launched in 2023, it made Georgia the only state in the country with a work requirement for its newly covered enrollees.

Pathways covers about 20,000 people.

Now the state wants Washington to raise its federal match from roughly 67% to 90% — the rate reserved for states that fully expand Medicaid. Stuart Portman, who runs the Department of Community Health's division of medical assistance plans, explained why:

"The federal government fundamentally reshaped the operational and financial realities of Georgia's waiver. Therefore, we ask that the federal government also provide the enhanced match necessary to make that expansion viable."

What reshaped it? The new federal Medicaid eligibility rules in Trump's tax break and spending cuts package — the budget bill passed last year. Those rules take effect next year, and they require Georgia to add exemptions its own program never had: parents of children under 13, people formerly in foster care, people who are medically frail.

Georgia's own projections say those exemptions will add about 100,000 people to the rolls. And in its public notice, the state wrote that "Georgia does not have the financial capacity to fund this expanded scope without additional federal dollars."

Read that sentence again. It's the state of Georgia saying it cannot afford the law its congressional delegation voted for.

Who voted for it

On July 3, 2025, the House passed H.R. 1 by 218 to 214. Every Georgia Republican in the chamber voted yes. Six of them are people we track:

• Rick Allen (GA-12)
• Andrew Clyde (GA-9)
• Mike Collins (then GA-10, now running for U.S. Senate)
• Brian Jack (GA-3)
• Rich McCormick (GA-7)
• Austin Scott (GA-8)

Four votes the other way and the bill fails. Any four.

None of them have to answer for the state budget hole now, because the request for money is coming from Atlanta, not Washington. That's the trick of a bill like this — Congress writes the rule, and the state gets handed the bill and the blame.

Allen said this wouldn't happen

Rick Allen, who chairs the House health subcommittee, told a reporter last year that the health cuts wouldn't touch Georgia at all — because Georgia never expanded Medicaid in the first place. When a hospital CEO in his own district said the bill would cost him his ICU, Allen said the CEO was "dead wrong."

KFF put Georgia's loss at $2.29 billion.

Georgia's Department of Community Health has now filed a public notice saying the federal changes make the state's program financially unsustainable. That is the state's own health agency, under a Republican governor, contradicting the claim.

The cheaper option nobody wants to say out loud

There is a way for Georgia to get the 90% match. It's the way every other state got it.

Leah Chan, director of health justice at the Georgia Budget and Policy Institute, laid it out:

"Georgia already tried this tactic in 2019 under the Trump administration, and it failed. But I think what we do know is that the temporary federal approval for Pathways expires in December. So rather than wasting our time pursuing dead ends, we could simply just raise the Pathways income eligibility limit from 100% to 138% of the federal poverty level and pull down the enhanced 90% match authorized under the Affordable Care Act."

She's right about 2019, too. Georgia asked the first Trump administration for the enhanced match without full expansion, and HHS said no — the 90% rate goes to states covering people up to 138% of the poverty line, about $22,025 for a single adult. Georgia is asking the same administration the same question again.

Kemp's office is careful about the framing. Spokesperson Annalise Morning said "the waiver modification is NOT a Medicaid expansion for Georgia," but rather something to "preserve the long-term sustainability of Georgia Pathways."

So the state wants expansion money at expansion rates without calling it expansion, from an administration that already refused once.

What's actually at stake

Pathways' temporary federal approval expires in December. A request to run it through 2030 is still pending.

Under Trump's budget bill, an estimated 150,000 Georgians will lose health coverage — and if the enhanced ACA premium tax credits are also allowed to expire, a Georgia-specific analysis puts the total at 492,000 Georgians uninsured by 2034.

Whitney Griggs of Georgians for a Healthy Future summed up the state's posture in one line: "What I'm getting from this is: 'We'd like to continue Pathways as is.'"

Meanwhile, Natalie Crawford of the bipartisan group Georgia First questioned whether doubling down is even fiscally responsible compared to full expansion, which "maximizes available federal dollars, further reduces the number of uninsured Georgians and better strengthens our healthcare system."

You can say something about it

Georgians can comment on the proposed waiver changes in writing through Sept. 14. There's a virtual public hearing on Aug. 19 at 11 a.m. and an in-person hearing at the Department of Community Health's board room at 12:30 p.m. on Aug. 24.

The six members of Congress who voted for the law creating this problem are not on the agenda at either one. They should be.

Source

Alander Rocha, "Georgia officials say new federal Medicaid rules threaten state's partial expansion program," Georgia Recorder, Aug. 14, 2026. Photo: the_burtons/Getty Images, via Georgia Recorder.