Georgia's Pathways to Coverage program, a limited Medicaid expansion requiring enrollees to work or complete other qualifying activities, is set to expire at the end of 2026 unless renewed by the next governor. Launched in 2023 under Gov. Brian Kemp, Pathways covers more than 20,000 people and helped inspire the federal Medicaid work requirements taking effect nationwide January 1.
Keisha Lance Bottoms, former Atlanta mayor, defeated Republican Rick Jackson to become Georgia's next governor, making her the state's first Democratic governor in over two decades and the first Black woman elected governor in U.S. history.
Grady Health System, an Atlanta-based safety-net system with 18 locations, has signed a revenue cycle management agreement with Ensemble Health Partners. Ensemble will operate Grady's end-to-end revenue cycle across hospital and physician services, while Grady retains control of revenue cycle strategy and patient financial policies.
Georgians for a Healthy Future outlines what residents need to know as Georgia Access open enrollment runs Nov. 1, 2026 through Jan. 15, 2027, with no pre-enrollment window shopping available this year. Most insurers have proposed premium increases over 20% for a second consecutive year, contributing to a drop in Marketplace enrollment from 1.3 million last fall to roughly 900,000 by September after enhanced premium tax credits expired. The piece also details federal changes under H.R. 1, including new repayment requirements for subsidy overpayments, the end of year-round enrollment for those at 100-150% of the federal poverty level, and the loss of Medicaid, PeachCare for Kids, and Marketplace subsidy eligibility for many lawfully present immigrants starting in 2026 and 2027. Georgia Medicaid and PeachCare for Kids continue to accept applications year-round through Georgia Gateway.
Why it mattersState eligibility workers, enrollment assisters, and health plans serving Georgia's Marketplace and Medicaid populations must prepare for eligibility verification changes, subsidy clawbacks, and coverage losses among immigrant populations shifting between Medicaid, PeachCare, and Marketplace coverage.
Georgia state Sen. Brian Strickland will hold a press conference on October 22 to address a 30% cut in payments for Applied Behavior Analysis (ABA) therapy made by Amerigroup, Georgia's Medicaid contractor for children in foster care. The payment reduction took effect September 1, 2026, and affects ABA providers serving foster children with autism and related behavioral health needs. Strickland's event signals legislative scrutiny of the contractor's rate decision and its impact on access to care for a vulnerable Medicaid population.
Why it mattersProviders serving foster children through Amerigroup face reduced reimbursement that could curtail ABA therapy access, while state lawmakers signal possible pressure on the contract or rate-setting process.
Three years into Georgia's Pathways to Coverage program, the state's Medicaid work requirement demonstration has enrolled only 18,527 people, roughly 13% of uninsured, low-income working Georgians who potentially qualify. The report finds 43% of everyone ever enrolled since July 2023 later lost coverage, largely due to paperwork problems and income fluctuations rather than failure to meet work hours. Two new qualifying activities added in October 2025 for parents of young children and SNAP work-program participants remain severely under-enrolled compared to similar populations in SNAP. Georgia still has the nation's second-highest rate of uninsured non-elderly adults, and the brief flags potential program changes coming in January 2027.
Why it mattersState Medicaid officials and advocates face mounting evidence that administrative burden, not work-requirement noncompliance, is driving coverage churn and suppressing enrollment in a program other states may look to as a model.
In a blog post, Georgia primary care physician Kreena Patel, MD, MPH argues that the lack of Medicaid expansion in Georgia, compared with her prior experience in expanded-Medicaid Arizona, directly worsens patient access and health outcomes. She describes patients skipping visits or stretching medication refills due to cost after ACA marketplace tax credits expired, and contrasts the robust wraparound support staff at her Arizona FQHC with the thin staffing at her Georgia FQHC. She cites a visit cap of 12 Medicaid visits per year as a specific barrier preventing timely management of chronic conditions like hypertension. The piece frames these firsthand clinical experiences as evidence for expanding Medicaid coverage in Georgia.
Why it mattersGeorgia providers and FQHCs face compounding financial and staffing strain as non-expansion status and reduced marketplace subsidies push more cost-sharing burden directly onto low-income patients, driving care delays and worse chronic disease control.
Georgia Watch, a statewide consumer advocacy nonprofit, presented its 2026 Consumer Champion Awards to six individuals and organizations for consumer protection work. Honorees include state legislators who sponsored healthcare-related bills, such as Sen. Kay Kirkpatrick's legislation limiting AI-only coverage denials and reducing prior authorization requirements, and Rep. Darlene Taylor's work on Community Health Worker certification, higher Medicaid reimbursement rates, and maternal home visiting program expansion. Other awards recognized work on financial fraud protection and civil justice access. The awards were presented October 1, 2026, in Atlanta.
Why it mattersState Medicaid stakeholders should track these legislators' continued influence, since their past bills touch Medicaid reimbursement rates, prior authorization rules, and community health worker programs that affect provider payment and managed care utilization review in Georgia.
Georgia state agencies submitted budget requests for Amended FY 2027 and FY 2028 under Gov. Brian Kemp's directive to keep spending largely flat. The Department of Community Health requested an additional $152.9 million for AFY 2027 and $343.7 million for FY 2028 for Medicaid and PeachCare based on projected utilization, accounting for the largest share of new agency funding requests. Overall state agency requests rose from $38.5 billion to $38.8 billion in AFY 2027 and $39.6 billion in FY 2028. The Georgia Budget and Policy Institute warns that HB 463, enacted in 2026 to cut income taxes by $6.3 billion once fully phased in, will strain the state's ability to fund Medicaid and other services without new revenue, following $344 million in executive budget cuts Kemp made in May.
Why it mattersState Medicaid agency funding levels and provider rates for FY 2028 will hinge on whether lawmakers can reconcile rising Medicaid utilization costs with revenue losses from the state's new income tax cuts.
In a comment submitted to Georgia's Department of Community Health, GBPI responds to the state's proposed amendment to the Georgia Pathways to Coverage Section 1115 demonstration waiver. The advocacy group asks the department to add more detailed projections of cost and enrollment impacts to the amendment request. GBPI also calls for removal of any language that would allow discontinuing coverage for low-income Georgians under the waiver. The comment was submitted September 14, 2026, during the public notice and comment period for the proposed amendment.
Why it mattersState officials and advocates tracking Georgia Pathways will need to watch whether DCH revises the amendment's cost projections and coverage-termination provisions before CMS review.
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