ATLANTA – Advocates seeking health insurance for more low-income Georgians are encouraged that Medicaid expansion is starting to draw support among what for years has been unified Republican opposition.
Although just four GOP state senators joined 17 Democrats when Senate Bill 50 was introduced late last month, it was still a milestone for Laura Colbert.
“This bill is really exciting because it’s Georgia’s first bipartisan legislation that would close Georgia’s coverage gap,” said Colbert, executive director of Georgians for a Healthy Future.
The measure would create PeachCare Plus, expanding Medicaid access for Georgians making less than 138% of the federal poverty level.
Currently, only Georgians who earn at or below the poverty level qualify for coverage. Unlike 40 other states, Georgia has not sought the expanded access – and associated federal money – that has been on the table for more than a decade.
To qualify in Georgia now, a single person must earn less than $15,650 and a family of four is capped at $32,150.
To qualify for the state’s Pathways to Coverage program – a limited form of Medicaid expansion Gov. Brian Kemp rolled out in 2023 – adults must work, go to school, volunteer or do other qualifying activities for 80 hours a month.
No other state has such a requirement. The upshot: a tiny fraction of eligible Georgians are covered.
“If you take away the 6,500 people in Pathways, we have over 200,000 people living in the health insurance coverage gap, without access to affordable health care,” said Leah Chan, an analyst with the Georgia Budget and Policy Institute.
Expanding Medicaid to allow access for those earning up to 138% of the poverty level would add hundreds of thousands to the eligibility list.
The federal government would cover 90% of the cost, but Kemp has consistently questioned the longevity of that funding stream, worried about the cost shifting to Georgia taxpayers.
Grant Thomas, deputy commissioner with Georgia’s Department of Community Health, said at a recent hearing for SB 50 that Kemp’s approach is saving taxpayers money.
“Because we only expanded to 100% of the federal poverty level, we were able to keep 816,000 Georgians on private insurance in which the state does not pay a dollar,” Thomas said. “So that’s 816,000 people we’re not paying 10% of those costs as a state had we fully expanded Medicaid.”
Kemp has said he will petition the federal government to extend Pathways another five years. His extension request will also ask for changes that would expand access a little by waiving the work requirement for impoverished parents of children 6 and under.

The sweeping changes advocates seek aren’t part of his plan, and there aren’t great odds that lawmakers will force his hand.
One of the four Republicans who signed onto SB 50 has since dropped off. That leaves three Republicans. There are 23 Democrats in the 56-member Senate, and even with those three there are not enough votes for passage.
And it would still have to get through the House of Representatives, where no Republicans have signed onto similar legislation by Democrats
Still, everyone knows about spiraling health-care costs, including residents in Republican-leaning rural areas, said Sen. David Lucas, D-Macon, the chief sponsor of SB 50.
“Now rural legislators who are Republicans, they’ve got to consider who they represent and how they’re going to help the folks that they do represent,” he said.
Sen. Russ Goodman, R-Cogdell, is one of the Republicans who signed SB 50.
He said he doesn’t know that he would vote for the measure, but he worries about the finances of rural hospitals.
It’s personal: his son was electrocuted at age 11.
“He lived, but he had to be life flighted,” Goodman said. “If we didn’t have a rural hospital 12 miles from my house, I don’t know that he’d be here today. I live in a very, very, very rural area.”
Goodman said he just wants the Senate to discuss Medicaid expansion.
Sen. Carden Summers, R-Cordele, also signed SB 50 to have a discussion. He wants to talk about whether expansion would help rural hospitals.
“We’ve had some hospitals on the verge of closing for 10 years,” he said. There are millions and millions of dollars available, he added. “Let’s tap into it.”
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Georgia’s pending federal request for changes to the Pathways to Coverage program must go through a public comment period. The deadline to post a letter is Feb. 20. Mail to: Shawn Walker at the Georgia Department of Community Health, P.O. Box 1966, Atlanta, GA 30301-1966. Georgians can also participate in a live hearing via Zoom from 3 p.m. to 5 p.m. on Monday.