Georgia Pathways and the Federal Work Requirement

Check your situation in Georgia

When it starts in Georgia

• July 2023: Pathways began with its own work requirement under a federal waiver.
• CMS extended the Pathways waiver temporarily through December 31, 2026.
• January 1, 2027: Pathways rules change to the federal version. Current members are not affected until their 2027 renewal.
• August 2026: DCH said it would ask CMS for a higher federal match rate for Pathways. No CMS decision had been announced as of October 30, 2026.

Who has to meet it

Georgia did not adopt the full ACA Medicaid expansion. The federal law also covers adults in waiver programs that give similar coverage, which is why it applies to Georgia Pathways to Coverage but not to other Georgia Medicaid members.

The rule applies to people ages 19 to 64 enrolled in Georgia Pathways to Coverage, unless they are pregnant, have Medicare, or are exempt. You meet it in a month with 80 hours of work, community service, a work program, or school (in any mix), by going to school at least half-time, or with at least $580 in monthly income.

You are exempt if, for example, you care for a child 13 or younger or a person with a disability, are pregnant or postpartum, are American Indian or Alaska Native, are medically frail, are a veteran with a total (100%) VA disability rating or TDIU, were in foster care at 18 and are under 26, are in drug or alcohol treatment, meet SNAP or TANF work rules, or left jail or prison in the last 3 months. See the full exemption list.

How Georgia checks and how to report

Months checked: Applicants must meet the rule in the month just before they apply. The Pathways page says members keep meeting it during enrollment and are checked at the yearly renewal.

Report changes to DFCS within 10 calendar days, online through Georgia Gateway, by phone, or in person.

Other things to know in Georgia

• The 80-hour rule stays, but the federal version adds new ways to qualify: $580 a month in income, or a 6-month income average for seasonal workers.
• The federal version also adds exclusions that Pathways did not have, such as American Indian and Alaska Native people, former foster youth, people who are medically frail, people meeting SNAP or TANF work rules, caregivers, postpartum women, and veterans with a 100% disability rating.
• Some old Pathways activities change. For example, the Pathways page says job readiness becomes part of education.

Official tools and contacts

• Report and upload: Georgia Gateway
• DFCS Customer Contact Center: 1-877-423-4746
• Georgia Pathways: H.R. 1 changes to Pathways
• Agency: Georgia Department of Community Health (DCH); eligibility through DFCS

Federal protections that apply in Georgia

• The state must check its own records before asking you for proof.
• If it can't confirm you meet the rule, you get a notice and at least 30 days to respond, and your coverage continues meanwhile.
• You get written notice and the right to a fair hearing before coverage ends, and you can reapply at any time.
• If you lose Medicaid for not meeting the rule, you cannot get marketplace premium tax credits for those months. Learn more.