Medicaid Demonstrations: Information on Administrative Spending for Georgia Work Requirements
This report examines Georgia’s Medicaid demonstration testing work requirements—the only such active program in the nation—and provides detailed findings on administrative costs, implementation challenges, and federal oversight weaknesses.
GAO found that from FY 2021 through mid-2025, Georgia spent $54.2 million in administrative costs (88 percent federally funded) to implement its “Pathways to Coverage” program, with most expenses tied to IT system changes for eligibility and reporting systems.
Enrollment was significantly lower than projected, driving up administrative costs per person, and the report details how CMS approved certain federal matching rates above recommended levels for marketing and monitoring activities. GAO concludes that CMS’s failure to consider administrative costs in demonstration approvals and its inconsistent oversight of enhanced funding pose fiscal risks—especially as nationwide Medicaid work requirements expand under new federal legislation
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