United Spinal Association Advocacy Network

United Spinal Association of Georgia is part of United Spinal Association’s National Advocacy Network. We participate annually on the Roll on Capital Hill in Washington, DC in addition to advocating for the rights of people with disabilities right here in Georgia.

Join via UnitedSpinal.org

Closing Georgia’s Coverage Gap: Why United Spinal Association of Georgia Supports Medicaid Expansion

United Spinal Association of Georgia (USAGA) is adding its voice to the organizations across the state calling for full Medicaid expansion. For Georgians living with spinal cord injuries and other mobility disabilities, health coverage is about more than doctor visits.

It determines whether a person can get a working wheelchair, the supplies they use every day, and the personal care that lets them live independently.

The short version: Georgia already spends real money on healthcare access and gets a worse return than full expansion would deliver. The question is no longer whether to spend. It is whether to spend well.

Georgia’s Coverage Gap

Georgia has the third-highest share of uninsured residents in the nation. About 240,000 low-income Georgians fall into the “coverage gap”: they earn too much to qualify for the state’s traditional Medicaid program but too little to receive subsidies on the ACA marketplace.

Full Medicaid expansion would extend coverage to an estimated 470,000 or more Georgians, including about 155,000 uninsured women and about 32,000 uninsured veterans and military spouses.

Why This Matters to People with Disabilities

Many people with spinal cord injuries rely on Medicare, which typically covers about 80% of the cost of durable medical equipment and supplies. The remaining 20% coinsurance for a wheelchair, catheters, or other essential supplies can quickly become unaffordable. For many people, Medicaid is what fills that gap.

Georgia also sets notably strict income limits for the Medicaid pathways available to people with disabilities. As a result, many Georgians with serious disabilities and limited incomes still go without the coverage they need for equipment, supplies, and personal care services.

The Cost of Standing Still

Billions in Federal Funds Left on the Table

Georgia forgoes roughly $3 billion in federal funding each year, more than $8 million a day, and over $21 billion to date.

A Lower Federal Match

Full expansion draws a 90% federal match. Georgia’s current alternative, Pathways to Coverage, receives 67%.

Rural Hospitals Under Strain

Seven rural Georgia hospitals have closed since 2013, and more than half of those remaining operate in the red. In states that expanded Medicaid, hospitals’ uncompensated care costs fell by roughly 56% to 60%.

What Full Expansion Would Deliver

Coverage for 470,000 or more Georgians

An estimated 56,000 jobs created each year, including about 12,000 in rural communities

A $6.5 billion annual boost to state economic output, including $1.3 billion in rural areas

Greater taxpayer value: Full expansion is more cost-effective than Pathways over its first two years, leveraging higher federal matches and new revenue.

Georgia’s Own Data: The Pathways Experience

Georgia launched Pathways to Coverage in mid-2023 as a limited alternative to full expansion. The results so far make a strong case for a more efficient approach:

Low enrollment. After two full years, Pathways had enrolled 8,077 people, about 6% to 7% of the target population, against projections that ranged from 31,000 to 345,000. Enrollment has since grown to roughly 18,500.
High overhead. The state has spent about $110 million on the program. Less than one dollar in three (about $34 million) paid for actual healthcare. Technology and enrollment systems consumed 47% ($52 million), and a single year of awareness advertising cost $21 million.
High cost per person. That works out to $13,597 in total program cost per active enrollee.
Paperwork barriers. About 60% of applications have been denied, and 54% of interested applicants never finished applying because of work-requirement paperwork.

Whatever path Georgia chooses, it should be one that reaches the people it is meant to serve and draws the highest available federal match.

Why 2026 Matters

Georgia faces a Medicaid decision in the coming months, not years:

A $1.4 billion funding question. Georgia has asked the federal government to raise the Pathways match from 67% to 90%, the same request denied in 2019. Policy experts note the request likely conflicts with federal law without full expansion. State officials have warned that without it, Pathways could become financially unsustainable, putting coverage for about 18,500 current enrollees at risk.
New federal work requirements begin in January 2027. These rules are expected to expand Pathways’ target population toward 120,000 people, a scale the program has not yet shown it can manage efficiently.

Georgia’s next governor and General Assembly will face these decisions soon after taking office. Closing the coverage gap will take support from lawmakers across the political spectrum, and we believe the case for expansion is one that people of every party can support: it improves access to care, strengthens rural hospitals, and makes better use of Georgia taxpayers’ dollars.

Standing with Georgia’s Health Advocates

USAGA joins a broad community of Georgia organizations already working to close the coverage gap, including the Cover Georgia Coalition convened by Georgians for a Healthy Future, the Georgia Budget and Policy Institute, and disability- and disease-specific groups such as the Spina Bifida Association, the Arthritis Foundation, and the Lupus Foundation.

We bring a distinct perspective to that effort: the experiences of Georgians living with spinal cord injuries and mobility disabilities, whose independence depends on consistent, affordable coverage.