The Georgia Department of Community Health has projected up to 100,000 people could eventually benefit from Georgia Pathways to Coverage. But the nation’s only Medicaid program that makes recipients meet a work requirement is off to a very slow start.

“We will continue working to educate Georgians about Pathways’ innovative, first-of-its-kind opportunity and enroll more individuals in the months to come,” Kemp’s office said in a statement.

The program’s creeping progress reflects fundamental flaws as compared to Medicaid expansions in other states, including the extra burden of submitting and verifying work hours, experts say. And some critics note it’s happening just as the state, as part of a federally mandated review, is kicking tens of thousands of people off its Medicaid rolls — at least some of whom could be eligible for Pathways.

“Pathways to Coverage is falling well short of these commitments to uninsured Georgians. Medicaid expansion would be a more effective way to meaningfully cover state residents and connect them to care,” Laura Colbert, executive director of the advocacy group Georgians for a Healthy Future, said in a statement Friday.

The state Department of Community Health had declined to provide sign-up numbers to the newspaper until the Journal-Constitution told Kemp’s office it would report that the state appeared to be violating its open records law. The department then provided the records, but denies violating the law.

The Biden administration has already tried to revoke Georgia’s Medicaid plan once and is monitoring it, so any missteps could have broader consequences. They could also hamper future efforts by Republicans to make Medicaid eligibility dependent on work.

The state launched Pathways on July 1 just as it began a review of Medicaid eligibility following the end of the COVID-19 public health emergency. Federal law prohibited states from removing people from Medicaid during the three-year emergency.

The state previously said it delayed the reevaluations of 160,000 people who were no longer eligible for traditional Medicaid but could qualify for Pathways to help them try to maintain health coverage. But observers have said they have detected little public outreach to target populations.

Thirty-nine states have expanded Medicaid eligibility to nearly all adults with incomes up to 138% of the federal poverty level, $20,120 annually for a single person and $41,400 for a family of four. North Carolina will become the 40th state to do so in December. None of those states require recipients to work in order to qualify.

That broader Medicaid expansion was a key part of President Barack Obama’s health care overhaul in 2010, but many Republican governors, including Kemp, rejected it. In addition to imposing a work requirement, Pathways limits coverage to able-bodied adults earning up to 100% of the poverty line — $14,580 for a single person or $30,000 for a family of four.

Kemp has argued full expansion would cost too much money. State officials and supporters of Pathways say the work requirement will also help transition Medicaid recipients to better, private health insurance, and argue that working, studying or volunteering leads to improved health.

Critics say many low-income people struggle to document the required 80 hours a month of work, volunteer activity, study or vocational rehabilitation.