In July 2023, the state of Georgia did what many states had floated and few had dared: it implemented Medicaid work requirements under a pilot program called Pathways to Coverage. The policy required able-bodied, non-disabled adults to work, study, or volunteer at least 80 hours per month to maintain Medicaid eligibility.
On paper, the initiative was framed as a pathway to upward mobility and personal responsibility.
In practice, it had all the makings of a coverage cliff.
More than 250,000 Georgians were newly eligible under the pilot. But within the first 90 days, only about 7,500 enrolled. That’s less than 3%. The primary reasons? Administrative complexity. Digital access barriers. And there was a striking gap in communication between the policy and the people it impacted.
For health systems, this wasn’t just a bureaucratic glitch—it was a business-critical disruption. The implications were immediate:
- Patients lost coverage in the middle of treatment plans.
- Emergency department usage spiked as primary care access plummeted.
- Revenue forecasts weakened as Medicaid reimbursement volume dropped.
- Care teams found themselves navigating paperwork instead of patient care.
But in the midst of mounting uncertainty, several forward-thinking health systems across Georgia took a different approach. They didn’t just react—they reimagined.
Instead of treating Medicaid work requirements as a threat to continuity, they treated them as a call to build new kinds of continuity. The result: a series of on-the-ground strategies that transformed a rigid policy into a human-centered connection strategy—and preserved both care and margin along the way.
The Reframe: From Policy Burden to Growth Opportunity
While national coverage focused on the fallout, local systems got to work. They recognized that work requirements—however polarizing—had one consistent weakness: they weren’t designed for how real people live.
Many of the patients affected were part-time workers, caregivers, gig workers, or students juggling multiple jobs. Others lacked access to the internet, transportation, or language-congruent resources. The systems that succeeded in Georgia didn’t try to fix the law. They focused on fixing the experience.
As one community strategy lead put it:
“We stopped thinking like a health system and started thinking like a support system.”
That shift made all the difference.
The Strategic Plays That Delivered
1. Deploying Community Navigators—In Places That Matter
Rather than relying on patients to navigate a maze of online portals and government forms, health systems met them where they already were libraries, churches, barbershops, neighborhood centers, community colleges—even grocery stores.
These navigators weren’t call center reps or case managers. They were trained community advocates—often multilingual—who knew how to simplify complex requirements into real-world steps.
Their charge was clear:
- Help patients understand what the 80-hour requirement meant.
- Show them how to document qualifying activities (work, training, caregiving, volunteering).
- Walk them through application steps—on paper, online, or in person.
- Ensure they stayed connected to their care team throughout.
In one case, a rural health system embedded navigators in four counties with the highest Medicaid churn risk. Within six months, disenrollment in those zones was 47% lower than in control counties with no navigator program.
2. Building Workforce & Employer Partnerships
Several systems saw the overlap between Medicaid eligibility and workforce instability as an opportunity. They partnered with local employers, workforce boards, and job training programs—not just to help patients retain benefits, but to create real, sustainable employment pathways.
In Savannah, one system collaborated with healthcare staffing agencies and local high schools to place young adult Medicaid patients in part-time clinical assistant roles. These jobs counted toward work requirements and addressed staffing shortages—a win for everyone.
In Atlanta, a collaborative with five regional employers enabled patient-employees to auto-generate verification forms through their payroll providers, which were then routed directly to Medicaid case managers. That one integration reduced verification errors by 63% and eliminated one of the most common causes of coverage loss.
3. Launching Patient-Focused Communication Campaigns
Generic mailers weren’t going to cut it.
Successful systems deployed omni-channel campaigns with a singular goal: simplify, personalize, and support. These campaigns featured:
- Geo-targeted digital ads in areas with high Medicaid density
- Plain-language SMS alerts before redetermination deadlines
- QR-code flyers in clinics, pharmacies, and public transit stops
- Mobile-first microsites with “3 Steps to Keep Your Medicaid” guides in multiple languages
One urban system layered its campaign with interactive webinars hosted by community influencers and health plan reps. These live Q&As were streamed on Facebook and YouTube and averaged more than 600 participants per session. The system saw a 42% drop in missed redetermination deadlines among attendees.
The Measurable Results
Systems that approached Medicaid work requirements through the lens of connection and support—not just compliance—saw tangible benefits.
| Metric | Without Strategy | With Patient-Centered Engagement |
|---|---|---|
| Medicaid disenrollment rate | 41% | 21% |
| Missed follow-up appointments | 38% | 16% |
| Preventable ED utilization | Baseline | ↓ 19% |
| Navigator program ROI | Not measured | 7:1 return via revenue preservation |
| Patient satisfaction (NPS) | +71 | +82 |
These aren’t just nice numbers—they reflect real momentum. Systems preserved continuity of care, protected predictable revenue, and built trust with vulnerable populations who too often feel left behind.
What This Means for CMOs and Growth Leaders
Policy shifts like Medicaid work requirements can feel like operational black holes. But for marketing and growth leaders, they’re also strategic inflection points.
Here’s how health systems outside of Georgia can act now:
🔹 Map Risk by Zip Code
Use claims data and payer partnerships to identify areas with high Medicaid penetration, low digital access, and high redetermination failure. Build communication and support strategies around those zones.
🔹 Engage Your Employer Partners
You don’t have to build job pathways alone. Collaborate with large local employers to track hours, support documentation, and promote health literacy in the workplace.
🔹 Rebrand Compliance as Connection
Don’t just tell patients what’s required—show them you’re there to help. Every text, flyer, and navigator conversation is a chance to reinforce that your system is on their side.
🔹 Integrate Your Channels
Turn policy education into an integrated campaign with your digital, social, community, and patient experience teams aligned under one message: We’ll help you stay covered—and stay cared for.
Final Word: Compliance Is a Minimum. Connection Is the Advantage.
Healthcare policy is rarely written with human complexity in mind. But health systems don’t have to be passive recipients of top-down mandates.
What Georgia’s experience proves is this: even when the rules are rigid, the response doesn’t have to be. When systems activate their creativity, partnerships, and communication strengths, they can transform uncertainty into connection—and connection into sustained growth.
This is the kind of strategy that doesn’t just protect revenue. It earns trust.
And in a market where loyalty is everything, that’s the ultimate ROI.
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