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ATLANTA (AP) — Georgia Gov. Brian Kemp on Monday defended and reaffirmed his new Medicaid program – the only one in the country with a work requirement – further dimming the chances that the state could pass a broader expansion of tax-funded health insurance for low-income earners without a work requirement in the near future.

To qualify for Georgia Pathways, all recipients must demonstrate they have worked, volunteered, completed training or completed vocational rehabilitation for at least 80 hours per month. The program was launched in July 2023, but so far has enrolled only a tiny fraction of the state’s eligible residents.

Kemp praised the program Monday during a panel discussion that also included Georgia Department of Community Health Commissioner Russel Carlson and Fire Protection and Insurance Commissioner John King. The governor’s office also showed a video featuring a Pathways recipient, Luke Seaborn, 53, who praised the program and later said in a phone interview with The Associated Press that it helped him pay for an injection for nerve pain.

“Being first is not always easy,” Kemp said. But he added, “We will continue to work on it and make sure that people continue to sign up.”

As of early June, Pathways had just over 4,300 members, well below the 25,000 members state officials had expected in the program’s first year.

The Kemp administration has blamed the Biden administration for the slow start. Pathways was supposed to launch in 2021, but the Biden administration objected to the work requirement in February and later lifted it. Georgia sued and a federal judge reinstated the work requirement in 2022.

Carlson said the delay hampered efforts to get Pathways up and running, including educating those involved and potential beneficiaries. It also meant the launch coincided with an onerous Medicaid eligibility review required by the federal government, he said.

The Biden administration has said that when it lifted the work requirement, it did not prevent Georgia authorities from implementing other aspects of Pathways. The state’s authorities also had high expectations for enrollment in Pathways, despite verifying Medicaid eligibility.

Carlson said the state has launched a major campaign to promote Pathways, including radio and television ads, as well as advertising on college campuses.

“We feel like Georgia Pathways is being given the open sea for the first time, so to speak,” he said.

Critics of Pathways have said the state could provide health insurance to about 500,000 low-income people if it passed a full expansion of Medicaid without a work requirement, as 40 other states have done.

This broader expansion of Medicaid was a key part of President Barack Obama’s 2010 health care reform. In exchange for offering Medicaid to nearly all adults earning up to 138 percent of the federal poverty level, states receive more federal funding for those newly insured. Pathways limits coverage to people earning up to 100 percent of the federal poverty level.

Kemp has opposed a full expansion, saying the long-term costs to the state would be too high. His administration has also promoted Pathways as a way to move people from state support to private insurance.

The governor said Monday that hundreds of thousands of former Medicaid recipients in the state can now obtain health insurance under the Affordable Care Act thanks to improvements in Georgia’s health care marketplace.

A program the state implemented with federal approval has lowered premiums and increased competition in the market, the governor said. The Biden administration has also significantly increased health insurance subsidies under the ACA, although Kemp, a Republican, did not mention that change in his remarks Monday.

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