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Elton John has won many awards in his career, but his latest honor has nothing to do with his music, his musicals or his charity work — it has to…

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She was poised to claim the presidency, but Joe Biden and a disastrous campaign defeated her.

by Margaret Coker, The Current

This article was produced for ProPublica’s Local Reporting Network in partnership with The Current. Sign up for Dispatches to get stories like this one as soon as they are published.

Last summer, as political debate swirled over the future of Georgia’s experiment with Medicaid work requirements, Gov. Brian Kemp held a press conference to unveil a three-minute testimonial video featuring a mechanic who works on classic cars.

Luke Seaborn, a 54-year-old from rural Jefferson, became the de facto face of Georgia Pathways to Coverage, Kemp’s insurance program for impoverished Georgians. In a soft Southern drawl, Seaborn explained how having insurance had improved his life in the year that he had been enrolled: “Pathways is a great program that offers health insurance to low-income professionals like myself.”

Kemp lauds Pathways as an innovative way to decrease the state’s high rate of uninsured adults while reining in government spending, holding the program up as an example to other Republican-led states eager to institute Medicaid work requirements.

But in the nine months since Seaborn’s video testimonial was released, his opinion of Pathways has plummeted. His benefits have been canceled — twice, he said, due to bureaucratic red tape.

“I used to think of Pathways as a blessing,” Seaborn recently told The Current and ProPublica. “Now, I’m done with it.”

Rather than an enduring symbol of success, Seaborn’s experience illustrates why the program struggles to gain traction even as the state spends millions of dollars to burnish Pathways’ brand. The Current and ProPublica previously reported that many of the approximately 250,000 low-income adults potentially eligible for the health insurance program struggle to enroll or maintain coverage.

The politics of Pathways were not on Seaborn’s mind when he received a phone call last summer from an insurance executive who handles Pathways clients. One of the first Georgians to enroll in the program in 2023, Seaborn had written a letter thanking his insurance provider for covering a procedure for his back pain. The executive from Amerigroup Community Care wanted to know: Would he take part in a promotional video for Pathways?

Seaborn, a supporter of the governor, said yes without hesitation. Soon afterward, Kemp’s press secretary, Garrison Douglas, arrived at his auto repair shop, located a few miles from the governor’s hometown, and spent hours filming in the garage filled with vintage Ford and Chevy trucks and handpainted gas station signs.

A trained chemical engineer, Seaborn had quit his corporate job to embrace his dream of repairing classic cars. But the realities of being a small business owner made that path difficult, Seaborn said, especially when it came to shouldering the cost of health insurance for himself and his son. Pathways eased the way, he said.

Seaborn said he was surprised when the governor called him out by name weeks later at the press conference during which his testimonial video was released. He wasn’t expecting to be the singular face of Pathways.

By November, though, Seaborn encountered some of the problems that other Georgians say have soured their opinion on Pathways. Seaborn said he had logged his work hours into the online system once a month as required. But his benefits were canceled after he failed to complete a new form that he said the state had added without adequate warning. Seaborn said the form asked for the same information he had been submitting every month, just in a different format. The state’s Medicaid agency did not respond to questions about Seaborn’s experience or the new form.

He said he called the same insurance executive who had asked him to take part in the testimonial. She told him she would be lunching with one of Kemp’s aides that day and promised to help, he recalled. Within 24 hours, Seaborn said, his benefits were restored, and a representative from Georgia’s Division of Family and Children Services, which administers federal benefits programs, called to apologize.

Douglas said the governor’s office “had no involvement in Mr. Seaborn’s case.” The insurance company did not respond to requests for comment.

Pathways enrollees must submit paperwork every month proving they had completed the requirements necessary for coverage: 80 hours of work, study or volunteering. But the state says it is not verifying the information on a monthly basis — only during enrollment and upon annual renewal.

Seaborn said that after his coverage was restored, his insurance company told him he would no longer have to file his work hours monthly; the next time he would need to submit such documentation would be during his annual reenrollment. Nevertheless, Seaborn said he signed up for text and email notifications from the Pathways program so that he wouldn’t be caught off guard if requirements changed again.

Even so, technical glitches and more red tape caused him to lose his coverage once more, he said. He stopped receiving texts from the Pathways program in February. When he logged in to the digital platform in early March to make sure everything was in order, a notice informed him that his benefits would be terminated on April 1. The reason: he had missed filing an annual income statement. He said the surprise requirement had popped up on the digital platform even though his coverage was not up for renewal.

“My head exploded,” he said. “I didn’t get a text or an email. I did what I was supposed to, but that wasn’t good enough.”

Seaborn said he went ahead and filed the information, although it was late. He tried to call his insurance provider again for an explanation — and help. He reached out to the Division of Family and Children Services as well. This time, however, he said no one called him back.

In April, Seaborn paid out of pocket for his and his son’s prescription medications, an extra $40 that he said is difficult for him to afford.

Ellen Brown, a spokesperson for Georgia’s Division of Family and Children Services, would not say why Seaborn’s benefits were terminated.

“We are sorry to hear this happened and are looking into how we can better serve our customers and resolve communication gaps in the future,” Brown said in a written statement Friday. “Every Georgian that seeks our services is important, and we take these matters very seriously.”

Meanwhile, Seaborn received a phone call that day from the same Division of Family and Children Services representative who had apologized to him after he was kicked off Pathways last fall. He said she told him she would make sure he got his coverage back. The representative did not respond to a request for comment from The Current and ProPublica.

On Monday evening, Seaborn received a text message to alert him to a notification in the Pathways digital platform. He logged on: A notice confirmed that he had been reenrolled, a change of fortune that he credited to The Current and ProPublica’s questions to state officials about his predicament because he had already given up on contacting people for help.

“I am so frustrated with this whole journey,” Seaborn said. “I’m grateful for coverage. But what I don’t understand is them leaving me like a mushroom in the dark and feeding me nothing, no information, for more than a month.”

by Margaret Coker, The Current

This article was produced for ProPublica’s Local Reporting Network in partnership with The Current. Sign up for Dispatches to get stories like this one as soon as they are published.

When the state of Georgia handed Deloitte Consulting a $10.7 million marketing contract last July to promote the nation’s only Medicaid work requirement program, the initiative was in need of serious PR.

At the time, a year after the program’s rollout, less than 2% of those eligible for Georgia Pathways to Coverage had enrolled, well short of state targets.

To get the word out, the state turned again to the firm that it had relied on to build and manage the program. About 60% of the marketing contract went toward creating and placing ads about Pathways on television and radio, including during NFL games and morning talk shows.

Much of the remainder of the seven-month contract would go toward two efforts: $250,000 per month for Deloitte-trained teams to hand out brochures and Pathways-branded merchandise at community events and $300,000 a month for Deloitte to produce reports about its own performance.

When Deloitte’s publicity campaign ended in February, enrollment in Pathways remained less than 3% of the approximately 250,000 Georgians who are potentially eligible.

The marketing contract is part of a larger suite of services that Georgia has commissioned from Deloitte for its Medicaid experiment. Deloitte has made at least $51 million as of Dec. 31 to manage Pathways, including creating and maintaining its problematic software platform, as The Current and ProPublica previously reported. It is also earning at least $3 million more to oversee the state’s relationship with federal regulators, including its application to extend the experiment beyond its expiration this fall.

Deloitte’s outsize — and unusual — role in promoting the program it has built has allowed the firm to keep pulling in payments despite Pathways’ struggles. And there is virtually no public accounting of how well it is increasing enrollment, a key goal of the policy experiment.

An excerpt of Deloitte’s marketing contract shows its $300,000 per month expenditure on reports on its own performance, $250,000 per month for community outreach and $10.7 million total budget. (Obtained by The Current and ProPublica. Highlighted by ProPublica.)

The marketing contract, obtained through a public records request, allows Deloitte to charge the state nearly half a million dollars for a final report on its publicity campaign, which was due to be submitted in February. When The Current and ProPublica requested the monthly and final performance reports, the state said they needed to be “reviewed” first and demanded $900 for that work. The news outlets did not pay because previous responses to public records requests for Deloitte’s Pathways contracts were heavily redacted, with the general counsel’s office at the Department of Community Health citing “confidential/trade secret.” The agency did not charge for those records.

The state recently approved another $10 million to Deloitte, Fiona Roberts, spokesperson for the Department of Community Health, Georgia’s Medicaid agency that oversees Pathways, said in response to questions about the effectiveness of Deloitte’s marketing efforts. The new marketing contract, which runs until November, includes more community meetings and a text message campaign by Salesforce Marketing Cloud rolling out in May to potentially eligible Georgians, Roberts said.

“In 20 years of researching these kinds of programs, I can’t think of another instance like this” in which a state has selected a for-profit company to both manage and market a federal benefit program, said Joan Alker, executive director for Georgetown University’s McCourt School of Public Policy Center for Children and Families, where researchers have concluded that Medicaid work requirements prevent people from accessing health insurance.

Deloitte has designed and managed Medicaid and other benefit programs for many states, including Georgia, making the firm one of the nation’s experts in government health policy. But Alker said that when states want to educate and enroll residents in federal safety net programs, they typically select local nonprofits that have established relationships with low-income communities. Georgia’s arrangement with Deloitte raises questions, she said, about “whether the state is more committed to spending money on consultants or poor people.”

Deloitte, which has been in charge of the Pathways communications strategy for the past three years, declined to answer questions about its Georgia Pathways work, referring requests for information to the Department of Community Health. A contract signed in 2023 worth approximately $7 million stipulates that Deloitte would “develop first draft of response to media inquiries” on behalf of the Department of Community Health, but that responses “will be submitted by DCH and not Deloitte.” Deloitte’s duties also include drafting talking points for media interviews, including for the governor.

Roberts declined repeated requests for an interview with agency officials. When asked about Deloitte’s marketing and outreach work and whether the firm has met the state’s goals, she described the effort as a “robust, comprehensive awareness and outreach campaign throughout the state” that has generated 1.6 million visitors to the Pathways website since the campaign’s August 2024 launch.

“The state has invested heavily in marketing and outreach to reach Georgians potentially eligible for Pathways,” Roberts said in a written statement.

In 20 years of researching these kinds of programs, I can’t think of another instance like this.

—Joan Alker, executive director for Georgetown University’s McCourt School of Public Policy Center for Children and Families

Gov. Brian Kemp has described Pathways as an innovative alternative to expanding Medicaid, something 40 other states have done. By contrast, Georgia’s program covers only the poorest individuals who can prove they are working, studying or volunteering at least 80 hours a month. Congressional Republicans are pointing to similar work requirements as a model in their budget negotiations.

In early 2024, less than a year after Pathways’ launch, however, Georgia legislators — including some of Kemp’s Republican allies — considered ending the experiment and instead expanding Medicaid without any work requirements. Georgia’s uninsured rate was 11.4%, or 1.2 million people, compared to the national average of 8% in 2023, the latest data available, according to KFF, a nonprofit focused on national health issues. State data showed that Pathways enrollment was well under the first-year target of 25,000 published in Georgia’s agreement with the federal government. As of April 25, approximately 7,400 Georgians were enrolled, according to the Department of Community Health.

An independent evaluation team commissioned by the state recommended ways to boost enrollment in a December 2024 report. The evaluators, Public Consulting Group, highlighted North Carolina’s strategy of allowing residents from rural communities and communities of color to help create outreach campaigns for its expanded Medicaid program in 2023. North Carolina Medicaid officials told The Current and ProPublica that they designed their outreach efforts to maximize participation in the new program, with a two-year target of enrolling 600,000 people. They achieved that goal within one year.

Georgia and Deloitte, however, took a different tack. The $10.7 million marketing contract does not lay out specific enrollment goals as a way of measuring the success of Deloitte’s efforts. The purpose of Pathways “is not and has never been to enroll as many Georgians as possible,” according to the state’s application to the federal government to continue the experiment.

The contract budgeted $247,000 to create up to four testimonial videos featuring satisfied Pathways clients; only one can be found on the state Medicaid agency’s YouTube channel, where it has received approximately 350 views since it was posted in January. The state did not respond when asked how many testimonials Deloitte produced.

Few people stopped by the Georgia Pathways booth at the Washington County Health Fair in Sandersville, Georgia, in March. (Nicole Craine for ProPublica)

Meanwhile, another part of Deloitte’s marketing strategy has also failed to catch wind: Deloitte had sent public relations teams to dozens of community events including farmers markets, a school Christmas pageant and a catfish festival to plug Pathways and encourage applications.

In March, one such team drove two hours from Atlanta to a health fair in Central Georgia’s rural Washington County. At the Pathways booth, the Deloitte team barely looked up from their phones for three hours. Residents largely bypassed the team to chat with locals staffing other kiosks where they could receive diapers, information on subsidized in-home nursing care and blood pressure screenings. Of those who stopped at the Pathways booth, only a handful asked about enrollment.

Other public events were tied to the state’s pursuit of federal permission to extend the Pathways program beyond September, when its original five-year mandate expires. Georgia is once again paying Deloitte to ensure that happens.

The monthslong process, managed by Deloitte, requires opportunities for public comment. A summary of these comments must be submitted with the application, which Deloitte is drafting. Health advocacy organizations say public outreach for this effort, especially to Black Georgians, has been superficial at best.

The only notice for two virtual public meetings appeared on a Department of Community Health web page that was not linked from the agency’s homepage. During both virtual events, health care advocates criticized the program’s inequitable access, but state officials did not engage with the speakers.

A third event — an in-person meeting in the rural 10,000-person town of Cordele — was added later and posted on the same website just one week before it was scheduled to occur. Only about a dozen people, some traveling for more than 80 miles, showed up to the noon meeting on St. Patrick’s Day.

Georgians traveled up to 80 miles to speak at a public meeting about Pathways held by the Georgia Department of Community Health in Cordele in March. (Nicole Craine for ProPublica) The town of Cordele has a population of around 10,000 people. (Nicole Craine for ProPublica)

The low attendance reflected the meeting’s out-of-the-way location and holiday timing, not a lack of public interest, said attendee Sherrell Byrd, executive director of Sowega Rising, a community advocacy group based in the majority Black town of Albany.

Inside the one-story cinder block building, three state health officials sat along a table at the front of the largely vacant room. One by one, attendees rose to the microphone to complain of technical glitches in the Pathways enrollment process, the lack of customer service and the generational health care inequalities faced by Black Georgians.

Tanisha Corporal, who lives approximately 140 miles away in Atlanta, was the only person to participate virtually. She told the Department of Community Health officials that she had submitted a Pathways application three times over the Deloitte-built digital portal only to have her file disappear. The licensed clinical social worker whose nonprofit job ended in January 2024 said state agencies offered her little enrollment support.

Grant Thomas, deputy commissioner for the Georgia Department of Community Health, sits in the back of the room during a public meeting on the Georgia Pathways program in Cordele. (Nicole Craine for ProPublica)

The state health officials did not respond to any of the speakers during the meeting. Grant Thomas, Kemp’s former health policy advisor and deputy director of the state Medicaid agency, sat in the back of the room and did not interact with the attendees. Thomas declined to speak on the record.

“There is a lot of disdain for real-life problems of Georgians who look like us,” Byrd said.

Robin Kemp of The Current contributed reporting.

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