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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.
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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.
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.
