ATLANTA — Georgia health leaders, tasked with evaluating whether Medicaid should be expanded in the state, are figuring out what that looks like once Donald Trump returns to the White House.

Caylee Noggle, chair of the state’s Comprehensive Health Coverage Commission, vowed Thursday to continue improving health care quality and access for Georgians. But she acknowledged how policy options play out remains unknown.

“This is a very interesting time to be doing this work,” she said. “We are in a sort of unknown territory and changing dynamics in a federal landscape. We’re trying to design and look at options that may shift in the middle of some of what we’re even looking at.”

Noggle, a former top aide to Gov. Brian Kemp who was appointed in June to lead the commission, told the other eight members to stay “dynamic” over the next several months “as new federal policies and priorities are shared.”

Medicaid is the federal program that provides health care coverage for low-income children and some adults. The Affordable Care Act, also known as Obamacare, gave states the ability to expand Medicaid to all low-income adults, with the federal government paying 90% of the cost. While 40 states have done that, Georgia has not.

Expansion has remained unpopular among Republicans, who control the state government. Instead, Kemp last year launched an alternative system, called Georgia Pathways to Coverage, which provides coverage for adults making below the federal poverty line if they work at least 80 hours per month, attend a technical college or perform another state-approved activity.

For some, medical conditions prevent them from completing the work requirements, and the program has attracted just 4,500 uninsured applicants out of an estimated 240,000 eligible Georgians. More than 90% of the $26 million cost has gone toward administrative and consulting fees.

President Joe Biden’s administration fought with Kemp’s office over an extension for Pathways, which was originally approved for a five-year term, mostly because of the work requirement. Kemp’s office challenged that denial, but a federal judge ruled in July that the Biden administration was within its rights to allow the program to expire.

Kemp worked closely with the Trump administration to devise Pathways. If Trump keeps the same priorities in his second term, Pathways is likely to get a new life.

“Thanks to (the) Trump administration’s previous approval, our state was able to develop and launch innovative programs that addressed Georgia’s specific health care needs,” Garrison Douglas, a spokesperson for Kemp, previously told The Atlanta Journal-Constitution. “We look forward to working with the Trump administration again and all our partners to extend, improve and streamline these programs — making them even more accessible for hardworking Georgians.”

It’s also unclear whether federal incentives to expand will remain in place. But the state’s top Democrats have pushed the state to cover more uninsured Georgians.

U.S. Sen. Raphael Warnock told the Georgia General Assembly in January that “the time is now” to expand Medicaid after he and U.S. Sen Jon Ossoff secured $1.2 billion in incentives in the 2021 coronavirus relief package to speed an expansion.

On Thursday, Warnock added, “Regardless of the recent election outcome, I’m willing to work in a bipartisan manner with anyone in Washington if it means getting good done for Georgians, especially when it comes to strengthening access to affordable health care.”

Expansion is also top of mind for Georgia Democrats.

“It’s always a priority for us because of the number of Georgians who do not have health care and because of what has happened to our rural hospitals.” state Rep. Carolyn Hugley said shortly after she was elected House minority leader Thursday.

She also said she is encouraged that Republican Lt. Gov. Burt Jones is open to discussing the issue.

“I don’t know where I am on it, to be honest with you,” Jones said on the AJC’s “Politically Georgia” radio show Nov. 7.

Democratic state Rep. Michelle Au, a medical doctor, was skeptical of Jones’ guarded response.

“Burt Jones is the most closely allied with Trump,” she said, and she blamed him for thwarting progress on Medicaid expansion. “Obviously he’s going to run for governor. If he’s just saying nothing, no one can pin him either way. It’s not like we can’t read between the lines.”

Earlier this year, Georgia passed a revision of the state’s certificate of need system, which governs the establishment of new medical facilities.

Democrats hoped to tie Medicaid expansion to CON as part of that effort. They maintain that the reason many areas in Georgia have gaps in health care is not only because of bureaucratic red tape, but because many rural hospitals serve poor patients who do not have health insurance.

Those hospitals are required to provide life-sustaining care, but they don’t make any money off uninsured patients who cannot afford to pay. With Medicaid expansion, they would recover at least some of their costs, Democrats said.

Republicans, however, have been more interested in a waiver plan similar to one Arkansas has embraced where the state used federal expansion dollars to buy plans for people with lower incomes on the Health Insurance Marketplace. Proponents say this waiver plan would allow health care providers to be paid higher commercial rates.

The commission Noggle chairs is designed to sort through the options.

“Our job is to stay focused on the policy and the options and how we continue to move Georgia forward,” she said. “We’ll do that regardless of what things look like.”

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(Staff writers Mark Niesse and Ariel Hart contributed to this article.)

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