When the state of Georgia handed Deloitte Consulting a $10.7 million advertising and marketing contract final July to advertise the nation’s solely Medicaid work requirement program, the initiative was in want of great PR.

On the time, a 12 months after this system’s rollout, lower than 2% of these eligible for Georgia Pathways to Protection had enrolled, effectively in need of state targets.

To get the phrase out, the state turned once more to the agency that it had relied on to construct and handle this system. About 60% of the advertising and marketing contract went towards creating and putting advertisements about Pathways on tv and radio, together with throughout NFL video games and morning discuss reveals.

A lot of the rest of the seven-month contract would go towards two efforts: $250,000 per 30 days for Deloitte-trained groups handy out brochures and Pathways-branded merchandise at group occasions and $300,000 a month for Deloitte to supply stories about its personal efficiency.

When Deloitte’s publicity marketing campaign led to February, enrollment in Pathways remained lower than 3% of the roughly 250,000 Georgians who’re probably eligible.

The advertising and marketing contract is an element of a bigger suite of providers that Georgia has commissioned from Deloitte for its Medicaid experiment. Deloitte has made not less than $51 million as of Dec. 31 to handle Pathways, together with creating and sustaining its problematic software program platform, as The Present and ProPublica beforehand reported. It’s also incomes not less than $3 million extra to supervise the state’s relationship with federal regulators, together with its software to increase the experiment past its expiration this fall.

Deloitte’s outsize — and weird — function in selling this system it has constructed has allowed the agency to maintain pulling in funds regardless of Pathways’ struggles. And there may be nearly no public accounting of how effectively it’s rising enrollment, a key objective of the coverage experiment.

The advertising and marketing contract, obtained by a public data request, permits Deloitte to cost the state practically half 1,000,000 {dollars} for a remaining report on its publicity marketing campaign, which was as a consequence of be submitted in February. When The Present and ProPublica requested the month-to-month and remaining efficiency stories, the state mentioned they wanted to be “reviewed” first and demanded $900 for that work. The information retailers didn’t pay as a result of earlier responses to public data requests for Deloitte’s Pathways contracts had been closely redacted, with the final counsel’s workplace on the Division of Neighborhood Well being citing “confidential/commerce secret.” The company didn’t cost for these data.

The state lately permitted one other $10 million to Deloitte, Fiona Roberts, spokesperson for the Division of Neighborhood Well being, Georgia’s Medicaid company that oversees Pathways, mentioned in response to questions concerning the effectiveness of Deloitte’s advertising and marketing efforts. The brand new advertising and marketing contract, which runs till November, contains extra group conferences and a textual content message marketing campaign by Salesforce Advertising and marketing Cloud rolling out in Could to probably eligible Georgians, Roberts mentioned.

“In 20 years of researching these sorts of packages, I can’t consider one other occasion like this” by which a state has chosen a for-profit firm to each handle and market a federal profit program, mentioned Joan Alker, government director for Georgetown College’s McCourt College of Public Coverage Heart for Kids and Households, the place researchers have concluded that Medicaid work necessities stop folks from accessing medical insurance.

Deloitte has designed and managed Medicaid and different profit packages for a lot of states, together with Georgia, making the agency one of many nation’s consultants in authorities well being coverage. However Alker mentioned that when states wish to educate and enroll residents in federal security internet packages, they sometimes choose native nonprofits which have established relationships with low-income communities. Georgia’s association with Deloitte raises questions, she mentioned, about “whether or not the state is extra dedicated to spending cash on consultants or poor folks.”

Deloitte, which has been accountable for the Pathways communications technique for the previous three years, declined to reply questions on its Georgia Pathways work, referring requests for data to the Division of Neighborhood Well being. A contract signed in 2023 value roughly $7 million stipulates that Deloitte would “develop first draft of response to media inquiries” on behalf of the Division of Neighborhood Well being, however that responses “shall be submitted by DCH and never Deloitte.” Deloitte’s duties additionally embrace drafting speaking factors for media interviews, together with for the governor.

Roberts declined repeated requests for an interview with company officers. When requested about Deloitte’s advertising and marketing and outreach work and whether or not the agency has met the state’s targets, she described the trouble as a “sturdy, complete consciousness and outreach marketing campaign all through the state” that has generated 1.6 million guests to the Pathways web site for the reason that marketing campaign’s August 2024 launch.

“The state has invested closely in advertising and marketing and outreach to succeed in Georgians probably eligible for Pathways,” Roberts mentioned in a written assertion.

Gov. Brian Kemp has described Pathways as an modern different to increasing Medicaid, one thing 40 different states have executed. Against this, Georgia’s program covers solely the poorest people who can show they’re working, learning or volunteering not less than 80 hours a month. Congressional Republicans are pointing to comparable work necessities as a mannequin of their funds negotiations.

In early 2024, lower than a 12 months after Pathways’ launch, nevertheless, Georgia legislators — together with a few of Kemp’s Republican allies — thought of ending the experiment and as an alternative increasing Medicaid with none work necessities. Georgia’s uninsured charge was 11.4%, or 1.2 million folks, in comparison with the nationwide common of 8% in 2023, the most recent information out there, in response to KFF, a nonprofit targeted on nationwide well being points. State information confirmed that Pathways enrollment was effectively underneath the first-year goal of 25,000 revealed in Georgia’s settlement with the federal authorities. As of April 25, roughly 7,400 Georgians had been enrolled, in response to the Division of Neighborhood Well being.

An unbiased analysis crew commissioned by the state really helpful methods to spice up enrollment in a December 2024 report. The evaluators, Public Consulting Group, highlighted North Carolina’s technique of permitting residents from rural communities and communities of colour to assist create outreach campaigns for its expanded Medicaid program in 2023. North Carolina Medicaid officers informed The Present and ProPublica that they designed their outreach efforts to maximise participation within the new program, with a two-year goal of enrolling 600,000 folks. They achieved that objective inside one 12 months.

Georgia and Deloitte, nevertheless, took a distinct tack. The $10.7 million advertising and marketing contract doesn’t lay out particular enrollment targets as a approach of measuring the success of Deloitte’s efforts. The aim of Pathways “is just not and has by no means been to enroll as many Georgians as potential,” in response to the state’s software to the federal authorities to proceed the experiment.

The contract budgeted $247,000 to create as much as 4 testimonial movies that includes happy Pathways shoppers; just one may be discovered on the state Medicaid company’s YouTube channel, the place it has acquired roughly 350 views because it was posted in January. The state didn’t reply when requested what number of testimonials Deloitte produced.

In the meantime, one other a part of Deloitte’s advertising and marketing technique has additionally did not catch wind: Deloitte had despatched public relations groups to dozens of group occasions together with farmers markets, a faculty Christmas pageant and a catfish competition to plug Pathways and encourage functions.

In March, one such crew drove two hours from Atlanta to a well being truthful in Central Georgia’s rural Washington County. On the Pathways sales space, the Deloitte crew barely seemed up from their telephones for 3 hours. Residents largely bypassed the crew to speak with locals staffing different kiosks the place they may obtain diapers, data on sponsored in-home nursing care and blood strain screenings. Of those that stopped on the Pathways sales space, solely a handful requested about enrollment.

Different public occasions had been tied to the state’s pursuit of federal permission to increase the Pathways program past September, when its unique five-year mandate expires. Georgia is as soon as once more paying Deloitte to make sure that occurs.

The monthslong course of, managed by Deloitte, requires alternatives for public remark. A abstract of those feedback should be submitted with the applying, which Deloitte is drafting. Well being advocacy organizations say public outreach for this effort, particularly to Black Georgians, has been superficial at finest.

The one discover for 2 digital public conferences appeared on a Division of Neighborhood Well being internet web page that was not linked from the company’s homepage. Throughout each digital occasions, well being care advocates criticized this system’s inequitable entry, however state officers didn’t interact with the audio system.

A 3rd occasion — an in-person assembly within the rural 10,000-person city of Cordele — was added later and posted on the identical web site only one week earlier than it was scheduled to happen. Solely a few dozen folks, some touring for greater than 80 miles, confirmed as much as the midday assembly on St. Patrick’s Day.

The low attendance mirrored the assembly’s out-of-the-way location and vacation timing, not an absence of public curiosity, mentioned attendee Sherrell Byrd, government director of Sowega Rising, a group advocacy group primarily based within the majority Black city of Albany.

Contained in the one-story cinder block constructing, three state well being officers sat alongside a desk on the entrance of the largely vacant room. One after the other, attendees rose to the microphone to complain of technical glitches within the Pathways enrollment course of, the shortage of customer support and the generational well being care inequalities confronted by Black Georgians.

Tanisha Corporal, who lives roughly 140 miles away in Atlanta, was the one individual to take part nearly. She informed the Division of Neighborhood Well being officers that she had submitted a Pathways software thrice over the Deloitte-built digital portal solely to have her file disappear. The licensed scientific social employee whose nonprofit job led to January 2024 mentioned state businesses provided her little enrollment assist.

The state well being officers didn’t reply to any of the audio system in the course of the assembly. Grant Thomas, Kemp’s former well being coverage advisor and deputy director of the state Medicaid company, sat at the back of the room and didn’t work together with the attendees. Thomas declined to talk on the file.

“There’s a whole lot of disdain for real-life issues of Georgians who appear to be us,” Byrd mentioned.