ATLANTA (AP) — Georgia will become the first state to offer federally subsidized health insurance to its residents only through private brokers under a plan being approved by President Donald Trump's administration.

A separate part of the plan would offer Medicaid to some of the state's poorest able-bodied adults, but only on the condition that they work, volunteer, receive job training or attend school.

“This opportunity will help hardworking Georgians climb the ladder, while having a health care safety net below them. We are making insurance accessible for those who need the most," Republican Gov. Brian Kemp said in an announcement Thursday at the state Capitol.

Opponents have attacked the plan’s failure to fully expand Medicaid, say work requirements will be a bureaucratic nightmare for recipients and warn that letting private companies control Georgia's insurance marketplace could decrease enrollment because people are used to shopping at Healthcare.gov.

“I would dispute the characterization that this is a step forward,” said Laura Colbert, executive director at Georgians for a Healthy Future, a lobbying group that seeks better health care access. “I think that Georgia can do much better, and can do it more cost effectively.”

Centers for Medicaid and Medicare Services Administrator Seema Verma approved one waiver from normal federal law on Thursday on behalf of Trump's administration. Verma says a second waiver will be approved in coming days.

“Georgia is going a step further and moving away from a government-run system and is instead leveraging the private sector and competition to enroll people in coverage, and we applaud this innovative, market-driven approach,” Verma said.

Under Kemp’s proposal, uninsured adults in Georgia who make no more than the federal poverty level would qualify for Medicaid assistance if they spent at least 80 hours a month working, volunteering, training or studying. They would also have to pay monthly premiums. The federal poverty level is just under $12,500 for an individual.

While 500,00 Georgians could benefit from full Medicaid expansion, projections show about 50,000 could be covered under Kemp's plan in the first year, with the governor saying the number would grow to 270,000 over five years. Work requirements in other states have been approved by the Trump administration but tied up in court challenges.

“They do not support the goals of the Medicaid program and therefore, federal courts have found them unlawful,” Colbert said.

She said the private broker plan could also face a court challenge if it decreases overall enrollment, because that would violate the Affordable Care Act.

Medicaid expansion, as originally envisioned under President Barack Obama’s federal health overhaul, planned for Georgia to offer state-federal Medicaid coverage to all able-bodied adults making up to 133% of the federal poverty level. People with incomes above the poverty line qualify for subsidies on the private insurance marketplace, but Medicaid may offer lower premiums and deductibles.

The federal government would pay for 67% of Georgia's narrower program, the same share that it subsidizes other Medicaid benefits, not the 90% that 38 other states normally get under full Medicaid expansion.

Georgia will also spend state money on a reinsurance program beginning in 2022 that would allow companies to lower monthly premiums for all customers. Twelve other states have reinsurance programs, according to the Kaiser Family Foundation.

Georgia officials say their proposals respond to a bleak health care environment. Average premiums for some ACA health plans in the state have increased by more than 40% over the past two years to nearly $7,500 a year, according to the governor’s office. Enrollment in ACA plans in Georgia has declined by 22% since 2016 and now stands at nearly 460,000.

Exiting the federal marketplace and not setting up a state marketplace is the main innovation Georgia is offering. Kemp's administration says private brokers or websites will provide better service and offer more options. Georgia says it won't subsidize plans that don't meet federal benefit levels. But brokers could sell noncompliant plans to customers in search of cheaper premiums.

Kemp says the plan will cost the state $218 million yearly, with all elements phased in by 2023. More than half the cost could come due in the budget beginning next July.

The governor again dismissed full Medicaid expansion as too expensive, saying it would cost $547 million yearly. A 2019 projection by the state auditor found it would costs $213 million and cover 598,000 people in 2022.

The announcement comes as people are already voting in General Assembly races for the Nov. 3 election. Democrats, aiming to gain seats in the state House and Senate, have made full Medicaid expansion a central issue.

“Their plan is disastrous for Georgians’ health care and that’s why we must vote them out,” state Democratic Party chair Nikema Williams said.

Two Democratic lawmakers attended Kemp’s announcement, including state Rep. Patty Bentley of Butler.

“I would love to have full Medicaid expansion, but this is what we have right now,” Bentley said, saying she was in favor of anything that would increase access.

___

Follow Jeff Amy on Twitter at http://twitter.com/jeffamy.