ATLANTA (AP) — Georgia Gov. Brian Kemp Monday defended and doubled down on his signature Medicaid program — the only one in the nation with a work requirement — further dimming chances the state could adopt a broader expansion of the taxpayer-funded low-income health plan without a work mandate any time soon.

Georgia Pathways requires all recipients to show that they performed at least 80 hours of work, volunteer activity, schooling or vocational rehabilitation in a month to qualify. It launched in July 2023, but has so far signed up a tiny fraction of eligible state residents.

Kemp touted the program Monday during a panel discussion that included Georgia Department of Community Health Commissioner Russel Carlson and Insurance and Safety Fire Commissioner John King. The governor’s office also played a video testimonial from a Pathways recipient, Luke Seaborn, 53, who praised the program and later told The Associated Press in a phone interview that it had helped him pay for an injection for nerve pain.

“Being first is not always easy,” Kemp said. But he added, “We’re going to keep chopping and keep getting people signed up.”

Pathways had just over 4,300 members as of early June, well below the minimum of 25,000 members state officials expected in the program’s first year.

The Kemp administration has blamed the Biden administration for the slow start. Pathways was supposed to launch in 2021, but the Biden administration objected to the work requirement that February and later revoked it. Georgia sued and a federal judge reinstated the work mandate in 2022.

Carlson said the delay hampered efforts to get Pathways going, including educating stakeholders and potential beneficiaries. It also meant the launch coincided with a burdensome review of Medicaid eligibility required by the federal government, he said.

The Biden administration has said it did not stop Georgia officials from implementing other aspects of Pathways when it revoked the work requirement. State officials had also set lofty enrollment expectations for Pathways despite the Medicaid eligibility review.

Carlson said the state has launched a major campaign to promote Pathways that includes radio and television ads. It is also conducting outreach on college campuses.

“We feel like Georgia Pathways for the first time will be granted open seas, if you will,” he said.

Critics of Pathways have said the state could provide health coverage to about 500,000 low-income people if, like 40 other states, it adopted a full Medicaid expansion with no work requirement.

That broader Medicaid expansion was a key part of President Barack Obama’s health care overhaul in 2010. In exchange for offering Medicaid to nearly all adults with incomes up to 138% of the federal poverty level, states would get more federal funding for the new enrollees. Pathways limits coverage to people making up to 100% of the federal poverty level.

Kemp has rejected full expansion, arguing that the state’s long-term costs would be too high. His administration has also promoted Pathways as a way to transition people off government assistance and onto private insurance.

The governor said Monday improvements to Georgia’s health care marketplace have helped hundreds of thousands of former Medicaid recipients in the state sign up for health care coverage under the Affordable Care Act.

A program the state implemented with federal approval has reduced premiums and increased competition in the marketplace, the governor said. The Biden administration has also significantly boosted health insurance subsidies under the ACA, though Kemp, a Republican, did not mention that change in his remarks Monday.