That’s a problem, said Laura Colbert, the director of the patient advocacy group Georgians for a Healthy Future. “Middle-income consumers with pre-existing conditions who want to remain in the marketplace…
Blog (May 2013)
CARE-M is a coalition of organizations who advocate on behalf of vulnerable populations, patients, and health care consumers in Georgia (Georgians for a Healthy Future is a member of the coalition). The coalition was formed shortly after the Georgia Department of Community Health (DCH) announced plans to explore redesigning Georgia’s Medicaid and PeachCare for Kids (CHIP) programs to ensure that the voices of these patients and consumers were heard in the process. Many CARE-M partners have been appointed to and serve on task forces and work groups convened by DCH to gain stakeholder input.
In May 2013, CARE-M released an updated version of its principles and concerns around Medicaid redesign, described below (you may also download this document in pdf format here).
CARE-M Principles and Concerns: Updated May 2013
CARE-M Principle: Improved healthcare outcomes for members should be the primary goal that drives changes to Medicaid. Improvement in the Medicaid system of services and supports will result in improved healthcare outcomes for the members.
Background — DCH’s Expressed Goals
o Enhance appropriate use of services by members
o Achieve long term sustainable savings in services
o Improve health care outcomes for members
CARE-M – Cross-cutting Concerns:
Concern 1: State Oversight and Accountability: Regardless of the details of any change or redesign, DCH must build and maintain adequate staff capacity and expertise at the state level to implement the plan, oversee operations, and diligently enforce contract requirements.
Concern 2: Medicaid Vehicle: As of Spring 2013 plans include using an 1115 waiver for foster children but a decision has not been made about whether or not an 1115 or a 1932(a) will be used for the Aged, Blind and Disabled populations. It is important that this decision be made soon and be communicated to stakeholders immediately. Regardless of the vehicle chosen it is critical to maintain the elements of care management that are working now and to consistently implement best practices.
Concern 3: Stakeholder Participation: Each population included in managed care must be fully engaged in designing, implementing, and monitoring the outcomes and effectiveness of the managed care program and be empowered to bring issues occurring in care delivery forward to the attention of the managed care entities and the Department of Community Health. This involvement should not end with the awarding of contracts, but should continue with providing feedback on system performance and recommendations for plan improvement. In order to perform this role effectively, stakeholders need access to performance data and progress on established benchmarks. After integration has been implemented, consumer involvement should extend into ongoing monitoring through representation in standing advisory groups at both a state and local plan level.
Concern 4: Definition of Medical Necessity: The definition of medical necessity for persons under age 21 is statutory and requires that determinations be based on the needs of the individual child. Medical necessity standards for persons age 21 and over should be modified to include those home and community-based services that are necessary to support individuals in a stable way in their homes, whether in the community or in a long-term care facility, despite having been excluded under a prior narrowly construed definition of medical necessity.
Concern 5: Appeals and Independent Problem Resolution: Stakeholders must be certain that any managed care system implemented in Georgia includes an easily navigable appeal system that ensures full Medicaid rights. The managed care system must include an independent ombudsman who has expertise in the delivery of Medicare and Medicaid benefits to seniors and persons with disabilities, including Long-Term Services and Supports and Behavioral Health services. This ombudsman will assist beneficiaries with appeals and will identify systemic problems in the CMO and be able to bring those concerns to the agency authority.
For more information about CARE-M, click here.
Thank you to the dozens of community groups, nonprofit organizations, and health care stakeholders who responded to our survey about your plans to conduct consumer outreach and facilitate enrollment into the new health insurance options that will become available to many uninsured and underinsured Georgians later this year through the new health insurance exchange, or marketplace. Georgians for a Healthy Future will compile the results and share them as part of a resource document later this summer. In the meantime, here are two new resources that may be useful for you.
- Families USA, a national consumer health advocacy organization, has developed an online resource center for navigators and others working on outreach and enrollment. You can visit the resource center here.
- Consumers Union, the policy and action division of Consumer Reports, has developed a consumer-tested brochure to help consumers understand the new health insurance tax credits. The brochure is available here.
You can also find links and resources regarding health insurance navigators on the Georgians for a Healthy Future website here.
It’s time for our state policymakers to catch up to their constituents. A new public opinion survey out today from the Joint Center for Political and Economic Studies finds strong support within Georgia and across the Deep South for covering the uninsured through an expansion of Medicaid. Sixty-one percent of Georgians support expanding Medicaid, including forty-seven percent of self-identified conservatives. In addition, fifty-five percent of Georgia respondents said that the Medicaid program is important because they like knowing that it exists as a safety net to protect low-income people who can’t afford needed care. Four in ten said it was important because they or someone they know may need to rely on Medicaid benefits in the future. Georgians care about the health of their families and communities and want our policymakers to do the right thing. Please sign the Cover Georgia petition or distribute postcards throughout your network to ensure this majority support for Medicaid is heard.
The Georgians for a Healthy Future board of directors invites you to join us for an evening of camaraderie, conversation, and celebration as we gear up for the next big phase of health reform implementation: connecting hundreds of thousands of uninsured Georgians to coverage. Since our founding in 2008, Georgians for a Healthy Future has worked with all of you to provide a strong voice for Georgia’s health care consumers in the policy decisions that impact their lives. Please save the date for a reception and fundraiser on the evening of June 27th to celebrate our successes and prepare for the challenges ahead. Thanks to national health reform, consumers have more options than they have ever had before. But covering Georgia’s uninsured will take all of us, working in concert, to move our state forward. We need all hands on deck! Please join us for an entertaining evening of celebration and conversation about our collective strength and how Georgians for a Healthy Future will continue to work on behalf of all Georgians to help navigate the rough waters ahead.
Thursday, June 27th from 6:00 to 8:00pm
Nelson Mullins Riley & Scarborough
201 17th Street NW, Atlanta, GA 30363
Tickets are $60.
Host Committee Levels:
Cadet ~ $250
First Mate ~ $500
Captain ~ $1000+
To join the host committee, email Cindy Zeldin
To register, click here.