Less expensive coverage comes with more risks “The administration’s rule change is dangerous for Georgia consumers,’’ said Laura Colbert of Georgians for a Healthy Future
Blog (June 2018)
Georgians for a Healthy Future has a new resource available to help low-and middle-income consumers navigate the often confusing and opaque health care, health insurance, and social services systems. The My Health Resource Guide provides consumers with an understandable, easy-to-use tool to help them better understand the health and social services systems that impact their health and connect with needed resources.
Included in the guide are sections about health insurance, finding a health care provider, and accessing mental health and substance use treatment services. The guide also points consumers to social services that fulfill other basic needs like transportation to and from health appointments, housing and food assistance, and legal support. All of the resources referenced in the guide are provided for free or at low-cost by community-based organizations or public agencies.
GHF developed the My Health Resource Guide to be distributed to and used by consumers, but we also anticipate it will be useful to professionals who know and work with low- and middle-income Georgians. We invite enrollment assisters, community health workers, social workers, clinicians, and others to use it as a reference or to distribute it directly to clients, patients and family members.
Teresa began working as a teacher for the Headstart preschool program in 1994 but retired in 2010 because multiple health conditions made it difficult for her to work. Now her family’s only source of income is her husband’s monthly disability check, which is too high to allow him to qualify for Medicaid and too low to allow them to qualify for financial help to purchase private insurance through the Affordable Care Act. (Teresa cannot qualify for Medicaid no matter how low her income is because she does not have a disability or a child under the age of 18.) Both of them fall in Georgia’s coverage gap.
Teresa and her husband are just two of 197 of the Georgians in Clay County that are uninsured because Georgia’s decision makers have not extended health insurance coverage to low-income adults in Georgia (those making less than $16,000 annually for an individual or $20,780 for a family of three.)
Teresa struggles to manage multiple health conditions, the worst of which is a jaw condition that has caused her teeth to rot. Because Teresa has not had health coverage since 2009, she has had to find alternative, insufficient treatments for her jaw condition. She would have to pay $5000—almost four months of income—to receive the necessary medical remedies to alleviate her pain and stop the dental deterioration. If Georgia were to close the coverage gap, Teresa would be able to see her doctor on a regular basis without having to forgo appointments and services that would otherwise be too costly.
Georgia’s Governor and legislature have so far rejected the option to close the state’s coverage gap, leaving people like Teresa and her husband uninsured. Until Georgia’s policymakers extend health insurance to all low-income Georgians, Teresa, her husband, and 240,000 other Georgians will likely continue to skip health care appointments and forgo needed care because they have no pathway to coverage.
Your story is powerful! Stories help to put a human face to health care issues in Georgia. When you share your story, you help others understand the issue, its impact on Georgia, and its importance.
Your health care story is valuable because the reader may be your neighbor, friend, someone in your congregation, or your legislator. It may inspire others to share their stories or to become advocates. It is an opportunity for individuals who receive Medicaid or fall into the coverage gap, their family members, their physicians and concerned Georgia citizens to show that there are real people with real needs who will be impacted by the health policy decisions made by Congress and Georgia’s state leaders.
Share your story here!
Georgia currently ranks 51st in children’s mental health services but an infusion of dollars into Georgia’s system of care is expected to have a positive impact around the state. Governor Deal and the state legislature included an additional $21.4 million in the FY2019 state budget to improve and expand children’s behavioral health services. Of that allotment, $4.3 million are dedicated to fund 13 additional grants for the Georgia Apex Program, a school-based mental health program that improves early identification, access to and coordination of needed behavioral health (BH) services for children with behavioral health needs.
Nearly one in ten Georgia children ages 2 to 17 years have one or more diagnosed emotional, behavioral, or developmental conditions and these conditions become more prevalent as children hit adolescence. Behavioral health issues can manifest in chronic absenteeism, classroom disruption, discipline issues, or other adverse behaviors at school, which can prevent young people from being academically successful.
To address the behavioral health needs of Georgia’s students, the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) launched the Georgia Apex Program in 2015 to “[create] partnerships between community-based mental health providers and local schools to provide school-based mental health services.” The three main goals of the Apex Program are:
- To increase access to mental health services for children and youth;
- To provide early detection of child and adolescent mental health needs; and
- To increase coordination between community-based mental health providers and the local schools and districts they serve.
The Apex Program places mental health providers in schools to provide services like screening, assessment, counseling and therapy, and referrals to community support services like youth club houses. The program began with 29 community health providers in 104 Georgia schools, and as of February 2018, the program had expanded to 320 schools. Over the first two years of the program, more than 5000 students who had not previously received mental health services were screened and provided with the appropriate services and supports for their needs.
More than three quarters (76%) of the schools served by the Apex Program are located in rural areas where behavioral health services are more limited, and almost half (46.6%) are located in elementary schools so that services are available to younger students, when behavioral health conditions are often less severe and more treatable.
In addition to increasing access to care for students in need, the program has demonstrated success by integrating into a variety of school settings and improving coordination and communication between providers and school staff. Further, providers are able to bill for 75-90% of the students served each month, indicating the model may be financially sustainable.
The Georgia Apex Program is a promising model that brings mental health care services to Georgia children, reducing barriers to health care and improving their chances for academic success.
To learn more about the Georgia Apex Program:
- Visit the Georgia Department of Behavioral Health & Developmental Disabilities’ Office of Children, Young Adults and Families or email firstname.lastname@example.org
- Read the resources available at Georgia State University’s Center of Excellence for Children’s Behavioral Health at the Georgia Health Policy Center.
- Watch the video below from the Georgia Department of Behavioral Health & Developmental Disabilities and see how the Georgia Apex Program is making a difference in the lives of children and their families.
Last week, Virginia became the latest state to expand health care coverage to low-income adults when the Virginia legislature voted to close the its coverage gap and Governor Northam signed the new budget. More than 400,000 Virginians are expected to gain coverage as a result, and the state anticipates declines in uncompensated care costs for hospitals, an increase in people receiving needed health services, and greater financial security for those set to gain coverage. The vote comes after years of advocacy and engagement from constituents and advocates who worked to convey to legislators the importance of health coverage and the impact the change would have on the lives of hundreds of thousands of Virginians.
Unlike Virginians, 240,000 hard-working Georgians cannot yet look forward to putting a health insurance card in their pockets. These friends and neighbors make too little to get financial help to buy health insurance and don’t qualify for Medicaid in Georgia, leaving them stuck in the state’s coverage gap.
Georgia remains one of 17 states that is still refusing billions in federal health care dollars to provide health coverage to low-income adults in the state. As in Virginia, Georgia’s Governor and state legislature can choose to close the coverage gap at any time, and here are five reasons they should do so as soon as possible:
- Thousands of Georgians would gain health coverage–240,000 Georgians would gain the peace of mind, access to care, and financial protection that insured Georgians have. These Georgians make less than $12,140 a year or $20,780 for a family of three. Most are working in sectors like retail, child care, construction, and food service, low-paying jobs that do not come with benefits.
- Georgia’s rural hospitals are economic anchor institutions–rural communities need their hospitals to provide accessible healthcare, sustain well-paid jobs, and facilitate economic stability. Closing the coverage gap would create at least 12,000 new jobs and $1.3 billion in new activity in Georgia’s rural communities each year.
- The resulting job growth is greater than what the state would gain by attracting Amazon’s HQ2–extending health coverage to more Georgians would create 56,000 new jobs across the state, more than the 50,000 jobs that Amazon is promising at its second headquarters. Even better, the new jobs would be scattered across the state rather than concentrated in and around Atlanta.
- Georgia’s tax dollars are currently sitting unused in Washington, D.C.–By refusing to extend health insurance to low-income Georgians, the state is missing out on $8 million per day ($3 billion dollars per year). Instead of giving up hard-earned tax dollars, Georgia’s policy makers could bring that money back to the state to help low-income parents, veterans, and workers put health insurance cards in their wallets.
- It is the biggest step Georgia can take to slow the substance use crisis —One quarter (25%) of Georgians who fall in the coverage gap are estimated to have a mental illness or substance use disorder. If they were covered by health insurance, treatment and recovery services would be within reach, allowing them to resume full, healthy lives. As a result, 36,000 fewer Georgians each year would experience symptoms of depression and the state could make significant progress in addressing its ongoing substance use crisis.
After five years of delay, Virginia’s leaders made the right decision and as a result, 400,000 Virginians will see healthier futures. Now is the time for Georgia’s decision makers to follow suite by putting 240,000 insurance cards in wallets all across the state.
Virginia State Capitol Image – Skip Plitt – C’ville Photography