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
Georgians for a Healthy Future hosted an educational forum titled Strong Foundations: Building a System of Care to Address the Behavioral Health Needs of Georgia Children on Tuesday, May 15. The forum explored the behavioral health needs of Georgia children and youth, Georgia’s publicly-supported behavioral health landscape, and successes and opportunities in the current system of care. The event also raised awareness about Georgia’s system of care in an effort to improve access to behavioral health services for children and youth.
The event began with Respect Institute speaker Tammie Harrison, who shared her experiences navigating the behavioral health care system and getting to a place of recovery.
Because many of the event attendees were new to the topic of children’s behavioral health (BH), GHF’s Executive Director Laura Colbert provided some foundational information about the prevalence of children’s BH conditions, contributors to poor BH, and the pathways to BH care and supports for young Georgians. You can find Laura’s PowerPoint slides here. She also debuted GHF’s new behavioral health fact sheet.
Dante McKay, Director of the Office of Children, Young Adults, & Families at the Georgia Department of Behavioral Health & Developmental Disabilities (DBHDD) provided attendees with an overview of DBHDD’s work, the 2017 System of Care state plan, and how the recently signed FY19 budget would impact the department’s ability to serve Georgia children and youth.
Dr. Erica Fener-Sitkoff, Executive Director of Voices for Georgia’s Children moderated a panel discussion of BH service providers, which included Wendy Farmer of Behavioral Health Link, Laura Lucas of Project LAUNCH (DBHDD), and Monica McGannon of CHRIS 180. The panelists discussed barriers to accessing BH services, which they said include continued stigma, lack of trained workforce, and transportation. The panel also identified innovative efforts, like Project LAUNCH and mobile crisis services, to bring BH services closer to consumers when and where they need it. When asked how Georgia’s next Governor could continue to make progress in the area of children’s behavioral health, panelists suggested a focus on workforce development, increasing access to community-based substance use treatment for teens, and prevention and early intervention.
If you missed the event, a recording of the webcast is available here.
To see photos, review materials, and read more about our Strong Foundations event, please visit the event page.
Valerie is a mother of three children living in Lamar County. Medicaid covers all three of Valerie’s children, and they rely on the health coverage it provides for their varying health needs. Valerie sometimes has difficulty accessing the care and information the family needs because they live in a rural area, but acknowledges that Medicaid is a lifeline that makes it possible for her to focus on her family’s other needs. Without health insurance through Medicaid, Valerie would have to pay hefty medical bills to ensure her children receive the care they require.
Susie is the sole caretaker of her young granddaughter, but she has a hard time caring for herself because she is stuck in Georgia’s coverage gap. She makes more than $6300 annually, so she doesn’t qualify for Medicaid coverage as a caregiver, and she doesn’t make enough to receive financial help to buy health insurance through the Marketplace. Susie is currently undergoing treatment for cancer but because she lacks health coverage, Susie is only able to receive cancer treatments from a doctor that allows her to make low monthly payments. Susie has other chronic health issues that need to be managed but finds it difficult to receive consistent care without insurance. Because Georgia’s elected officials have not extended Medicaid to cover caregivers like Susie, she struggles to care for herself while working to ensure her young granddaughter receives the care and support she needs to grow up healthy and thrive.
Medicaid provides access to needed health care services for low-income soon-to-be-moms, new mothers, and very low-income parents of minor children. For moms like Valerie, Medicaid makes being a mom a little easier by ensuring that their children have access to the health care services they need to grow and stay healthy. For others, Medicaid would help them get or stay healthy so they can best fulfill the responsibilities of being a mothers or caregivers. Over 150,000 uninsured women like Susie would gain health insurance if Georgia’s decision makers extended Medicaid to cover low-income adults (those making less than $16,000 annually for an individual or $20,780 for a family of three).
Despite several missed opportunities to address consumer health concerns during this year’s state legislative session, the FY2019 budget includes several impactful investments. Last week, Governor Nathan Deal traveled through Georgia and held budget signing ceremonies in Atlanta, Acworth, Blue Ridge, Statesboro, and Tifton for the $26 billion spending plan which will begin on July 1 of this year through June 30, 2019. The infusion of dollars into children’s mental health is especially noteworthy and exciting because of the impact it is expected to have across the state.
Governor Deal has recently made children’s behavioral health one of his top health care priorities and this year included in his proposed budget $20.6 million to fund recommendations from the Governor’s Commission on Children’s Mental Health. During its consideration of the state budget, he legislature ultimately increased the funding dedicated to these recommendations to $21.4 million.
These funded recommendations include behavioral health crisis services, supported employment and education for young adults with behavioral health needs, provider training and telehealth, and opioid abuse prevention for youth. Funding for suicide prevention will in part go towards expanding the capacity of GCAL, the Georgia Crisis and Access Line, which provides 24/7 online and telephone support for people who are seeking services for developmental disabilities, mental health, or substance use issues. Some of the additional funding is also dedicated to 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 BH needs..
In the coming months, we will break down the Commission’s funded priorities and their impact on young Georgians. Look for our Healthy Minds, Healthy Bodies blog mini-series.
Looking for more information on this topic? Georgians for a Healthy Future will be hosting an educational forum later this month during which we will explore the behavioral health needs of Georgia children and youth, Georgia’s publicly-supported behavioral health landscape, and successes and opportunities in the current system of care. Join us in person or via webcast for this exciting and important event!
Travis suffered from a series of strokes when he was 11 years old that left him with several physical disabilities. He is one of the approximately 250,000 Georgians with disabilities to be covered by Medicaid.
Several years ago, Travis started volunteering with DisabilityLINK because he believes in the power of community and he likes being able to help others. Since then, he was hired as a Independent Living Specialist at the organization, where he connects people with disabilities to community-based resources and assists in coordinating various events at the DisabilityLINK office. He also works alongside other activists on issues such as housing, accessibility and self advocacy.
Travis recognizes that Medicaid is the reason he is able to financially support himself and work for an advocacy organization. Without the support Medicaid provides, Travis explains, he would not be able to help others the way he has been able to through his work at DisabilityLINK. When asked what he wanted others to know about him being able to receive affordable health insurance he replied, “With me working I am able to be a tax paying citizen.”
Medicaid is essential to ensuring that people with disabilities, like Travis, are able to lead fulfilling, independent lives as active participants in their communities. Georgia’s Medicaid program provides almost 2 million low-income children, people with disabilities, seniors, pregnant women, and very low-income parents with access to the health care services that they wouldn’t have otherwise.
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!
Georgians for a Healthy future partnered with Step Up Savannah to host a health advocacy training on Tuesday, April 3rd. Advocates learned how they could participate and lead health advocacy efforts in their own community and received information about pressing health advocacy issues in Georgia. Representatives from Healthy Savannah and the Chatham County Safety Net Planning Council were also in attendance to share local resources.
The significance of Medicaid was highlighted throughout the event. Participants learned that Medicaid primarily covers low-income children, people with disabilities, seniors, and pregnant women, including 40,000 of Chatham County residents. Alyssa Green, GHF’s Outreach & Education Manager, discussed Georgia’s opportunity close the coverage gap so that 240,000 more Georgians would have access to health insurance coverage. Alyssa shared the story of a Georgia woman who works part-time at DisabilityLINK but is stuck in the coverage gap and, as a result, has trouble managing her high blood pressure.
GHF’s Executive Director Laura Colbert introduced ways that people can advocate for the health care issues that matter most to them, like increased access to healthcare, bringing down health care costs, and protecting the Medicaid program. She explained how to build a relationship with legislator, communicate support or opposition for significant bills, and other forms of advocacy.
The training concluded with presentations from the Chatham County Safety Net Planning Council and Healthy Savannah. The two Savannah-based organizations provided participants with information and resources to promote and build a healthy local community.
If you are interested in hosting a training like this in your community, please contact Alyssa Green at email@example.com or 404-567-5016 x 2 for more information.
Every day four Georgians die from opioid overdose and recent data from the Centers for Disease Control and Prevention confirm that the epidemic shows no signs of slowing. Health care providers, public health professionals, community leaders, and families are all searching for effective strategies to slow and stop this growing public health crisis. Some initial steps have been taken by Georgia policy makers and others to increase access to life-saving drugs like naloxone, improve and expand the prescription drug monitoring program (PDMP) to prevent over-prescribing, and raise public awareness about the risks of opioids and other substances, but more is needed. Solutions must include evidence-based strategies that emphasize prevention and early intervention, as well as timely treatment and support for recovery.
An exciting development within Georgia’s Medicaid program gives health care providers an additional tool to aid in the fight against substance use disorders, especially among adolescents and young adults. Georgia’s Medicaid agency has activated the reimbursement codes for a tool called SBIRT, which stands for Screening, Brief Intervention and Referral to Treatment. SBIRT is a set of tools that identifies people who use alcohol or other drugs at harmful levels and guides follow-up counseling and referral to treatment before serious long-term consequences occur.
Ninety percent of adults who meet the medical criteria for addiction started smoking, drinking, or using other drugs before they were 18 years old. Because Medicaid and PeachCare for Kids cover half of all Georgia children, the activation of the Medicaid reimbursement codes for SBIRT is a powerful opportunity to identify youth substance use and intervene early. Studies show that simply asking young people about drugs and alcohol use can lead to positive behavior changes and that brief interventions reduce the frequency and amount of alcohol or other drug use by adolescents.
This policy change was the product of a sustained advocacy effort by Georgians for a Healthy Future (GHF) and the Georgia Council on Substance Abuse (GCSA). We anticipate it will lead to the screening of an estimated 145,000 Georgia youth annually and that 36,000 of those youth will present substance use behaviors that prompt a brief intervention with a health care provider. Initial data from Georgia’s Medicaid agency demonstrates that some providers are already making use of the SBIRT codes in their practices.
Notwithstanding these exciting results, we have committed to continue our efforts to improve access to screening, early intervention, and recovery services and supports for young people across Georgia. While the Medicaid reimbursement codes allow physicians, physician extenders, and advanced practice registered nurses to provide SBIRT services, we recognize that RNs, LPNs, licensed clinical social workers, and certified peer counselors can and should be able to provide SBIRT to youth and adults. Further, the codes allow SBIRT to be provided primarily in health care settings, but that excludes schools and other community-based settings where most young people spend their time.
We invite you to join our efforts to prevent substance use among young Georgians. Spread the word by giving our new fact sheet to the providers in your clinic, public health department, or hospital. If you are a health care provider, attend a training to develop the skills to implement SBIRT with the people that you care for. Join our on-going advocacy efforts to activate the reimbursement codes for more practitioner levels (including RNs and LPNs) and more settings by contacting us to let us know you are interested.
The opioid and substance use crisis that is sweeping Georgia and impacting communities nationwide will require a full spectrum of solutions that leverage the expertise of health care providers, public and private resources, and community and family supports. SBIRT is an evidence-based tool that can play a significant role in our collective efforts to reduce substance use and create a healthier Georgia for all of us.
To learn more, visit our Keeping Youth on a Healthy Path page.
For health care providers: download our new fact sheet here.
Appropriations Health Subcommittee heard bill to close the coverage gap
Last Tuesday, the House Appropriations Health Subcommittee met for a hearing about HB 669, a bill that would close Georgia’s coverage gap by extending health insurance to low-income Georgians as allowed by the Affordable Care Act. Minority Leader Bob Trammell presented the bill to the committee and outlined how it would bolster economic activity in rural Georgia, increase access to care for low-income Georgians, and be a smart investment of tax-payer dollars. Committee members asked questions about the bill’s impact on people with mental health conditions and the costs and savings of the bill, and all expressed a desire to find a common solution to Georgia’s high uninsured rate and barriers to health care. No vote was taken on HB 669, so the bill remains in the House Appropriations Health subcommittee.
For a more detailed account of the hearing and to encourage the committee members to continue the conversation, check our latest blog post by clicking here.
Surprise billing: where the bills stand and prospects for passage
Surprise billing legislation received a significant amount of attention from legislators early in this session. Several of these bills aligned with GHF’s policy priority of facilitating greater access to care and ensuring financial protections for consumers purchasing private insurance. HB 314 (formerly SB 359) is expected to be amended and get a vote today in the House. The legislation would prevent consumers from receiving balance bills when they unexpectedly receive care from providers that are not in their insurance plan networks during emergencies. Surprise out-of-network medical bills can be hundreds of thousands of dollars and it’t time to legislation in Georgia that protects consumers.
Call your State Representative today and urge them to vote “YES” on House Bill 314 because this legislation protects patients from surprise bills in emergency situations.
Education legislation impacting behavioral health needs of young students passed by the Senate
HB 740, which requires schools to provide a multi-tiered system of supports for a student in pre-school through third grade prior to expelling or suspending the student for five or more days was passed by the Senate last week. The bill must now return to the House for agreement before being sent to the Governor for his signature. The legislation provides increased opportunities for schools to screen students for a variety of academic and behavioral health needs, and connect them to the appropriate health and other services.
Rural health bill and Health Coordination & Innovation Council bill moving forward
The House agreed to Senate changes to HB 769, the rural health care bill, which allows the bill to move to the Governor’s desk for approval. The complementary bill, SB 357, creating the new Health Coordination & Innovation Council, passed the Senate and House and must now return to the Senate for agreement. Both bills included negotiated changes to better coordinate the two bills’ likely impacts.
Stay up to date on the status of bills these last few days of session and check out our full list of health care related legislation at GHF’s legislative tracker.
Changes in Health Care and Policy in the 2018 Georgia Legislative Session
Georgians for a Healthy Future and the Georgia Budget and Policy Institute will be presenting “Changes in Health Care and Policy in the 2018 Legislative Session” on Thursday, April 19th at 10:00 AM. Make sure to join GBPI and GHF to hear an overview of the bills, resolutions, and budgets that were passed and that will affect Georgia’s health care system and health care consumers. Tune in to this webinar to find out how this session’s legislation may affect your work, your health care, or your coverage.
Yesterday morning the House Appropriations Health Subcommittee met for a hearing about HB 669, a bill that would close Georgia’s coverage gap by extending health insurance to Georgians making less than $16,000 for an individual and $22,000 for a family of three (138% of the federal poverty line). Minority Leader Bob Trammell presented the bill to the committee and outlined the three goals of the legislation:
- To bolster economic activity across Georgia, especially in rural communities
- To move beyond a patchwork approach to health care by putting insurance cards in the wallets of more Georgians
- To better leverage state dollars that are currently going to the federal government rather than providing coverage for hard-working Georgians.
Leader Trammell pointed out that the General Assembly consistently aims to run Georgia like a business by investing dollars smartly and efficiently. However, by refusing to extend health insurance to low-income Georgians, the state is missing out on $8 million per day ($3 billions dollars per year) that could be used to help treat and care for Georgians. Leader Trammell added that other states that have closed their coverage gap have seen drops in uncompensated care costs as large as 60%. Further benefits included support for rural economies by preventing future hospital closures and better treatment for those with substance use disorders.
Some members of the subcommittee expressed their support for closing the coverage gap, while others had questions about the costs of extending coverage to low-income Georgians. As GHF has previously reported, Georgia can afford the estimated annual costs and the investment would draw down $9 federal dollars for every $1 dollar spent by the state for expanded coverage. Representative Stephens brought up the possibility of raising the tobacco tax to raise additional revenue for Georgia’s health care needs. All members of the committee recognized the need to increase access to care for all Georgians and the need for bipartisanship in finding a Georgia-specific way to resolve the issue.
No vote was taken on HB 669, so the bill remains in the House Appropriations Health subcommittee.
We are grateful to the committee for considering Georgia’s opportunity to put an insurance card in the pockets of low-income Georgians and support continued conversation on the issue. You can help by thanking the members of the committee and asking them to ensure the conversation continues to move forward towards a solution. Send an email now!
Rep. Butch Parrish – Chairman
Rep. Lee Hawkins – Vice Chair
Rep. Pat Gardner
Rep. Carolyn Hugley
Rep. Ron Stephens
Rep. Darlene Taylor
Health care bills re-appropriated for new purposes
Each year, as the end of the legislative session comes into view, legislators work to ensure that priority legislation can be successfully passed before the Sine Die deadline. Sine Die is the day that legislative session ends and is scheduled for March 29th this year. This often results in major changes to legislative language or the combination of related bills. These changes are evident in several notable health care bills, which we have detailed here.
- This week, the Senate HHS committee heard HB 161, which effectively decriminalizes needle exchange programs in Georgia. The bill passed out of committee but with major additions. The additions are largely taken from SB 352 which, among other things, establishes a Commission on Substance Abuse & Recovery headed by a Director (for a more detailed review of SB 352, read our previous coverage here). The bill now awaits approval by the Senate Rules Committee in order to receive a vote on the Senate floor.
- The House HHS committee this week voted to pass SB 325 which, in its original form, would have allowed Georgia to enter into the Interstate Medical Licensure Compact. However, all of the bill’s original language was removed and substituted with new legislative language that, among other provisions, limits step therapy and sets up a process for physicians to request exceptions (previously HB 519). Step therapy is a requirement by some insurers that patients try a series of lower-cost treatments before the insurer will cover the treatment prescribed by a patient’s physician. SB 325 will now go to the House Rules committee to be approved for a vote by the full House.
Health Care Bills Favored By Legislative Leadership Passed
Rural health bill and Health Coordination & Innovation Council bill passed by respective chambers
Two bills named as priorities by legislative leaders passed their respective chambers this week. The rural health care bill, HB 769, passed the Senate and SB 357, legislation creating the new Health Coordination & Innovation Council, passed the House. Both bills included negotiated changes to better coordinate the two bills’ likely impacts. Because the bills passed with changes, they will each need to return to their chamber of origin for an “Agree” vote before they are eligible for the Governor’s signature.
Legislation Impacting Social Determinants of Health
Legislation concerning suspension of young students passed by Senate committee
HB 740, which requires schools to provide a multi-tiered system of supports for a student in pre-school through third grade prior to expelling or suspending the student for five or more days, was passed by the Senate Education & Youth Committee on Thursday. The legislation provides increased opportunities for schools to screen students for a variety of academic and behavioral health needs, and connect them to the appropriate health and other services. The bill will now need approval by the Senate Rules Committee to reach the floor for a vote by the full Senate.
Legislation to promote healthy housing fails; Resolution proposing study committee introduced
Housing, one of the most recognized social determinants of health, can influence a person’s physical and mental health, and access to economic opportunity and necessary social and health services. Earlier this session, Representative Scott Hilton introduced HB 954, which would have prohibited landlords from retaliating against tenants who complain about unhealthy or unsafe rental housing but the bill never received a hearing in the House Judiciary Committee. In order to lay the groundwork on this issue for future legislative sessions, Representative Sharon Cooper has sponsored HR 1431 establishing a study committee on healthy housing, which if passed would evaluate the scope of unhealthy housing problems in the state, its impact on Georgia families and the costs of unhealthy housing to the state and local communities, and would identify promising initiatives and policies in other states that address unhealthy housing.