Care for Georgia’s Kids: Modernizing Medicaid and PeachCare
Care for Georgia’s Kids is a collaborative health care advocacy project sponsored by Voices for Georgia’s Children and Georgians for a Healthy Future with support from the Georgia Health Foundation.
More than a third of Georgia’s children access the health care system through the Medicaid or PeachCare for Kids™ programs. As such, the strength and effectiveness of these programs is of vital importance to the health of Georgia’s children.
The Department of Community Health’s Medicaid Redesign
Earlier this year the Department of Community Health (DCH) began evaluating Medicaid and PeachCare for Kids™ and assessing how other states manage these programs. The assessment aims to address three main goals through this process: 1) improve health care outcomes for members, 2) enhance the appropriate use of services by members, and 3) achieve long-term sustainable savings in services. To learn more about the strategies to achieve these goals, click here. Ensuring that these programs are strong and that they are structured to best meet the needs of vulnerable children requires the deliberate engagement of the advocacy community, particularly since these programs are frequently targeted for budget cuts.
To help ensure that DCH identifies and adopts the best possible solution, Georgians for a Healthy Future and Voices for Georgia’s Children jointly sponsored an independent study aimed at identifying best practices from other states around features of these programs such as enrollment and retention; access to providers; and achievement of quality indicators. As we look ahead to potential policy changes for Medicaid and PeachCare, our goal is to ensure that these changes rely upon best practices in coverage, access, and quality to ensure all of Georgia’s children get the health care services they need.
Care for Georgia’s Kids will seek to educate policymakers, stakeholders, and the public about the best practices we are identifying through our study and to build a consensus for the best possible solutions that work for Georgia. This website will serve as a platform for explaining these potential solutions, as a forum for discussion by interested parties, and a resource for those looking to get involved in the process.
If you want to stay informed and be part of the effort to sustain health care programs that are vital to Georgia’s children, please take a minute to let us know.
THE KELLENBERG STUDY:
Researched and prepared by Kellenberg Consulting, this study sought to identify existing programs that have improved health care outcomes, ensured access to vital services, controlled the utilization of available health care resources, and generated administrative cost savings. The report, titled “Modernizing Medicaid and PeachCare for Kids: Promising Program Design Options for Georgia’s Children”, shows us that Georgia can greatly increase the number of children covered and keep children covered while also trimming administrative costs and improving quality outcomes.
- Download Full Report
- Download Report Cover Letter to the GA Dept. of Community Health
- Download Report Recommendations In Brief
- Read the Report Press Release
As we look ahead to potential policy changes for Medicaid and PeachCare, our goal is to ensure that any changes rely upon best practices in coverage, access, and quality to ensure all of Georgia’s children get the healthcare services they need. The following recommendations address ways to increase access, coverage and quality.
1. Simplify Eligibility
Studies show that children with continuous coverage have better outcomes than those who do not. DCH can make getting and keeping coverage easier by allowing electronic verification during the enrollment process, offering express lane eligibility at application or renewal and moving to a 12-month continuous eligibility system. This will not only make it easier for families to get coverage but will also cut down the administrative burden associated with eligibility process.
2. Improve Access to Specialty Care
Getting coverage is only half the battle—making sure that coverage leads to access is critical to improving health outcomes. In many parts of the state, finding a provider that accepts Medicaid and PeachCare is sometimes difficult and even more so if a specialist is needed. DCH can adjust provider reimbursement rates for specialty care while also exploring technological advances (i.e. telemedicine) that can reach coverage gaps across the state.
3. Ensure Access to Coordinated Care
Ensuring that children have a medical home and a primary care provider can make coordinating all aspects of care (both physical and behavioral) easier. The use of electronic health records has yielded positive results in other states and would allow for better data-driven performance tracking as well as ensuring that timely and appropriate care is received.
4. Strengthen Accountability
Providers as well as care management organizations should be held accountable for performance on health measures. Increasing standards around childhood immunization and lead screening, for example, would bring Georgia in line with national standards. Additionally, adding more well-child visits for older children would signal a commitment to children’s health and ultimately lead to healthier children.
5. Use All Available Resources
There are many opportunities to improve the access, coverage and quality of healthcare for children in Georgia and to properly address them, DCH should pursue both public and private grants and make the most out of opportunities to improve the current Medicaid and PeachCare systems.
REDESIGN STRATEGY REPORT:
Navigant Consulting has concluded the assessment phase of the redesign process and released its Strategy Report to DCH. The Strategy Report includes a national and Georgia-specific environmental scan of the Medicaid and CHIP programs, as well as three delivery options for DCH to consider as it moves into the Procurement and Implementation Phases of the redesign process. These options build upon one another, with each adding features beyond the one before it:
- Georgia Families Plus
- Georgia Families Plus Transitioning to “Commercial Style” Managed Care Program – Enrolls
- Georgia Families Plus Transitioning to “Commercial Style” Managed Care Program that Requires Inclusion of Accountable Care Organizations (ACOs) and Patient-centered Medical Homes (PCMHs)
The three delivery options evaluated in the report reflect each proposed option’s ability to meet the goals and strategies as defined by DCH. For a more detailed description of these options or to read the report and appendices in their entirety, click here.
The next part of the Recommendation Phase includes an analysis and evaluation of the Strategy Report with the goal of finalizing the redesign model by April 2012. DCH is soliciting feedback on the Strategy Report either through their Feedback Tool or by submitting a brief comment or question to MyOpinion@dch.ga.gov. The deadline for submitting detailed feedback, comments or questions is February 29, 2012, at 5 p.m. (ET).
ADDITIONAL RESOURCES:
Here are links to websites that provide important information about various aspects of Medicaid and PeachCare for Kids™
- Facts about Medicaid and PeachCare for Kids™
Georgia’s Medicaid Program: http://www.georgia.gov/00/
PeachCare for Kids: http://www.georgia.gov/00/
Georgia Medicaid Facts from CMS: http://www.medicaid.gov/
Georgia Medicaid Facts from the Kaiser Family Foundation: http://www.statehealthfacts.
- Department of Community Health Website
- Request a Presentation
- Share Your Personal Story
- About Voices for Georgia’s Children
- About Georgians for a Healthy Future
