Healthy Minds, Healthy Bodies: Getting to know the Georgia Apex Program

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:

  1. To increase access to mental health services for children and youth;
  2. To provide early detection of child and adolescent mental health needs; and
  3. 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 georgia.apex@dbhdd.ga.gov
  • 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.

 


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Sine Die

Thats a wrap for the 2018 Georgia legislative session!

The Georgia General Assembly completed the 2018 legislative session in the early morning hours on Friday. A flurry of significant bills passed in the final days of the session. We are disappointed that agreement could not be reached to protect consumers from surprise out of network medical bills, but are heartened that other legislation passed to improve access to health care for consumers across the state. Check out our summary of the more notable bills below and find a full list of health care related legislation at GHF’s legislative tracker.

 


Everything you need to know about the 2018 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 GHF and GBPI to hear an overview about the bills, resolutions, and budgets that were passed and that will affect Georgia’s health care system and consumers. Tune in to this webinar to find out how this session’s legislation may affect your work, your health care, or your coverage.


 

WHAT HAPPENED LAST WEEK
HB 683: Amended FY2018 Budget | PASSED

HB 683 makes adjustments to the state budget for the current fiscal year which runs through June 30, 2018. The FY2018 supplementary budget (also called the “little budget”), makes necessary, mid-year adjustments to the current state budget. Governor Deal signed signed the $25.4 billion amended budget on March 9, 2018 at a ceremony in Polk County. The budget included $1.2 million for hospitals to offset costs due to the high number of flu cases.


HB 684: FY2019 Budget | PASSED 

HB 684 is the budget document for the coming state fiscal year which will run from July 1, 2018 to June 30, 2019. The budget, which totals $26.2 billion, includes several new investments in children’s mental health per the recommendations of the Governor’s Commission on Children’s Mental Health, and fully funds and the Maternal Mortality Review Committee’s (MMRC) recommendations at $2 million. For more information on the health care highlights in the proposed FY2019 budget, read the Community Health and Behavioral Health budget overviews from the Georgia Budget & Policy Institute.


HB 314: Surprise billing legislation | DID NOT PASS

Legislators failed to reach an agreement about how to best resolve the problem of surprise out of network billing for Georgia consumers. HB 314 (formerly SB 359) would have prevented 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 are more common when insurance plan provider networks are very narrow and restrictive. Georgia’s provider networks are the narrowest in the nation.


SB 357: Legislation to establish Health Coordination and Innovation Council | PASSED

SB 357 establishes the Health Coordination and Innovation Council and an advisory board to the Council. The Council will act as a statewide coordinating platform, bringing together all of health care’s major stakeholders. It’s members will include the Commissioners of several state agencies as well as a primary care physician, a pharmacist, a dentist, and representatives from the academic community, but there are no specifications about who will serve on the Council’s advisory body. The legislation sunsets in 2022 and will have to be reauthorized in order to operate past July 1st of that year.


HB 769: Recommendations from the Rural House Development | PASSED

HB 769 is the result of the 2017 House Rural Development Council’s work. The bill included a number of provisions, most prominently of which was the creation of a Rural Center for Health Care Innovation and Sustainability within the existing State Office of Rural Health. The bill also increases the rural hospital tax credit to 100%, directed the Department of Community Health to streamline and create efficiencies within the state medical plan, allows for the establishment of micro-hospitals, sets up an incentive program for physicians practicing in rural areas, and redefines “rural county”.


HB 827: Rural hospitals tax credit increase | DID NOT PASS

HB 827, introduced by Rep. Trey Kelley, would have expanded the rural hospital tax credit program from a 90% credit to a 100% credit. The tax credit program went into effect last year and has resulted in the donation of about $10 million to rural hospitals thus far. The legislation was tabled late in the legislative session because the tax credit language was included in HB 769.


HB 740: Education legislation impacting behavioral needs of young students | PASSED

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 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.


SB 325: Interstate Medical Licensure Compact Act & Step therapy | DID NOT PASS

SB 325 would have allowed Georgia to enter the “Interstate Medical Licensure Compact Act” which allows health care providers to more easily obtain licenses to practice in multiple states. It would also have granted states easier access to investigative and disciplinary information about providers. 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 351: Changes for APRNs | DID NOT PASS

SB 351 would have expanded from four to eight the number of advanced practice registered nurses a physician is allowed to supervise and would allow APRNs to order radiographic imaging for patients if their supervising physician delegated the authority. The legislation was significantly diminished from the original proposal which would have granted APRNs a greater scope of practice.


SB 352: Legislation to establish Commission on Substance Abuse & Recovery | DID NOT PASS

SB 352 establishes a Commission on Substance Abuse & Recovery, headed by a director and charged with coordinating data among relevant government entities; informing strategies to combat the opioid crisis within the Departments of Public Health and Education, the Attorney General’s Office, and other state entities; consulting with the Governor’s office on a potential Medicaid waiver related to opioid abuse; and developing and informing other efforts to expand access to prevention, treatment, and recovery support services across the state.


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New Publication

Collaborating for Consumers

CollaboratingWithConsumers-1This August, GHF invited both advocates and enrollment assisters to the second annual Getting Georgia Covered summit. Bringing these two groups together was the first step in fostering ongoing conversations and partnerships to ensure that health coverage translates into meaningful access to care for Georgians. Through the summit, GHF collected feedback and input for a report that highlights how assisters and advocates can team up for consumers. We invite you to read and share Collaborating for Consumers: How Assisters and Advocates Can Inform Policy, in which you will find opportunities and best practices for collaboration to achieve our shared goals.


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GHF and Consumer Assistance

Direct consumer support plays an important role in assisting consumers to enroll into and maintain their health coverage. Georgians for a Healthy Future, primarily a health advocacy organization, provided direct enrollment services to Georgians in the last two open enrollment periods through enrollment events, in-person appointments, phone assistance and referrals. GHF continues to engage with other enrollment entities through its Georgia Enrollment Assistance Resources (GEAR) network which is a central hub of Marketplace resources, and provides technical support to assisters through newsletters, e-blasts, trainings, webinars, and forums.

In OE3, GHF primarily focused on post enrollment work undertaking more complex consumer cases such as resolving coverage issues with the Marketplace and insurance providers, payment issues, tax filing and reconciliation issues, and issues with supplemental documents. In this role, GHF provided crucial support to consumers and enrollment assisters to resolve these types of issues and help consumers maintain their coverage, feel free to visit https://syntheticurinereview.com/whizzinator-kit/.

Here is what our consumers reported about their experiences

GHF conducted a post-enrollment consumer satisfaction survey with 25 consumers between April and July 2016. The survey participants reported that they sought a combination of services during their appointments. The table below provides the details for each type of post-enrollment assistance.

graph-for-blog

Twenty-four out of 25 (96%) participants reported that they were able to resolve the issues that they sought assistance for, as explained by these quotes…

“Paid my premium, sent supplemental documents, added two kids to the application, received delayed cards” – Res# 1, Female, 30.

 “My coverage had been suspended for over a month due to a technical issue. GHF helped me reinstate my suspended insurance by advocating on my behalf with both Marketplace and Ambetter. My benefits were reinstated within 3 business days”— Res# 16, Female, 62.


GHF Success Stories:

terry-caldwell

Tony Caldwell, a consumer with disability, was waiting to get his power wheelchair for over a year. With direct enrollment support from GHF, he was able to get his application completed during SEP and select a plan that covered his wheelchair. Tony quotes, “I finally ended up getting my power wheelchair that I had been waiting for over a year. It has helped me from passing out. Thanks to you all.”

 

 

 

clyde-mohammed Clyde Mohammed and his wife Sharda (West Indian couple) came to renew their marketplace plan at Switzer Public Library in Marietta. They also wanted to change their current plan since the premium was going up in 2016. Assisted the consumers to complete their application. They were found eligible for subsidies. They enrolled into a health plan with $57 monthly premium and $600 family deductible. The family was able to save over $150 in monthly premium by switching their plan.

The majority of the participants reported the Marketplace application process to be very complicated and that they couldn’t have resolved their issues without the help of an enrollment assister. Those participants who found the process to be comfortable reported the assistance they received to be the key reason.  Participants also reported that this page talk about it, from the education to enrollment assisters that made it easier for them to understand and use their new health insurance.

Trends from our direct consumer support experiences and those we have heard from our partners suggested that direct enrollment assistance was crucial for consumers in making enrollment decisions as well as tackling post-enrollment issues. Direct assistance will continue to be crucial for consumers, both new enrollees and re-enrollees, in the days to come as there will be changes in participating insurance providers, premium price, and personal details such as household size and income all of which will require enrollment assisters’ expertise.

 


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New Policy Report Released!

EnrollmentBrief2016imageGetting Georgia Covered: What We Can Learn from Consumer and Assister Experiences During the Third Open Enrollment Period

With three annual open enrollment periods completed and a fourth one just around the corner, the Health Insurance Marketplace has become established as the avenue for purchasing coverage for roughly half a million Georgians. This report builds on last year’s Getting Georgia Covered: Best Practices, Lessons Learned, and Policy Recommendations from the Second Open Enrollment Period and focuses on understanding the characteristics of the people who have enrolled in marketplace plans and the experiences of consumers and the enrollment assisters who helped them. Their insights can inform the work of advocates, stakeholders, and policymakers to reach shared goals of reducing the uninsured, improving access to care, and addressing affordability for consumers.

Inside you’ll find:

  • Key themes in consumer and assister experiences during the 2016 open enrollment period
  • Best practices for outreach, enrollment, and reaching eligible Georgians who remain uninsured
  • Policy opportunities to increase enrollment, improve access to care, and address affordability issues

Go to the report.


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The Impact of the Consumer Voice

for CVC blog 1Does a strong consumer voice make a difference in health policy outcomes? According to a Mathematica Policy Research evaluation of state-level consumer health advocacy projects supported by the Robert Wood Johnson Foundation (RWJF), yes!

At Georgians for a Healthy Future, consumer engagement is woven into each of our initiatives to bring the needs – and voices – of Georgia health care consumers into the public policy process. Over the past two years, one of our top priorities has been maximizing health insurance enrollment and ensuring that, once enrolled, consumers can access the care they need. Our work in this area, along with that of similar efforts in seventeen other states, was recently evaluated by Mathematica. The evaluation focused on the activities and outcomes of the eighteen Consumer Voices for Coverage (CVC) projects funded by RWJF.

for CVC blog 2Georgians for a Healthy Future was a CVC grantee in 2014-2016. Through this program, we focused on outreach, education, and enrollment in coverage and used this work to inform and strengthen our policy work. The CVC evaluation found that coalitions, such as the one led by GHF in Georgia, played a central role in successful outreach, allowed consumer advocates to work together to help maximize enrollment and retention, and helped identify policy issues needing attention.

These coalitions worked to increase enrollment in health coverage programs by building alliances with diverse stakeholders, mobilizing and engaging consumers, identifying achievable policy options to address issues arising from consumer experiences, designing and implementing communication strategies, and securing resources to sustain these efforts.

for CVC blog 3While the CVC program is winding down, Georgians for a Healthy Future’s work in this area will continue through our Georgia Enrollment Assistance Resource (GEAR) network and through our ongoing policy work around coverage, access to care, and health care value. As we continue this health policy and advocacy work, we will leverage the advocacy infrastructure and ability to translate consumer voices strengthened through CVC into concrete policy actions.

To read the complete Mathematica evaluation, click here.


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GEAR Update: Special Enrollment Period Changes

We want to hear from you – new SEP rules 

At the beginning of last year’s open enrollment period, GHF created GEAR, the Georgia Enrollment Assister Resource Network (GEAR). GEAR is a coalition of enrollment assisters and those closely involved in the enrollment process. Now the open enrollment is passed, GEAR is turning to tax time and special enrollment periods (SEPs). Last month, CMS announced the new special enrollment confirmation process. Georgians will now be required to provide sufficient proof to the marketplace to determine their SEP eligibility. Failure to provide supporting documents may lead to the denial of coverage. At GHF we advocate for policies that make enrollment in health insurance more inclusive and  fight policies that put up unnecessary barriers. We want to hear from you about this! If you’re an enrollment assister and are experiencing trouble enrolling consumers during a special enrollment period, let us know! If you’d like to join the GEAR network, you can do that here.


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Open Enrollment Ends

Pranaya Outreach 10.15GHF helped over 100 people get covered

Open enrollment formally concluded on January 31, 2016 and 587,845 Georgians enrolled in the Marketplace (healthcare.gov).

Throughout open enrollment, GHF worked to get Georgians enrolled through direct service and the creation of GEAR (or the Georgia Enrollment Assister Resource Network). GEAR is the new central hub of resources for Georgia’s enrollment assisters and community partners who work with consumers to educate them on their health and health care coverage options. If you are interested in learning more about GEAR or want to sign up for the newsletter, email Whitney. Additionally, during this open enrollment period we have provided enrollment assistance to 78 applicants and their families, totaling 141 Georgians. Of those, 91%  received financial assistance.


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Post-enrollment workbooks available!

Workbook_coverThis workbook is a take-home, interactive resource for the newly enrolled. It covers topics that enrollment assisters may not have time to cover during the enrollment appointment, such as how to find a primary care provider, how to make your first appointment, and even how to make a budget. People can fill in the workbook with their own information so they have all of their important health coverage information in one place. Download the workbook here.


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GHF In The News
Jul 12, 2018
Federal funding for ACA ‘navigators’ to drop dramatically in Georgia
Andy Miller

“During a time when the administration is making numerous, often confusing changes to health insurance, more consumer assistance is needed, not less."-- Laura Colbert, Executive Director, Georgians for a Healthy Future

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