Thanks to Carolyn Ingram from the Center for Health Care Strategies for serving as the keynote speaker for Georgians for a Healthy Future’s 4th annual Health Care Unscrambled policy breakfast event! Carolyn’s presentation described opportunities for flexibility with respect to the Medicaid program and provided illuminating examples from a handful of states taking innovative approaches. Carolyn’s presentation is available here.

The following opinion piece by Georgians for a Healthy Future’s Executive Director Cindy Zeldin originally appeared in today’s Atlanta Journal-Constitution.

Large majorities of young adults say they need and value health insurance, yet people in this age group are far more likely to be uninsured than children, seniors or older adults. Thirty-five percent of Georgians between 18 and 34 are uninsured. How can something so important be so elusive?

Until now, the health insurance of millenials had largely been neglected by public policy, leaving them with few options that provided adequate benefits at an affordable cost.

Most Americans get health insurance as a workplace benefit. They get a substantial employer contribution and receive these benefits on a pre-tax basis. Today’s young adults, however, are entering the job market in a tough economy. They are less likely to land jobs with health insurance. They often cobble together internships and part-time work to gain experience and make ends meet. For too many young adults, there simply has been no viable pathway to coverage.

The tide is turning. An estimated 3.1 million young adults nationwide — and 123,000 here in Georgia — have gained coverage as a direct result of an Affordable Care Act provision that allows parents to keep their children on policies up to age 26. This popular and effective public policy change was just a first step. The new health insurance exchanges will provide options for young adults who previously had nowhere to go.

These plans provide decent benefits and, in many cases, access to tax credits to make them affordable. The tax credits, available to individuals with annual incomes between $11,490 and $45,960, can be taken either at the time health insurance is purchased or at tax time. Some moderate-income individuals also can get help with out-of-pocket expenses.

For millenials who had been underwhelmed with the health insurance options available to them in the past, this is a breath of fresh air. For example, maternity coverage had been nearly impossible to secure in the Georgia non-group market for young couples ready to start a family. Now, this important benefit will be available.

While it is true some young adults enrolled in old plans may see higher premiums, many of those old plans didn’t provide adequate protection. Further, young adults who had a pre-existing chronic helath condition were locked out of the market entirely, a practice insurance companies must discontinue.

 The private insurance plans available through the exchanges won’t meet the needs of all young adults in Georgia. Those who have incomes that place them below the poverty line will likely remain uninsured unless Georgia expands its Medicaid program.

Most young adults want what Americans of all ages want: the peace of mind that comes with knowing that an unexpected cancer diagnosis or accident doesn’t equal financial ruin, and that they have access to basic medical services. The new coverage options are finally leveling the playing field for this generation. It’s about time.

During the 2013 Legislative Session, our state policymakers passed HR 107, which created a joint study committee on Medicaid reform. The purpose of the committee is to evaluate the state’s Medicaid program, examine best practices in other states, and plan for the future of the program. Many health care advocates monitored the legislation closely during the past Legislative Session because of the important role that Medicaid plays in providing health care services to our state’s most vulnerable citizens. The first meeting date for the study commission has been announced and will be held on August 28th from 10am – 12pm. The location for the meeting has not yet been announced, but more information about the committee is available here.

Georgia ranks 9th in the nation in the number of uninsured adults with a mental illness who could gain coverage through the Medicaid expansion, according to a new report from the National Alliance on Mental Illness (NAMI). The NAMI report describes the barriers that people with mental illness face in accessing services and the important role that Medicaid plays in connecting people to services so they can be healthy and productive members of their communities. Expanding Medicaid in Georgia is a major opportunity to change the lives of more than 86,000 low-income uninsured adults with mental illness in Georgia–if you haven’t already, please sign the petition in support of expanding Medicaid in Georgia and join us in our campaign to Cover Georgia!  The full NAMI report on Medicaid and mental health is available here.

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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.

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.

Based on feedback from consumer groups, the Centers for Medicare & Medicaid Services (CMS) announced today a shortened and simplified health coverage application that will help individuals easily apply for coverage when open enrollment begins on October 1, 2013.  Additionally, for the first time consumers will be able to fill out one simple application and see their entire range of health insurance options including those in the marketplace, Medicaid, PeachCare, and tax credits to help pay for premiums.  To view the new applications for individuals and families, click here and here, and here. 

The 2013 Georgia Legislative Session has ended. The 2014 state budget and dozens of bills now go to Governor Deal for his signature or veto (the governor does have the authority to line-item veto parts of the state budget). Bills that did not pass this year are still viable in the 2014 Legislative Session, which will be the second year of a two-year session. Below is a summary of bills that passed the General Assembly this year that could impact health care consumers. For a complete rundown of how health care-related legislation fared, see Georgia Health News’s recap.

Legislation that could impact Medicaid and PeachCare beneficiaries

The final 2014 budget eliminated proposed rate cuts for health care providers (a 0.74% rate cut had been proposed for non-primary care providers within Medicaid and PeachCare for Kids), eliminated a proposed coding change that would have resulted in cuts for certain providers, and included funds for enrollment growth in Medicaid. This is good news for access to health care services; however, Medicaid, PeachCare, and other public health programs have sustained deep budget cuts in recent years. In future years, if we are to improve the state’s health, additional investments in public health and health care delivery will be needed.

HR 107 would create a joint study committee on Medicaid reform that would study current Medicaid policies and procedures, models in other states, and other aspects of the Medicaid program and report to the General Assembly and the Governor by December 31, 2013 with recommendations. HR 107 passed both the House and the Senate.

SB 62 would create a Federal and State Funded Health Care Financing Programs Overview Committee, a joint committee of the General Assembly. SB 62 has passed both the House and the Senate.

SB 24, which would authorize the Department of Community Health to levy a fee on hospitals to continue drawing down federal funds to support Medicaid and PeachCare for Kids, was passed by both the House and Senate and was signed into law by the Governor back in February. The current hospital fee had been set to expire on June 30, 2013. The renewal of the fee was essential to ensuring Medicaid and PeachCare’s solvency and preserving access to hospital care in Georgia.

Legislation impacting health insurance consumer protections and access to insurance

SB 236 would require insurance companies to send concurrently with any statements sent to consumers that provide notice of premium increases an estimate of the portion of any premium increase that is due to the Affordable Care Act. How this is determined would be left to insurance companies to calculate, and they would not have to disclose their methodology. There would also be no requirement to present information about any other factors leading to premium increases or to notify consumers about available tax credits that may more than offset premium increases or about any cost savings or benefit enhancements they are receiving as a result of the Affordable Care Act. As such, this bill would result in consumers receiving incomplete and potentially misleading information.  SB 236 has passed both the House and the Senate.

HB 198 would require licensing, certification, and training for health benefit exchange navigators and would restrict their ability to assist consumers. While ensuring that consumers receive accurate information from navigators about their health insurance options and protecting consumers is an important goal shared by Georgians for a Healthy Future, HB 198’s restrictive language and potentially duplicative training requirements could deter community-focused nonprofits, whose participation in the navigator program will be essential in reaching vulnerable populations who have historically faced barriers to enrolling in health insurance, from becoming navigators or from providing appropriate consumer assistance. Georgians for a Healthy Future looks forward to working with policymakers to ensure this bill is implemented in a manner that minimizes duplication and encourages participation from community-focused nonprofit organizations. HB 198 has passed both the House and the Senate.

HB 389 would allow insurance companies to terminate, cancel, or non-renew conversion policies or any health insurance policies offered through the health insurance assignment system when guaranteed issue becomes available (with a 90-day cancellation period and a 90-day open enrollment period into new health insurance options made available through the Affordable Care Act). HB 389 has passed both the House and the Senate.

Georgians for a Healthy Future and Georgia Equality are working together over the next several months to engage LGBTQ communities in implementation of the Affordable Care Act (ACA) to ensure that those individuals and families know how the new law will affect their access to health care.  In an effort to explain how the Medicaid expansion and the creation of the new insurance marketplace, or exchange, will affect LGBTQ individuals, we have released two new publications, “Why Medicaid Expansion Matters to Georgia’s LGBT Community,” and “What Healthcare Reform Means to Georgia’s LGBT Community.”   Be sure to check back on our site for more information about healthcare reform and how it will impact Georgia’s LGBTQ community.

For a bill (except for the state budget) to remain viable, it must pass at least one chamber by the end of Day 30, known as Crossover Day. Crossover Day was last Thursday, March 7th.  Below is a summary of bills that have passed at least one chamber and that Georgians for a Healthy Future is monitoring, as they could have an impact on Georgia health care consumers if enacted into law.

Legislation impacting health insurance consumer protections and access to insurance

A trio of health insurance related bills are moving through the General Assembly. Consumer health advocates are concerned about these bills because they could restrict information and choices for consumers. 

SB 236 would require insurance companies to indicate on statements sent to consumers that provide notice of premium increases the portion of any premium increase that is due to the Affordable Care Act. How this is determined would be left to insurance companies to calculate, and they would not have to disclose their methodology. There would also be no requirement to present information about any other factors leading to premium increases or to notify consumers about any cost savings or benefit enhancements they are receiving as a result of the Affordable Care Act. As such, this bill would result in consumers receiving incomplete and potentially misleading information.  SB 236 has passed the Senate and is in the House insurance committee.

 
HB 198 would require licensing, certification, and training for health benefit exchange navigators and would restrict their ability to assist consumers. While ensuring that consumers receive accurate information from navigators about their health insurance options is an important goal, HB 198’s restrictive language and potentially duplicative training requirements could deter community-focused nonprofits, whose participation in the navigator program will be essential in reaching vulnerable populations who have historically faced barriers to enrolling in health insurance, from becoming navigators or from providing appropriate consumer assistance. HB 198 has passed both the House and and the Senate.

HB 389 would allow insurance companies to terminate, cancel, or non-renew conversion policies or any health insurance policies offered through the health insurance assignment system when guaranteed issue becomes available (with a 90-day cancellation period and a 90-day open enrollment period into new health insurance options made available through the Affordable Care Act). HB 389 has passed the House and is in the Senate Insurance committee.

Legislation that could impact Medicaid and PeachCare beneficiaries

HR 107 would create a joint study committee on Medicaid reform that would study current Medicaid policies and procedures, models in other states, and other aspects of the Medicaid program and report to the General Assembly and the Governor by December 31, 2013 with recommendations. HR 107 has passed the House and is in the Senate Rules committee.

SB 62 would create Federal and State Funded Health Care Financing Programs Overview Committee, a joint committee of the General Assembly. SB 62 has passed the Senate.

SB 163 would direct the Department of Community Health to examine and identify options for reforming Medicaid in Georgia, including but not limited to more use of managed care, with the purpose of bringing savings to the state. SB 163 has passed the Senate and is in the House Health and Human Services committee.