Open enrollment into the new health insurance marketplace, or exchange, begins in just under six months (October 1, 2013) for coverage starting in January 2014.  Georgia has one of the highest numbers of uninsured in the nation (1.86 million), and many of these uninsured Georgians will be able to access health care coverage for the first time through the marketplace.

According to research from Enroll America, however, more than three-quarters of the uninsured don’t know about the new health insurance marketplace. Multiple surveys have also found that when uninsured individuals learn about the new health insurance options that will become available to them through the marketplace, they say they will need help navigating the process.

That’s why the new navigator program is so important. Last week, the U.S. Department of Health and Human Services (HHS) released a funding opportunity announcement inviting organizations and individuals to apply for the navigator program. Groups may apply individually or as a consortium, although HHS is encouraging the consortium approach. Navigator responsibilities include:

• Maintain expertise in eligibility, enrollment, and program specifications;

• Conduct public education activities to raise awareness about the Exchange;

• Provide information and services in a fair, accurate, and impartial manner. Such information must acknowledge other health programs (such as Medicaid and the Children’s Health Insurance Program (CHIP));

• Facilitate selection of a Qualified Health Plan;

• Provide referrals to any applicable office of health insurance consumer assistance or health insurance ombudsman established under Section 2793 of the Public Health Service Act, or any other appropriate state agency or agencies, for any enrollee with a grievance, complaint, or question regarding their health plan, coverage, or a determination under such plan or coverage; and

• Provide information in a manner that is culturally and linguistically appropriate to the needs of the population being served by the Exchange, including individuals with limited English proficiency, and ensure accessibility and usability of Navigator tools, such as fact sheets, and functions for individuals with disabilities in accordance with the Americans with Disabilities Act and Section 504 of the Rehabilitation Act used in Holistic Drug and Alcohol Treatment centers and other similar types of organizations.

For entities interested in applying for the navigator funds, letters of intent (optional but recommended) are due on May 1, 2013 and applications are due to HHS on June 7, 2013.  To learn more about the navigator funding opportunity, click here.

Nearly 100 of you joined us last week for a meeting to begin discussing how consumer and community-focused nonprofit organizations can work collaboratively to maximize enrollment in Georgia. The meeting also was an opportunity for organizations considering applying to HHS for the navigator grants to network with each other and see if there were opportunities to submit joint applications. To those of you who were unable to join us, here are the resources and materials that were shared:

• HHS navigator funding opportunity announcement 
• Georgians for a Healthy Future’s navigator fact sheet
• Enroll America’s enrollment assisters fact sheet
• Enroll America’s navigator and in-person assistance programs
• Enroll America’s bridging the enrollment gap: the importance of providing in-person assistance
• Enroll America’s power point presentation
• Seedco’s power point presentation 
• Webinar power point presentation 

Join us for a webinar and in-person meeting about ACA Navigators April 10 and 11

If you or your organization are interested in applying for the upcoming funding opportunity provided through the Department of Health and Human Services (HHS) for navigator grants or you would like to connect with other organizations who will be applying, please join Georgians for a Healthy Future, Seedco, Families USA and Enroll America for an important webinar on April 10th, 2013 at 11am and an in-person meeting on April 11th, 2013 from 2:30 to 4:30pm at the Philip Rush Center (1530 DeKalb Ave).

 
In the next few days, HHS is planning to announce funding that will be available to organizations for outreach and assistance to help individuals and small employers enroll in health coverage. These grants are created as part of the navigator program that was established by the Affordable Care Act.  To learn more about navigators, click here.

To join us for the webinar, please click here to RSVP.  To join us for the in-person meeting to further discuss this funding opportunity and opportunities for collaboration on outreach and enrollment, click 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.

The Commission on Mandated Health Benefits, created through legislation passed in 2011 to advise the governor and the General Assembly on the social and financial impact of current and proposed mandated benefits and providers, held its first meeting on March 12th. The meeting was largely an organizational one, but members also discussed how the commission’s work might intersect with aspects of the Affordable Care Act such as essential health benefits and the bills before the General Assembly that would require insurance companies to cover autism, child hearing aids, and medical foods. The next meeting date has not yet been announced.  To read the minutes from the March 12th meeting, click here.

On March 23, the nation’s landmark health care reform legislation, the Affordable Care Act (ACA), turned 3 years old.  Though it has only been three years since its passage and while we are still months away from some of the law’s most prominent features taking effect (i.e. health insurance marketplace, individual mandate, etc.), millions of people have already taken advantage of some of the law’s provisions, including many Georgians. 

Here is how the ACA has affected Georgia:

• Young adults up to age 26 can now remain on their parent’s health plans.  As of December 2011, 123,000 young adults in Georgia gained insurance coverage as a result the health care law.
• Prescription drug coverage for Medicare beneficiaries is now more affordable through the gradual closing of the “donut hole.”  In Georgia, people with Medicare saved over $161.9 million on prescription drugs since the law’s enactment.  In 2012 alone, 99,057 individuals in Georgia saved over $72.5 million, or an average of $732 per beneficiary.  
• Preventive services are now available with no cost sharing for services such as colonoscopy screening for colon cancer, Pap smears and mammograms for women, well-child visits, and flu shots for all children and adults. In 2011 and 2012, 71 million Americans with private health insurance gained preventive service coverage with no cost-sharing, including 2,202,000 in Georgia. 
• Medical loss ratio ensures that insurance companies must provide consumers greater value by spending generally at least 80 percent of premium dollars on health care and quality improvements instead of overhead, executive salaries or marketing. If they don’t, they must provide consumers a rebate or reduce premiums. This means that 243,813 Georgia residents with private insurance coverage will benefit from $19,764,771 in rebates from insurance companies this year, for an average rebate of $134 per family covered by a policy.

To learn more about how the ACA has affected Georgia and its citizens, click here.  As we get closer to 2014 the focus will turn to the health insurance marketplace, or exchange, and how individuals who are currently uninsured can access new health care options.  Georgians for a Healthy Future will continue to monitor the implementation of the ACA and ensure that health care consumers are able to take advantage of the provisions of the law that most affect them.

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.

On Tuesday, February 19th, 2013, over 100 advocates, health care consumers, providers and others gathered at the State Capitol to deliver an important message to our elected officials: coverage matters.  Georgia has an unprecedented opportunity to drastically reduce the number of uninsured in our state by accepting the federal dollars and expanding coverage through Medicaid.  With nearly 2 million uninsured Georgians (that’s 1 in 5), it is likely you already know those people who would benefit from expanded coverage–they are your neighbors, your co-workers, and sometimes they are you.

There is still time to do your part: join the Cover Georgia coalition by helping us make the case for expanding coverage.  Pick up the phone and call your legislator and tell them why the decision to expand coverage through Medicaid is so important to Georgians like you.

Here are some key talking points:

• Expanding Medicaid in Georgia would create 70,343 new jobs and would infuse an additional $8.2 billion per year in economic activity into our state’s economy each year.
• This economic activity will result in an additional $276 million a year in state and local tax revenue.
• Money has already been set aside at the federal level to cover 100% of the costs of Georgia’s expansion for the first three years and at least 90% in future years. Should the federal reimbursement levels drop below this level, Georgia can pull out of the expansion at any time.
• Expanding Medicaid will bring an estimated $40.5 billion in federal funds into Georgia over a decade.
• Medicaid expansion will free up state dollars that are currently covering programs such as mental health, the Georgia AIDS Drug Assistance Program, the State Hemophilia Program, and indigent care.
• Hospitals lost $1.5 billion in uncompensated care in 2010. Increasing the number of insured patients by expanding Medicaid will help prevent struggling hospitals from closing and save Georgia taxpayers dollars that currently go toward covering uncompensated care.
• Medicaid improves access to care, health status, and financial security of enrollees who would likely otherwise be without coverage.
• Medicaid expansion in other states have reduced mortality, and based on an estimated 650,000 new enrollees, an approximate 3,693 lives could be saved each year in Georgia by expanding coverage through Medicaid.
• More than 38,000 new health care sector jobs will be created. Other industries such as real estate who can benefit from the hoa management greenville sc, restaurants, transportation, and other businesses will also benefit from more than 30,000 new jobs.
• Under the current Medicaid program, low-income childless adults and most low-income parents do not qualify for coverage, leaving many working Georgians without access to adequate health care.
• Georgia has one of the nation’s highest uninsured rates; expanding Medicaid will help cover more than 650,000 people.

To find your legislator’s contact information, click here.  Help us multiply our voice and our presence at the Capitol. Call your legislators now!

An analysis conducted by Dr. Bill Custer of Georgia State University and released today by the Healthcare Georgia Foundation finds that, if Georgia policymakers choose to accept the $40.5 billion in federal funds available to the state between 2014 and 2023 to expand Medicaid, this infusion of resources would create more jobs in Pensacola FL and 70,000 jobs countrywide, adding an annual $8.2 billion to statewide economic output and generating $276 million in state and local tax revenue annually.

As part of the Affordable Care Act, states can create a new eligibility category for Medicaid for people with incomes up to 138 percent of the federal poverty level, or approximately $15,850 for an individual or $26,950 for a family of three. In Georgia, according to the report, about 694,000 people would gain health coverage under this expansion, mostly childless adults and some parents.

To date, Governor Deal has rejected the offer to expand coverage citing concerns about the cost to the state.  As this new report details, however, expanding Medicaid would be an economic engine for Georgia. Of the more than 70,000 jobs that would be created, just over half would be in the health care sector; however, other industries such as real estate, food services, and wholesale trade businesses would also gain jobs. The report also shows the geographic distribution of jobs created throughout Georgia by state service delivery region. To read the full report, click here.

The 2013 Legislative Session continues at a swift pace, with legislators in session today for day 17 of the 40-day session (the legislative calendar is available here). Here are some key health care updates:

• Yesterday, the Health Subcommittee of the House Appropriations Committee heard from the Commissioners of the state’s health-related agencies, including the Department of Community Health and the Department of Public Health, about their proposed FY 2014 budgets. Today, the subcommittee will meet again from 2 – 4pm in Room 506 CLOB to take public comment on the proposed budgets. If you would like to comment, you must sign up in advance in Room 245 of the State Capitol. The Georgia Budget & Policy Institute has released an analysis of the 2014 proposed budget for the Department of Community Health, available here.

• 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 is expected to be signed into law by the Governor this morning. The current hospital fee is set to expire on June 30, 2013. The renewal of the fee is essential to ensuring Medicaid and PeachCare’s solvency and preserving access to hospital care in Georgia.

• HB 198 would require navigators to be licensed, place certain restrictions on their functions, and would give the Georgia Insurance Commissioner regulatory authority over them. Navigators are organizations or entities that apply for and receive federal grants authorized by the Affordable Care Act to provide individuals and small businesses with impartial information and assistance with enrollment in health coverage in the new health insurance marketplaces, or exchanges. While it is important that navigators are qualified to perform these functions and that there is adequate oversight to protect consumers, consumer advocates are also concerned that overly restricting navigators could have a chilling effect on the community-focused organizations whose participation in the navigator program will be critical in connecting hard-to-reach and vulnerable populations to coverage. Advocates worked with legislators to improve the bill, which passed the House Insurance Committee last week and was passed by the Rules Committee yesterday.