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.

Thank you to the dozens of community groups, nonprofit organizations, and health care stakeholders who responded to our survey about your plans to conduct consumer outreach and facilitate enrollment into the new health insurance options that will become available to many uninsured and underinsured Georgians later this year through the new health insurance exchange, or marketplace. Georgians for a Healthy Future will compile the results and share them as part of a resource document later this summer. In the meantime, here are two new resources that may be useful for you.

• Families USA, a national consumer health advocacy organization, has developed an online resource center for navigators and others working on outreach and enrollment. You can visit the resource center here.

• Consumers Union, the policy and action division of Consumer Reports, has developed a consumer-tested brochure to help consumers understand the new health insurance tax credits. The brochure is available here.

You can also find links and resources regarding health insurance navigators on the Georgians for a Healthy Future website 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.

The Georgians for a Healthy Future board of directors invites you to join us for an evening of camaraderie, conversation, and celebration as we gear up for the next big phase of health reform implementation: connecting hundreds of thousands of uninsured Georgians to coverage. Since our founding in 2008, Georgians for a Healthy Future has worked with all of you to provide a strong voice for Georgia’s health care consumers in the policy decisions that impact their lives. Please save the date for a reception and fundraiser on the evening of June 27th to celebrate our successes and prepare for the challenges ahead. Thanks to national health reform, consumers have more options than they have ever had before. But covering Georgia’s uninsured will take all of us, working in concert, to move our state forward. We need all hands on deck!  Please join us for an entertaining evening of celebration and conversation about our collective strength and how Georgians for a Healthy Future will continue to work on behalf of all Georgians to help navigate the rough waters ahead.

Thursday, June 27th from 6:00 to 8:00pm
Nelson Mullins Riley & Scarborough

Atlantic Station
201 17^th Street NW, Atlanta, GA 30363
Tickets are $60.

Host Committee Levels:
Cadet ~ $250
First Mate ~ $500
Captain ~ $1000+
To join the host committee, email Cindy Zeldin

To register, click here.

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. 

Many of the Affordable Care Act’s major health insurance reforms take effect in 2014. One of the most important changes impacting consumers will be the availability of substantial new tax credits to help individuals and families afford health care coverage. Individuals with annual incomes between about $15,860 and $45,960 (or between about $32,500 and $94,200 for a family of four) will be eligible for the health insurance tax credits. According to a new study by Families USA, about 800,000 Georgians will be eligible for these credits to help make coverage more affordable for them or they could use credit cards for this also by getting amazing credit card advice from reasonable sources online. Georgians for a Healthy Future joined with Families USA in a co-release of the report to highlight the Georgia-specific findings. You can find media coverage of the report’s findings here, here, and here. You can download the report here.

Georgians for a Healthy Future is currently working with Enroll America to assess the interest and capacity of Georgia community-based organizations, health care-focused nonprofits, and other stakeholders in working collaboratively on education, outreach, and enrollment into the new health insurance options available to consumers in 2014 through the Affordable Care Act. As a first step, we held a webinar on April 10th and an in-person meeting on April 11th that many of you attended. For those who missed the meetings, the materials can be found here.

While a big part of those meetings focused on the navigator program, we are asking for your help today regardless of whether you plan to apply as a navigator. If your organization has a stake in covering the uninsured, we’re asking you to complete a brief survey about your current work and future plans to engage in connecting uninsured Georgians to coverage. Georgians for a Healthy Future plans to use the overall results of the survey to guide the formation of a new enrollment-focused coalition and to inform an upcoming policy brief on health insurance outreach and enrollment (all information will be reported in aggregate unless we seek and receive your permission to do otherwise).

Please take a few minutes to complete this survey. Georgians for a Healthy Future is committed to advancing the goal of covering Georgia’s uninsured by bringing stakeholders together who are interested in and able to collaborate towards this shared goal. The results of this survey will provide a baseline and starting point for this important work. Thank you!

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