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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.

Open enrollment for the new health insurance marketplace begins on October 1st–a mere 53 days from today.  Over the past several months, Georgians for a Healthy Future has been working with community-based organizations, health care focused nonprofits, and other stakeholders to discuss plans for coordinating outreach and enrollment efforts in preparation for the new marketplace. Thanks to your robust participation, we have already had several productive conversations to get this effort underway. Last week, we held a webinar to share the latest information available on national and state plans around outreach and enrollment.

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During the 2013 Georgia Legislative Session, our state’s policymakers enacted HB 198 into law, which requires state training, licensure, background checks, and continuing education for navigators. Georgians for a Healthy Future has some concerns about this law and the potential hurdles it sets up for community-focused nonprofits already facing an uphill battle to reach, educate, and facilitate enrollment for consumers who haven’t historically had insurance. As such, we reached out to the Georgia Department of Insurance with suggestions to make the implementation of the law less burdensome for navigators, and some of our input was incorporated.

The proposed rule was presented at a hearing held by the Department of Insurance on July 30th. The regulation implementing HB 198 is available here. Georgians for a Healthy Future was also featured in two recent news articles in the Atlanta Journal-Constitution about the navigator program, available here and here.  Additionally, the Center for Public Integrity just released an article focusing on various state licensure laws as they affect navigators.  That article can be found here. We will continue to monitor this process with an eye towards ensuring navigators and assisters aren’t impeded from carrying out their important work.

Last week, health insurance premiums for the Marketplace were a hot topic, as Georgia’s Insurance Commissioner released some information about the rates that insurance companies proposed for the Marketplace. Georgians for a Healthy Future was frequently cited in media coverage of this issue, drawing attention to the fact that many consumers who were shut out of the market in the past would now be able to purchase insurance for the first time, with hefty tax credits that will make these plans affordable.

This issue was covered by the Atlanta Journal- Constitution, Georgia Health News, The Augusta Chronicle, and WSAV-Savannah. Articles featuring comments by Georgians for a Healthy Future’s Executive Director are available below.

Georgians for a Healthy Future and Seedco are teaming up for another webinar on July 31st from 2-3:30pm. The focus of the webinar will be on health insurance outreach and enrollment. Registration is now closed for the webinar, but we will post the slides and materials on our website following the webinar.

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.