Peach Pulse: July 13, 2012

Special Medicaid Redesign Edition

This morning the Department of Community Health announced its plans for moving forward with changes to our Medicaid and PeachCare for Kids systems.  Over the last several months, DCH along with consulting firm Navigant have been convening task forces and work groups to work through recommendations and innovations to our current delivery system.  This redeisgn process is seperate but parallel from the conversations currently taking place regarding whether or not to move forward with the Affordable Care Act’s Medicaid expansion provisions but ultimately will impact our overall Medicaid delivery system.  In their press release, DCH said:

“Today, the Georgia Department of Community Health (DCH) announced that it will move forward with implementing key recommendations from its Medicaid and CHIP (Children’s Health Insurance Program) Redesign task forces and workgroups. It will not, however, pursue wholesale restructuring of Georgia’s Medicaid program at this time because of increasing uncertainty at the federal level.”

The changes that the state will move forward with include: 

  • Proceeding with at-risk managed care to serve Georgia Families members
  • Transitioning children in foster care to one designated vendor statewide within the new Georgia Families program
  • Maintaining Georgia’s current Fee-For-Service structure for ABD populations and services
  • Moving forward with Home and Community-based Services Rebalancing. This rebalancing will help move patients from skilled nursing facilities to home and community based services.
  • Begin utilizing a value-based purchasing model. Value-based purchasing will allow DCH to continuously improve the quality of care for our members while better engaging our providers and ultimately containing costs.
  • Creating a one-stop portal will improve accountability and efficiency. Specifically the portal will give health care providers better information about their members and their medical history, streamline their credentialing process, and present providers with a measurement of key performance metrics and allow them to monitor quality and outcomes compared to their peers.
  • Creating a Common Pharmacy Preferred Drug List that will simplify the program and reduce administrative burden on providers

The Department has committed to continuing its work with the task forces and work group through the RFP process and past the go-live date.  As members of the Children and Families Task Force and Substance Use and Mental Health Working Group, Georgians for a Healthy Future will continue to provide a consumer voice in these discussions and will continue to advocate for greater access to care for Georgia’s most vulnerable citizens.  For more information about the redesign process, visit