Peach Pulse: May 17, 2012

What’s New in Georgia
Governor Deal Signs Legislation Restoring Child-Only Health Plans

Governor Deal signed HB 1166 (sponsored by Representative Atwood) into law on May 1st. The legislation requires insurance companies who sell policies in the individual health insurance market to also sell child-only plans during an open enrollment period. These plans had previously been available in Georgia, but insurance companies stopped writing new policies in response to a change in federal law that prohibited discrimination against children due to pre-existing conditions. HB 1166 drew widespread support and Georgians for a Healthy Future was proud to be a part of the coalition effort that ensured its passage.

Access to Care a Concern for Georgians

Two recent studies highlight the need for statewide strategies to improve access to care in Georgia. Last week, Kaiser Health News reported that Georgia was one of three states with the greatest increase in the number of people with unmet medical need over the past decade. Back in April, USA Today reported on a study of community health centers that found Georgia was the only state to rank at the bottom on 4 of 6 performance measures.

Insurance Rebates on the Way for Some Georgia Health Care Consumers

A provision of the Affordable Care Act requires health insurance companies in the individual market to spend at least 80 percent of premium dollars on medical care or quality improvement activities (it is 85 percent in the group market). Georgia insurance companies were permitted to phase this requirement in for the individual market over three years (requiring them to spend at least 70 cents on the premium dollar on actual health care in 2011, 75 cents on the dollar in 2012, and 80 cents on the dollar in 2013.) Designed to spur greater transparency, value, and accountability, the provision also requires insurance companies who do not meet this reasonable standard to issue rebates to consumers. As a direct result of this provision, Georgia consumers will receive an estimated $30 million in rebates this year. State-by-state information about anticipated rebates is available here, and a report from Georgia Health News is available here.

Medicaid and PeachCare Redesign Continues

The Department of Community Health (DCH) is continuing its work in redesigning Georgia’s Medicaid and PeachCare programs.  Various taskforces and workgroups have been convening to provide input into the process to ensure that the resulting redesign ensures coverage, access, and quality care to those eligible or enrolled in the programs.  There is still an opportunity to reach out to DCH to share your opinion on the process.  Send an email to and let DCH what you care about when it comes to covering our most vulnerable populations.

Georgians for a Healthy Future is proud to be a part of CARE-M: the Coalition to Assure Redesign Effectiveness for Medicaid.  CARE-M is comprised of several advocate groups across the state that have a vested interest in the ultimate redesign of Georgia’s Medicaid and PeachCare systems.  Many of these groups have been following DCH and Navigant’s progress and have drafted recommendations and policy papers on the topic.  To access these documents, click here. To learn more about our collective efforts, click here.  If you or your organization would like to learn more about the redesign process and would like to request a presentation, email Amanda Ptashkin.

New Changes in Effect for Pre-Existing Condition Insurance Plan (PCIP)

As of May 1, 2012, the Department of Health and Human Services, which administers high-risk insurance pools in twenty-four states including Georgia, reverted to its original requirements. In order to enroll in the program, applicants must submit one of the following pieces of documentation:

  • A denial letter from an insurer
  • An offer of coverage from an insurer that includes a pre-existing condition clause
  • A letter from a broker or agent that states the individual would be denied coverage

Applicants must still be uninsured for six months before enrolling in the PCIP, a provision that has not changed since the program began. The Department will also end the $100 broker referral bonus, which began in spring of 2011, as an incentive to increase enrollment.

As of February 2012, 56,257 people were enrolled in the 24 states that participate in the federal PCIP. In Georgia, 1,707 people have been enrolled since August 2010.

Celebrate National Women’s Health Week

National Women’s Health Week is a week-long health observance coordinated by the U.S. Department of Health and Human Services’ Office on Women’s Health. National Women’s Health Week empowers women to make their health a top priority. It also encourages women to take the following steps to improve their physical and mental health and lower their risks of certain diseases:

Representative Pat Gardner sponsored HR 2027 declaring May 13 through May 19, National Women’s Health Week in Georgia. The resolution urges all Georgians to participate in activities that support women’s health awareness and support all local efforts and initiatives to improve awareness of key women’s issues, including women participating on May 14, 2012, in National Women’s Checkup Day, a day on which women across the country are urged to visit their health care professionals.