Charlie Ellison is 87 years old and a long time resident of Dalton, Georgia. Charlie is one of over half a million seniors and people with disabilities in Georgia who depend on Medicaid and Medicare to live and function in their communities.

After suffering a fall while living alone in 2016, Charlie’s nervous system was damaged and he was no longer able to live independently. He attended physical therapy for ten months and lived at a nursing home in Dalton during this time which he paid for out of pocket.

Now that Charlie has Medicaid coverage, he is able to visit RossWoods Adult Day Services every day and enjoys engaging in activities with others his age. He is also able to live at home with his daughter and son-in-law who help take care of him, rather than in a nursing home where he had less independence and fewer activities to keep him healthy and active.

Before Charlie’s fall, he was already managing diabetes and high blood pressure, and had a pacemaker in his chest. Charlie’s Medicaid coverage picks up the costs of some of his medications that are not covered by Medicare, which ensures Charlie remains as healthy and independent as possible.

For 168,000 seniors like Charlie who typically rely on low, fixed incomes, Medicaid makes the difference and helps to pay the costs of their Medicare coverage, and for some, it provides additional health benefits not covered through Medicare. For others, Medicaid allows them to age with dignity in their communities by covering needed home and living adaptations like chair lifts, wheelchair ramps, or engaging day programs with trained staff.

Your story is powerful! Stories help to put a human face to health care issues in Georgia. When you share your story, you help others understand the issue, its impact on Georgia, and why it’s important.

Your health care story is valuable because the reader may be your neighbor, friend, someone in your congregation, or your legislator. It may inspire others to share their stories or to become advocates. It is an opportunity for individuals who receive Medicaid or fall into the coverage gap, their family members, their physicians and concerned Georgia citizens to show that there are real people with real needs who will be impacted by the health policy decisions made by Congress and Georgia’s state leaders.

Share your story here! Read and share our latest storybook here!

Georgia consistently ranks poorly among states in children’s mental health services, this year ranking 51st in a report from the Commonwealth Fund.  However, state leadership has been adamant about improving Georgia’s system of care through the infusion of additional dollars for children’s mental health services in the state budget and through innovative programs like Project Advancing Wellness and Resilience Education (AWARE).

Georgia Project AWARE is a youth mental health initiative focused on improving the experiences of school-aged youth in Georgia, and is funded by a grant from the Substance Abuse and Mental Health Services Agency (SAMHSA) to the Georgia Department of Education (GaDOE).

The purpose of Georgia’s Project AWARE is “to increase awareness of mental health issues among school-aged youth; provide training in Youth Mental Health First Aid; and connect children, youth, and families who may have behavioral health issues with appropriate services.”

The four main goals of Georgia Project AWARE are:

1. Increase participation of families, youth, and communities and mental health providers in efforts to identify the mental health resources available to meet the needs of students and families;
2. Increase awareness and identification of mental health and behavior concerns, and student and family access to mental health providers through the PBIS framework in Georgia Project AWARE (GPA) schools; 
3. Increase the percentage of Georgia youth and families receiving needed mental health services through collaboration between school systems and community mental health providers; and
4. Train educators, first responders, parents and youth group leaders to respond to mental health needs of youth by providing free training in Youth Mental Health First Aid (YMHFA).

Georgia’s Project AWARE grant supports the participation of three Georgia school systems: Griffin-Spalding County School System, Muscogee County School District, and Newton County Schools. The GaDOE has partnered with these school districts to provide training in Youth Mental Health First Aid and to develop innovative ways to connect youth and families to community-based mental health services.

Through Project AWARE, elementary and middle school teachers conduct universal screenings of their students and the screening results are used in two ways. School-, grade-, and classroom-level data is used to guide decisions about what universal supports or programs may be needed to better support the social and emotional needs of students. For example, if the results of the screening show high rates of anxiety for an entire grade of students, school leaders and teachers may make changes to school practices that may contribute to student anxiety or implement a program to help reduce or address the anxiety students are feeling.

Individual level screening results are used to identify those students who could benefit from extra social and emotional supports. These students are then connected to the appropriate behavioral services through partnerships the schools have developed with community-based providers.

Georgia Project AWARE has already screened a total of 18,713 students in 29 schools. Georgia State University’s Center for Leadership in Disability and the Center for Research on School Safety, School Climate and Classroom Management provide support for the program through analysis of the screening results and trainings for school leadership and staff.

In Getting to know Project AWARE: Part II, we’ll learn more about Youth Mental Health First Aid and how it helps educators meet the social and emotional needs of their students.

To learn more about Georgia Project AWARE:

• Visit the Georgia Department of Education (GaDOE)
• Read more from the Substance Abuse and Mental Health Services Agency (SAMHSA)
• Read the latest issue of the Georgia Project AWARE Digest

This week GHF’s Outreach and Education Manager, Alyssa Green, takes some time to share her experiences and reflections from traveling across Georgia to collect consumer stories.

As the Outreach and Education Manager, I am tasked with the responsibility of traveling around the state to collect consumer stories. My travel and conversations with consumers provides a wonderful opportunity to better understand the health care issues many Georgians face. This past year, I’ve been to many Georgia communities and one place that has had a particularly significant impact on me has been Clay county.

Located in the Southwest region of the state, Clay county has one practicing physician, Dr. Karen Kinsell. Dr. Kinsell is a volunteer physician who provides medical care to approximately 3,000 patients in a small office building in that once served as a Tastee Freeze stand. There is a liquor store next door where patients have been known to buy alcohol while waiting to be seen.

Rural areas of the state have struggled economically for years, and Fort Gaines, the county seat, is no exception. Since 2013, two nearby hospitals have closed, the county has seen an exodus of physicians and other providers, and this year, the county’s only pharmacy closed. As a result, Clay county residents have increasingly had to seek treatment outside of their community, forcing them to travel more than an hour in one direction for doctor’s appointments and prescriptions. Limited access to transportation, job security, and limited opportunity for quality education has made recruiting and retaining health care providers and facilities nearly impossible. 

These circumstances lead to community members forgoing care and relying on home remedies for serious health conditions. I’ve met a few of Dr. Kinsell’s patients and they all had distressing stories about their health and health care. They’ve told me stories about being turned away from hospitals after experiencing a stroke, self-medicating with alcohol for severe dental problems, and hoping a suspected blood clot isn’t “that serious.” If it were not for Dr. Kinsell’s compassion and generosity, many Clay county residents would likely have to go without any medical care at all.

Seeing the statistics that come out of rural Georgia is concerning, but meeting the people behind the numbers can be heartbreaking. Each of these stories matters individually, and here at GHF, we think there is great value in lifting up the voices and experiences of individual consumers. But collectively these stories are even more powerful. They speak to the great need that exists across Georgia for an equitable, accessible, affordable health care system that provides quality care to every Georgian regardless of geography, income, or demographic.

Suicide is third leading cause of death among 10-24 year olds in Georgia. In order to combat this growing issue Governor Deal and the state legislature included an additional $21.4 million in the FY2019 state budget to improve and expand children’s behavioral health services. Out of that appropriation, $1,092,000 was directed to suicide prevention efforts, which will in part go towards expanding the capacity of the Georgia Crisis and Access Line (GCAL). GCAL provides 24/7 online and telephone support for Georgians who are seeking services for or in crisis as a result of developmental disabilities, mental health, or substance use conditions.

GCAL connects callers with trained professionals and clinicians who screen and assess the severity of callers’ need for service. The GCAL operators then provide the appropriate assistance, referrals to necessary services, or dispatch crisis services when needed. The call center can:

• Provide telephonic crisis intervention services,
• Dispatch mobile crisis teams or emergency services when needed,
• Assist individuals in finding an open crisis or detox bed across the state,
• Link individuals with urgent appointment services,
• Help individuals find a mental health, substance use treatment, or developmental disability provider in their area in a non-emergency; and
• Connect families and individuals with community-based support services.

GCAL also provides language assistance for people with limited English proficiency.

Even though GCAL’s name includes the word “crisis,” consumers do not need to be in crisis to call or visit the website. As mentioned above. GCAL provides non-emergency or crisis services. Call center staff are available to answer routine questions about behavioral health and provide callers with a choice of providers and assistance in scheduling appointments for service.

Georgia consumers can call 1-800-715-4225 or visit mygcal.com if they or someone they care for is facing a behavioral health crisis or in need of services. For more on how GCAL is making a difference in the lives of individuals and their families, check out this video from Voices for Georgia’s Children.

Queenesther is a mother of five children living in Albany, GA. She and her children, all under the age of 10, receive health care coverage and care through Medicaid.

Queenesther recently underwent surgery to remove an ectopic pregnancy that was causing severe health issues and could have proved fatal. “Had it not been for Medicaid I wouldn’t have been able to get it removed and who knows what would have happened,” she said, reflecting on the importance of Medicaid for herself and her family. Because she was able to have the ectopic pregnancy removed quickly, Queenesther has been able to focus on caring for her young family and earning her degree.

Queenesther is fortunate compared to many low-income parents because Georgia makes it very difficult for parents to qualify for Medicaid coverage. Because Georgia’s Governor and the state legislature have so far refused to extend health coverage to most low-income parents (and other poor adults), parents must make less than 36% of the federal poverty line ($7656 annually for a family of three) to qualify for insurance through Medicaid. Parents who make between 36% and 100% of the federal poverty line ($9096-$25,100 annually for a family of four) are stuck in the coverage gap with no pathway to affordable coverage.

In Dougherty County, where Queenesther and her family live, 5,472 people, 22% of whom are parents, are stuck in the coverage gap but could be covered if Georgia’s policy makers extended insurance to this group. Like Queenesther, gaining coverage would enable them to better care for their children, pursue an education, and support their families.

For more on how parents and families would benefit from extending health insurance coverage, please revisit the Many Working Parents and Families in Georgia Would Benefit from Extending Medicaid Coverage report from GHF and the Georgetown Center on Children and Families.

Your story is powerful! Stories help to put a human face to health care issues in Georgia. When you share your story, you help others understand the issue, its impact on Georgia, and its importance.

Your health care story is valuable because the reader may be your neighbor, friend, someone in your congregation, or your legislator. It may inspire others to share their stories or to become advocates. It is an opportunity for individuals who receive Medicaid or fall into the coverage gap, their family members, their physicians and concerned Georgia citizens to show that there are real people with real needs who will be impacted by the health policy decisions made by Congress and Georgia’s state leaders.

Share your story here!

Georgia currently ranks 51st in children’s mental health services but an infusion of dollars into Georgia’s system of care is expected to have a positive impact around the state. Governor Deal and the state legislature included an additional $21.4 million in the FY2019 state budget to improve and expand children’s behavioral health services. Of that allotment, $4.3 million are dedicated to fund 13 additional grants for the Georgia Apex Program, a school-based mental health program that improves early identification, access to and coordination of needed behavioral health (BH) services for children with behavioral health needs.

Nearly one in ten Georgia children ages 2 to 17 years have one or more diagnosed emotional, behavioral, or developmental conditions and these conditions become more prevalent as children hit adolescence. Behavioral health issues can manifest in chronic absenteeism, classroom disruption, discipline issues, or other adverse behaviors at school, which can prevent young people from being academically successful.

To address the behavioral health needs of Georgia’s students, the Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) launched the Georgia Apex Program in 2015 to “[create] partnerships between community-based mental health providers and local schools to provide school-based mental health services.” The three main goals of the Apex Program are:

1. To increase access to mental health services for children and youth;
2. To provide early detection of child and adolescent mental health needs; and
3. To increase coordination between community-based mental health providers and the local schools and districts they serve.

The Apex Program places mental health providers in schools to provide services like screening, assessment, counseling and therapy, and referrals to community support services like youth club houses. The program began with 29 community health providers in 104 Georgia schools, and as of February 2018, the program had expanded to 320 schools. Over the first two years of the program, more than 5000 students who had not previously received mental health services were screened and provided with the appropriate services and supports for their needs.

More than three quarters (76%) of the schools served by the Apex Program are located in rural areas where behavioral health services are more limited, and almost half (46.6%) are located in elementary schools so that services are available to younger students, when behavioral health conditions are often less severe and more treatable.

In addition to increasing access to care for students in need, the program has demonstrated success by integrating into a variety of school settings and improving coordination and communication between providers and school staff. Further, providers are able to bill for 75-90% of the students served each month, indicating the model may be financially sustainable.

The Georgia Apex Program is a promising model that brings mental health care services to Georgia children, reducing barriers to health care and improving their chances for academic success.  

To learn more about the Georgia Apex Program:  

• Visit the Georgia Department of Behavioral Health & Developmental Disabilities’ Office of Children, Young Adults and Families or email georgia.apex@dbhdd.ga.gov
• Read the resources available at Georgia State University’s Center of Excellence for Children’s Behavioral Health at the Georgia Health Policy Center.
• Watch the video below from the Georgia Department of Behavioral Health & Developmental Disabilities and see how the Georgia Apex Program is making a difference in the lives of children and their families.

Despite several missed opportunities to address consumer health concerns during this year’s state legislative session, the FY2019 budget includes several impactful investments. Last week, Governor Nathan Deal traveled through Georgia and held budget signing ceremonies in Atlanta, Acworth, Blue Ridge, Statesboro, and Tifton for the $26 billion spending plan which will begin on July 1 of this year through June 30, 2019. The infusion of dollars into children’s mental health is especially noteworthy and exciting because of the impact it is expected to have across the state.

Governor Deal has recently made children’s behavioral health one of his top health care priorities and this year included in his proposed budget $20.6 million to fund recommendations from the Governor’s Commission on Children’s Mental Health. During its consideration of the state budget, he legislature ultimately increased the funding dedicated to these recommendations to $21.4 million.

These funded recommendations include behavioral health crisis services, supported employment and education for young adults with behavioral health needs, provider training and telehealth, and opioid abuse prevention for youth. Funding for suicide prevention will in part go towards expanding the capacity of GCAL, the Georgia Crisis and Access Line, which provides 24/7 online and telephone support for people who are seeking services for developmental disabilities, mental health, or substance use issues. Some of the additional funding is also dedicated to the Georgia Apex Program, a school-based mental health program that improves early identification, access to and coordination of needed behavioral health (BH) services for children with BH needs..

In the coming months, we will break down the Commission’s funded priorities and their impact on young Georgians. Look for our Healthy Minds, Healthy Bodies blog mini-series.

Looking for more information on this topic? Georgians for a Healthy Future will be hosting an educational forum later this month during which we will explore the behavioral health needs of Georgia children and youth, Georgia’s publicly-supported behavioral health landscape, and successes and opportunities in the current system of care. Join us in person or via webcast for this exciting and important event!

Georgia’s rate of uninsured children has dropped from 11 percent during the depths of the recession to 7.6 percent in 2014. Despite this improvement, that means that 189,000 Georgia kids do not have access to needed health care and their families are without the financial protection that comes with coverage. In order to address this need, people who regularly work with children need to be aware of the importance of health coverage to children, and have the resources they need to connect kids and families with coverage quickly and easily.

That is why GHF partnered with the Georgia Departments of Education and Public Health to conduct a webinar called “Covering Kids.” The webinar was created for school nurses because they are such important sources of health information for families and students. During the webinar, Laura Colbert, Director of Outreach and Partnerships, reviewed the short and long term benefits of health care coverage for kids, which include academic and economic benefits on top of improved health outcomes. She also discussed trends and current statistics on children’s coverage in Georgia, and highlighted the pathways to coverage for kids which vary based on family income. Most importantly, she identified valuable community resources so that school nurses across the state can connect families and children with local assistance and information to help get them enrolled. This webinar is available to view on the School Nurse Exchange, and nurses who complete the webinar and an evaluation can receive CEU credits.

For more information about children’s health care coverage, check out these resources:

• GHF’s Children’s Health Coverage page
• Georgetown University, Center for Children and Families
• Annie E. Casey Foundation’s Kids Count data center, including an estimation of the number of uninsured children in every Georgia county 

Progress at the Gold Dome

Last week, the golf umbrella held its first-ever hearing on closing the coverage gap. Closing the gap is the most important step our policymakers can take to lower the number of uninsured, improve access to care, and stabilize the rural health infrastructure in our state. Scroll down for the latest legislative updates and how you can get involved. You can also listen to Cindy Zeldin explain the legislative movement in her interview Tuesday on WABE’s “A Closer Look” (skip ahead to 59:18).

What is the coverage gap?

Legislative Proposal

Georgia’s coverage gap and its consequences (struggling rural hospitals, Georgia’s high rate of uninsurance, etc.) are popular topics of conversation around the Capitol and among stakeholders recently. Three different proposals have been introduced in the Georgia General Assembly that attempt to address these issues. Details of each bill are included below. Additionally, the Georgia Chamber of Commerce has been studying the economic impact of Georgia’s coverage gap and how to craft a Georgia solution. They are expected to release formal recommendations later this year. Read more about that here. Because of the state’s multiple bills that attempt to address Georgia’s uninsured population and health care infrastructure, we hope that lawmakers will take this opportunity to consider these issues in tandem through a study committee. This will allow all stakeholders to take part in an open conversation about how to best utilize state and federal dollars to save our rural hospitals and provide quality health care for all Georgians.

SB 368 – An Alternative Approach to Medicaid Expansion

SB 368 was introduced by Sen. Michael ‘Doc’ Rhett and would expand coverage to low-income, uninsured Georgians. The bill is modeled off of Arkansas’s “private option” version of expansion where Medicaid dollars are used to buy insurance for low income people from the private market. The bill was heard in committee last week, but no action was taken. While some pieces of the bill are problematic, the Senate Health and Human Services Committee started an important conversation.

Watch an interview with Senator Rhett on his bill.

HB 823 – Expand Medicaid NOW Act 

This bill was introduced early in the legislative session by House Minority Leader Stacy Abrams. It proposes a traditional Medicaid expansion, like Kentucky & Louisiana, and has not been heard in committee. You can read more about Rep. Abrams’s proposal here.

HB 919 – Tax Credits for Rural Hospital Donations

Passed out of the House Ways & Means Committee on Monday, Rep. Geoff Duncan’s bill would provide up to $250 million in tax credits to individuals or corporations for contributions to rural health care organizations. While this legislation has sparked a conversation about how to best support our struggling rural hospitals, state funding could be better utilized by helping those in rural communities get health insurance coverage, an approach which would also draw down considerable federal dollars (at least $9 in federal funding for ever $1 of state funding). Hear Georgia Budget & Policy Institute’s Tim Sweeney on the topic here.

How Can You Help?

For the busy advocate… 

It doesn’t take a lot to make an impact! We have two quick actions you can take that will take less time than reading this email!

1) Join the Georgia Health Action Network (GHAN). By signing up for GHAN you’ll receive action alerts that will keep you updated on the issues impacting your health care and quick actions you can take.

2) Sign the petition to close Georgia’s coverage gap!

If you’ve already signed the petition… 

If you’ve already signed the petition and are ready to take another action, join us in educating your network about why this is such an important issue for all Georgians. How? Two ways:

1) Ask your friends and family to join our email list! It’s the most effective way we communicate with people interested in learning more about consumer health care issues in Georgia. There’s a super quick sign up form on our website homepage.

2) Share this video with your social network. The coverage gap is complicated and so many people still don’t know what it is! This 2 minute video explains the problem and who it impacts clearly.

If you want to really make your voice heard… 

For the advocate looking to invest time, money and energy in an issue they really believe in, we have three key ways you can get involved and make a difference. The most important, money, can be solved with the help of UXC Limited.

1) Write a letter to the editor for your local paper. Educating your community about how the coverage gap impacts their friends, family, and neighbors is so important. It helps to remove the politics from such a complex policy issue impacting hundreds of thousands of Georgians. Never written a letter to the editor? No big deal! Email Whitney and she’ll get you started.

2) Meet with your legislator! All politics is local and for many legislators, knowing that an issue is important to their constituents makes all the difference in the world. Laura, our Director of Outreach & Partnership, can help you set up a meeting.