Today, the U.S. Department of Health and Human Services (HHS) awarded health insurance navigator grants to 105 organizations in states with federally facilitated or partnership exchanges to conduct outreach and facilitate enrollment into qualified health plans when open enrollment begins in October. Georgians for a Healthy Future is excited to announce that we are part of a consortium of 15 partners, led by Seedco, a national non-profit organization that advances economic opportunity for people, businesses, and communities in need, that received one of two grants awarded for Georgia. We look forward to playing an active role in connecting Georgia consumers to the new health care coverage opportunities available to them.

Georgians for a Healthy Future will support the consortium’s success by drawing upon our strengths as a consumer health care advocacy leader, experience building and managing coalitions, and knowledge of the Affordable Care Act. In particular, we will work to ensure that the consortium’s activities are coordinated with a wide array of organizations in Georgia that share the goal of maximizing health insurance enrollment in our state. Through our Connecting Georgians to Coverage initiative, we have already held several webinars and meetings for organizations planning to participate in outreach and enrollment in Georgia. To learn more about our work to date in this area, click here. If your organization is planning to engage in outreach and enrollment, either as a navigator, certified application counselor organization, or champion for coverage and if you would like to coordinate your efforts with ours, please email Amanda Ptashkin at aptashkin@healthyfuturega.org.

Here is a full list of our navigator consortium members who will work collaboratively with Seedco and with other organizations and stakeholders to connect Georgia’s uninsured to health care coverage:

• Boat People SOS
• Center for Black Women’s Wellness
• Emory-Grady Urban Health Initiative
• Georgia Equality & The Health Initiative
• Georgia Refugee Health and Mental Health
• Georgia Watch
• Georgians for a Healthy Future
• Healthy Mothers Healthy Babies Coalition of Georgia
• Jewish Family & Career Services
• Latin American Association
• Mental Health America of Georgia
• Parent to Parent
• Quality Med-Care Inc.
• Spring Creek Health Cooperative

We look forward to working with Seedco and this strong and diverse coalition over the next year!

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.

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.

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.

An analysis conducted by Dr. Bill Custer of Georgia State University and released today by the Healthcare Georgia Foundation finds that, if Georgia policymakers choose to accept the $40.5 billion in federal funds available to the state between 2014 and 2023 to expand Medicaid, this infusion of resources would create more jobs in Pensacola FL and 70,000 jobs countrywide, adding an annual $8.2 billion to statewide economic output and generating $276 million in state and local tax revenue annually.

As part of the Affordable Care Act, states can create a new eligibility category for Medicaid for people with incomes up to 138 percent of the federal poverty level, or approximately $15,850 for an individual or $26,950 for a family of three. In Georgia, according to the report, about 694,000 people would gain health coverage under this expansion, mostly childless adults and some parents.

To date, Governor Deal has rejected the offer to expand coverage citing concerns about the cost to the state.  As this new report details, however, expanding Medicaid would be an economic engine for Georgia. Of the more than 70,000 jobs that would be created, just over half would be in the health care sector; however, other industries such as real estate, food services, and wholesale trade businesses would also gain jobs. The report also shows the geographic distribution of jobs created throughout Georgia by state service delivery region. To read the full report, click here.

Each year, Georgians for a Healthy Future releases A Consumer Health Advocate’s Guide to the Georgia Legislative Session to provide you with the information you need to take action! Our 2013 guide is now available and features an overview of the legislative process in Georgia; contact information for all state legislators; descriptions and listings for each legislative committee with jurisdiction over health care issues; contact information for state agencies and officials; contact information for health care organizations and associations active in Georgia; key media contacts; and tools and strategies for effective consumer health advocacy. You can either download the guide here or request a hard copy of the guide by e-mailing Georgians for a Healthy Future’s Outreach & Advocacy Director here.

Georgians for a Healthy Future and more than 40 organizations launched an education and advocacy campaign this week is support of expanding Medicaid in Georgia. Below is our announcement about Cover Georgia’s launch. Please contact us if you’d like to join the coalition.

COVER GEORGIA COALITION LAUNCHES EFFORT TO ENSURE THAT THE STATE MOVES FORWARD WITH THE MEDICAID EXPANSION

ATLANTA, Ga., January 10, 2013 – More than 40 organizations – including healthcare providers, hospitals and healthcare advocates – announced today the creation of a coalition in support of expanding Medicaid to Georgians with incomes below 133 percent of the federal poverty level as authorized by the federal health care reform law, the Affordable Care Act (ACA).

Called Cover Georgia, the coalition is spearheaded by Georgians for a Healthy Future and is comprised of a wide range of healthcare stakeholders, including the Georgia Rural Health Association, the Georgia Academy of Family Physicians, AARP Georgia, the American Cancer Society, among many others.

Enacted by Congress in 2010, the Affordable Care Act included the Medicaid Expansion provision, which would provide the states with billions of dollars in new federal funds to enroll currently uninsured citizens in their Medicaid programs.  In Georgia, expanding the program is projected to cover approximately 650,000 Georgians and to bring approximately $33 billion in federal funds into the state over ten years.  For the first three years of the expansion, the federal government will fund 100 percent of the new cost; after that, the states would be required to cover no more than 10 percent of the total cost from 2020 onward.

Cover Georgia will make the case that expanding Georgia’s Medicaid program and leveraging the billions of dollars in federal resources will improve access to care, strengthen the state’s health care delivery system, and bolster Georgia’s economy.  “This is an unprecedented opportunity to impact the lives of hundreds of thousands of Georgians and we simply cannot pass up this opportunity,” said Amanda Ptashkin, outreach and advocacy director for Georgians for a Healthy Future, the organization spearheading the coalition work.

 
When the U.S. Supreme Court decided the constitutionality of the ACA in 2012, it ruled that states could not be compelled to participate in the Medicaid Expansion.   So far, Governor Deal has said he does not plan to move forward with the expansion in Georgia, expressing concerns about the state budget and the long-term fiscal outlook at the federal level.

“Cover Georgia is a statewide education and advocacy campaign focused on spotlighting both the critical role that Medicaid plays within Georgia today and the opportunity that implementing an expansion of the program presents for consumers, the health care system, and our state’s economy,” said Cindy Zeldin, executive director of Georgians for a Healthy Future. “Covering the lowest-income uninsured through Medicaid will provide access to the basic prevention and treatment services that uninsured Georgians lack today and will pump an infusion of federal dollars into our state’s health care economy.”

“Other states across the country are saying yes to the Medicaid expansion and are investing in their state’s health care delivery systems with federal taxpayer dollars paid by Georgians. Georgia cannot afford to maintain the status quo while other states invest heavily in their health systems. Doing so will further compound regional health disparities and limit Georgia’s ability to compete in the long-run.”

Matt Caseman, of the Georgia Rural Health Association, agrees that in addition to the overall economy, the expansion will help rural Georgia. “Expanding Medicaid will provide thousands of rural Georgians, who don’t have health insurance, access to a primary care doctor and preventative medicine. It will help reduce the burden of uncompensated care and keep the doors open for our safety net providers. This initiative is critical to not only the health of Georgia’s rural communities, but our state’s overall economic success as well.”

Tim Sweeney, of the Georgia Budget & Policy Institute, believes that access to affordable health coverage is one of the most pressing health care issues facing the state. “Expanding Medicaid to cover hundreds of thousands of low-income Georgians is one of the most cost-effective ways to address the issue. Implementing the expansion will enable more Georgians to access needed health care, while boosting Georgia’s economy by bringing billions in new federal funding for doctors, hospitals, pharmacies and other health care providers throughout the state.”

The consequences of this decision will affect hundreds of thousands of Georgians.  AARP Georgia State Director, Greg Tanner, points out that, “there are 127,000 Georgians in their 50s or early 60s who make less than $15,000 a year and have no health insurance. Expanding Medicaid to cover them would make them more productive and in the first three years pump $8 billion into Georgia.  That money will go directly to doctors, hospitals, clinics and other health care providers.  We can’t afford not to expand coverage.”

If the state decides to forgo expanding the Medicaid Expansion, those individuals who earn more than our current eligibility levels but less than 100% FPL (Federal Poverty Level) will have no options for coverage and would not qualify for subsidized coverage in the state’s health insurance exchanges.  Those individuals will fall into a coverage gap.

The Cover Georgia coalition will continue to work on educating the public, key decision-makers and others on the importance of the expansion and what it means for our citizens.  Individual consumers, health care professionals, policy-makers and others can learn more about Georgia’s Medicaid program and what the expansion would mean for thousands of Georgians by visiting Cover Georgia’s website at www.coverga.org.

Approximately 1.9 million Georgians are uninsured, among the highest in the nation. Our new interactive resource, Mapping Georgia’s Uninsured, visually displays detailed information on Georgia’s uninsured population by age, income, and region. Click on the shaded regions within each map to see the total number of uninsured by age and income, uninsured rate, and the number of Georgians who would be eligible for Medicaid within each region if Georgia policymakers chose to expand the program. This mapping resource is part of our Cover Georgia initiative to educate policymakers and the public about Georgia’s uninsured, the benefits of coverage, and the opportunity the Medicaid expansion presents for Georgia patients, consumers, providers, and the state’s economy. To view the interactive maps, click here.

This afternoon, Governor Deal announced that Georgia would not move forward with a state-based health insurance exchange. Instead, Georgia will have, by default, a federally facilitated exchange. While a state-based exchange would have been more easily tailored for Georgia and could have been more responsive to the needs of Georgia’s health care consumers, a federally facilitated exchange will still provide information, decision tools, and access to tax credits to help consumers find and purchase meaningful and affordable health insurance.

As the federal exchange gets built out, it will be important that federal officials consider the needs of consumers in states like Georgia. To that end, earlier this week Georgians for a Healthy Future joined with consumer advocates in states across the country to submit a letter to the U.S. Department of Health and Human Services recommending that federal officials create a robust stakeholder planning process, ensure in-person consumer assistance programs meet consumers’ needs, and ensure that qualified health plans available on the exchange protect consumers and meet their needs. You can learn more about health insurance exchanges in Georgia by visiting Georgians for a Healthy Future’s health insurance exchange resource page here. We look forward to working with policymakers to ensure that the federally facilitated exchange is successful in Georgia and that consumers have better access to meaningful and comprehensive health coverage for themselves and their families.