Georgians for a Healthy Future and the Georgia Budget and Policy Institute are proud to release our joint publication: Understanding Medicaid in Georgia and the Opportunity to Improve It. Inside you will find infographics, new data, and compelling charts that simplify the complex issue of Medicaid in Georgia. 

Part one explains who gets Medicaid in Georgia, how Medicaid protects Georgians during economic downturns, how Medicaid controls costs in the state, and more.

Part two outlines Georgia’s opportunity to close the coverage gap.  Here you’ll find out what Georgia’s health insurance coverage gap is, how we can use Medicaid to close it, and who stands to benefit detailed by job sector, demographics, and veteran status.

Part three details economic and social benefits of closing the coverage gap. Why is closing the coverage gap a good deal for Georgia and the state’s economy? What are the savings other states realize by closing the gap? How does coverage affect a person’s financial and physical health? 

Download the chart book here.

The pre-game to the 2016 Georgia legislative session kicked off with the convening of House and Senate study committees last week. Study committees meet during the off-session to take a deeper dive into specific policy issues that may arise when the session gets underway. Each committee will produce a report on its findings and recommendations by the end of the year and potentially introduce legislation during the 2016 session. Click here for a complete listing of House and Senate study committees.

GHF is following and participating in health-related study committees that directly impact consumers. Here’s what you need to know.

Senate Study Committee on the Consumer and Provider Protection Act (SR 561)

In light of changing practices and norms in the insurance market Senate Bill 158 the Consumer and Provider Protection Act was introduced in 2015. This bill outlined provisions for consumer and provider protections regarding health insurance and created the Senate Study Committee on the Consumer and Provider Protection Act. The aim of this committee is to understand how the current insurance environment is affecting the stability of providers and consumers’ access to care. The committee consists of legislators and representatives from the provider, insurer, and consumer communities, including GHF’s Executive Director Cindy Zeldin as the consumer representative. The committee plans to examine the operations of rental networks, contractual issues between insurers and providers, and network adequacy.

The first meeting of this committee was held on September 14^th at the State Capitol and focused on “rental networks,” also known as silent PPOs. The committee heard testimony from physician and insurer groups as well as from the Department of Insurance. Rental networks occur when third-party entities “rent out” physician-insurer negotiated rates to other payers. The second study committee meeting is scheduled for October 26^th at Tift Regional Health System in Tifton and will focus on “all-products clauses” and provider stability issues. The committee will then be back at the State Capitol on November 9^th for a meeting focusing on network adequacy and provider directories.

Georgians for a Healthy Future has identified network adequacy and the need for more accurate and user-friendly provider directories as important, emerging consumer issues. Network adequacy refers to a health plan’s ability to deliver the benefits promised by providing reasonable access to a sufficient number of in-network primary care and specialty physicians, as well as all and other health care services an insurer guarantees to provide.  GHF will present recommendations on meaningful standards to measure and ensure that provider networks are adequate, as well as how to design provider directories effectively for consumer use. If you are interested in providing testimony or input to this committee, please contact Senator Burke, the study committee chair. Please also let GHF know if these issues have emerged for communities or populations you serve so we can provide the strongest and most informed consumer voice we can on the committee.

Senate Study Committee on Youth Mental Health Substance Use Disorders (SR 487)

The first meeting of the Senate Study Committee on Youth Mental Health Substance Use Disorders convened last week at the State Capitol. The committee is charged with examining prevention strategies and identifying promising approaches to address youth Attention Deficit Hyperactivity Disorder (ADHD) and Substance Use Disorders (SUD). The first meeting included overview presentations from representatives of the Department of Education, Department of Behavioral Health and Developmental Disabilities, and Georgia Council on Substance Abuse (GCSA). The next meeting on October 7^th will focus on ADHD and the meeting following that, on October 22^nd, will delve into substance use disorders. Georgians for a Healthy Future has been working over the past two years with the Georgia Council on Substance Abuse to raise awareness about the promise of taking a public health approach to substance use disorders that focuses on prevention. We are teaming up with GCSA to host a lunch-time policy forum and discussion on this approach on October 22^nd at the Loudermilk Center prior to the study committee’s meeting later that afternoon. Please save the date and we’ll send more details soon. If you are interested in testifying at the October 22^nd study committee meeting to talk about prevention, please let Senator Unterman’s office know (you can also reach out to GHF and we can try to pass along your request).

Senate Study Committee on Women’s Adequate Healthcare (SR 560)

The Senate Study Committee on Women’s Adequate Healthcare met to discuss the current condition of women’s healthcare in Georgia, areas with existing deficits, and the growing number of women who are at risk of unhealthy outcomes. The Department of Public Health, Department of Human Services and Georgia Obstetrical and Gynecology Society along with Dr. Daniel G. Becker and Dr. Scheinberg vaginal rejuvenation surgeon presented data and information on areas in which women’s health is in high risk and he being one of the top cosmetic surgeon make this data matters, although some women don’t like surgery and prefer to use other products as analbleachingblueprint.com/vaginal-lightening-cream for this, the policy options to move the needle in the right direction on major health indicators. The next meeting will be health on October 6, 2015, from 9am- 2pm, at Georgia Regents University in Augusta.

House Study Committee on School Based Health Centers (HR 640)

Committee members for the House Study Committee on School Based Health Centers met to explore the associations between health and education and ways in which school based health centers can be leveraged to increase access, provide affordable care, and produce cost savings. The committee heard from Voices for Georgia’s Children, the Partnership for Equity and Child Mental Health, and the Global Partnership for Telehealth on the details of the relationship between health and education outcomes. The committee tentatively scheduled the next meeting for September 29^th and two additional meetings to follow.

We (Consumer Education Specialist, Whitney Griggs, and Community Outreach Manager, Laura Colbert) made the drive to Augusta this week to check in with health care stakeholders and consumers in the northeast Georgia city.  We were warmly welcomed by community partners and are excited to return for next week’s community forum Coverage and Access to Care: A Local Focus on Augusta.

Our primary purpose for the trip was to attend the Greater Augusta Health Network’s (GAHN) fall forum.  The forum covered a variety of topics, including how the local District 13 Department of Public Health provides much needed direct patient services to people in its service areas, GAHN’s on-going health care utilization data collection efforts, and the Affordable Care Act’s effect on small employers (51 to 99 employees).

The forum closed with a discussion panel of indigent care providers, including Medical Associates Plus, St. Vincent de Paul health clinic, and Christ Community Health Services. These providers described their determined efforts to provide care for Augustans who cannot afford health insurance or pay for their health care. Mentioned by all three panelists was the need to close Georgia’s coverage gap. Every day each clinic serves people who need health care coverage, like veterans who can’t get are at the VA. The clinics are able to do this work only because of generous donations and profits from a few insured patients. While these charity care clinics are doing amazing work, they say that they cannot provide all the care that is needed for Augustans in the coverage gap.  Each of the panelists made the case that closing the coverage gap would be great for their patients and clients, and for their clinics.

Christ Community Health Services generously hosted us in the afternoon, so we could talk to their patients about why closing the coverage gap is important to them. One of the patients they talked to was Tracy. Tracy has chronic pain in her back, and is managing anxiety and depression brought on by her back pain. Her pain makes it impossible for her to sit at a computer to do her graphic design work, which means she has no income and no health care coverage. Tracy is stuck in the coverage gap, I told her that There are several good CBD companies to choose from when shopping online and that’s something that may help her. Her mother, Maria, pays what she can for Tracy’s care and drives her to and from appointments.  Tracy told us that she isn’t asking for a hand-out, she “just wants the public benefits that I paid into when I was working.”

It was clear from our visit that closing the coverage gap is an important issue to health care stakeholders and consumers in Augusta.  To learn more about the coverage gap in Augusta and in Georgia, join us for a community forum next Thursday, September 24^th.

RSVP here.

You’re invited to a panel discussion about the state of health care in Augusta and across Georgia. Local stakeholders and community leaders will discuss the current state of health insurance coverage and access to care, present regional and state data on Medicaid and the uninsured, and discuss opportunities to work together to improve coverage and access to care through direct collaboration and through policy change. We will place a special focus on Georgia’s coverage gap and lessons learned from other states that have reduced their uninsured rates by expanding Medicaid or through alternative approaches, such as a waiver.     The event will take place at the Augusta Richmond County Public Library on Thursday, Sept. 24th, 9 to 11 am. Coffee and a light breakfast will be served. This event is free, but we ask that you please register so we can get an accurate head count.

Panelists include:

Dr. Jacqueline Fincher, MD, MACP

Board of Regents | American College of Physicians | Managing Partner,  McDuffie Medical Associates

A representative from Christ Community Health Services

Tim Sweeney, Deputy Director of Policy Georgia Budget and Policy Institute

Dr. Bill Custer, Director of Center for Health Services Research

Click here to register for the event.

This column was authored by Cindy Zeldin, Georgians for a Healthy Future’s Executive Director, and originally appeared in the Atlanta Journal-Constitution on September 28th, 2015.

Earlier this month, the Georgia Department of Community Health announced that it had abandoned plans — at least for now — to seek flexibility in Georgia’s Medicaid program to allow for expanded coverage and an innovative delivery-of-care model for the patient populations served by Grady Health System in Atlanta and Memorial Health in Savannah.

While this pilot program would have been fairly limited, it was designed with the changing health care landscape in mind and in the spirit of making the health system work better for patients. The proposal relied on an integrated care model with primary care medical homes, care coordination, data sharing and a focus on prevention. The costs to the state would have been nominal — negligible, even — as Grady offered to foot the bill. That this effort is not moving forward is a disappointment, but it should not be a conversation-ender.

For years, the nation’s uninsured rate appeared stuck at a stubbornly high level. This had implications for individuals and families who couldn’t access the care they needed, for communities and health systems that experienced spillover effects, and for overall health and productivity. Over the past year and a half, the tide has turned. The uninsured rate has steadily declined, and in some states it has plummeted to less than 5 percent.

It is a time of tremendous change in health care, yet this change is being felt unevenly. According to a recent Gallup-Healthways survey, states that both established their own health exchange (or a partnership exchange) and expanded Medicaid saw greater declines in their uninsured rates than states that did neither. States that viewed the changing health care landscape as an opportunity, and the Affordable Care Act as a toolbox, to improve coverage saw far better results than those who did not.

Many states taking this “opportunity and toolbox” approach are now building on the foundation of high coverage rates to invest in prevention, improve access to care and enhance value for consumers, often in collaboration with local health care stakeholders.

Kentucky, for example, has reduced its uninsured rate from over 20 percent to 9 percent since 2013. Combined with an intentional focus on prevention, this has translated to a more-than doubling of the number of screenings for breast, cervical and colon cancer and of dental and physical exams. Other states like Oregon are developing initiatives to contain costs, improve quality and achieve better price transparency for consumers.

Of course, not every promising initiative will be a smashing success, but the pace of innovation and advancement is historic for American health policy. Here in Georgia, approximately 500,000 people enrolled in coverage through the Health Insurance Marketplace, an exciting development that has helped bring our state’s uninsured rate down to just above 15 percent. In normal times, with all else being equal, this would be extraordinary.

And while this achievement is transformative for the people and communities impacted, these are not normal times for the health system. Georgia’s uninsured rate remains among the nation’s highest, and our health outcomes, among the nation’s poorest. Without a more deliberate focus on coverage, access, value and outcomes, Georgia risks falling further behind other parts of the country. We cannot continue to do less with less.

The demise of the Grady experiment, while a disappointment, should be a conversation starter about moving Georgia towards an “opportunity and toolbox” mindset. To date, our state has stayed on the sidelines while others have moved forward, but we don’t have to remain there.

The evidence is beginning to pour in from around the country, and we can take the most promising initiatives out there and use them to inform a uniquely Georgia approach. The clearest evidence we have shows us the decision by the majority of states (30 and counting) to expand Medicaid is foundational in transforming the health system. The Grady initiative, while not Medicaid expansion, was at its heart a delivery system reform that was predicated on moving its target population into coverage as a first and necessary step.

We cannot make progress as a state if 15 percent of our population is uninsured. Too many Georgians fall into a coverage gap our leaders can fix. Medicaid expansion should be on the table, not as a perfect solution, but as a necessary first step.

New health insurance opportunities created through the Affordable Care Act (ACA ) have led to historic reductions in the nation’s uninsured rate. Here in Georgia, more than half a million consumers signed up for health insurance during the open enrollment period that ended this past February, known as OE 2.

These strong enrollment numbers mean that more Georgia consumers can access the health care services they need and enjoy enhanced financial security for themselves and their families. The reduction in our state’s uninsured rate, although smaller than that of the nation as a whole, also has positive implications for the vitality of local health care systems and communities throughout Georgia.

Too many Georgians, however, remain uninsured, either because

• they are unaware that there are coverage options that can meet their needs and budget
• face cultural, linguistic, financial, or other barriers to coverage; or
• fall into the “coverage gap” that was created when Georgia declined to expand Medicaid as authorized under the ACA

The goals of this report are

• to explain the role of in-person assistance on enrollment outcomes and consumers’ experiences
• to explore best practices that helped achieve robust enrollment in Georgia
• to identify any common challenges or barriers to enrollment that Georgia consumers faced during OE2
• to highlight promising strategies and approaches to reach the remaining uninsured who qualify for affordable health insurance
• to put forth policy recommendations that can help facilitate a positive experience for health care consumers, both for those who are newly enrolled and for those who remain uninsured.

You can download and read the report below.

[embeddoc url=”https://healthyfutprod.wpengine.com/wp-content/uploads/2015/12/Getting-Georgia-Covered-Cover.pdf”]

While Georgia has made little progress on closing its coverage gap, the subject is a hot topic elsewhere.

• Montana has closed its coverage gap! As the 29^th state to close the gap, Montana will provide 70,000 Montanans with quality, affordable health care coverage.  The state is currently working with CMS to gain approval for its expansion proposal.
• Face Off in Florida–The debate over closing the coverage gap is as hot as sunburnt skin after spring break! Floridians have seen a sudden and unexpected adjournment of the legislative session, a stand-off with HHS over the low-income pool (LIP), and their governor file suit against the federal government.  The debate is far from over as the legislature plans to reconvene in June to complete their legislative responsibilities.
• Policy makers in both Alaska and Louisiana are discussing if and how to close their coverage gaps.  While their legislators debate whether or not to close the coverage gap during a special session, polls show that Alaskans are hugely in favor of the policy.  In Louisiana, Gov. Jindal remains opposed to the idea of closing his state’s coverage gap, but legislators are discussing their options.

While Montana closes its gap and other states think through their options, more and more studies are revealing that closing the coverage gap is good for states! It saves money in state budgets and facilitates job growth, especially in the health care sector.  Families USA summarized the new data in a recent blog post.

Please join us on Wednesday, March 25, from 8:45 am to mid-day for a morning of advocacy!  GHF will provide individuals and organizations with the opportunity to advocate for the important health issues that matter to you in the closing days of this legislative session.  You may want to advocate for closing the coverage gap, Medicaid payment parity, raising the tobacco tax, the Family Care Act, rural health care access, or another health policy issue.  You’re all invited to participate!  We’ll provide breakfast, an advocacy training, and an opportunity to share and network with other health advocates.

To sign up, click here.  If you have any questions, please contact Laura Colbert.

Yesterday marked the 27th day of the 2015 Legislative Session. Crossover Day, the 30th legislative day and the deadline for a bill to pass its chamber of origin to remain viable for 2015, is set for next Friday, March 13th. Sine Die, the 40th and final legislative day for the year, will be April 2nd.

It has been a big week for health care issues at the State Capitol. GHF brought the consumer perspective to Senate Insurance on Wednesday and shared with the committee through testimony from our Executive Director the challenges that consumers face in obtaining accurate information about provider networks at the time they sign up for health insurance and why setting network adequacy standards is important for consumers. Her testimony was provided as part of the discussion around SB 158. Also this week, legislation was introduced in the Senate that would establish a study committee onpreventing youth substance use disorders, the Senate began its work on the FY 2016 budget, and a range of other health care bills were discussed.

The State Budget:  The FY 2016 Budget passed the House of Representatives and is now in the Senate. The Senate expects to finish their revisions to the budget this week and send it back to the House and then to a conference committee.

Medicaid Parity:  Last week, the House of Representatives added $2.96 million in the budget to increase reimbursement for certain OB/GYN services and $1.5 million for reimbursement rate increases for certain primary care services. Because Medicaid parity has been shown to be an effective strategy for improving access to care, GHF supports raising Medicaid reimbursement rates to parity with Medicare rates. We are advocating for a higher appropriation amount for Medicaid reimbursement rate increases as the budget moves through the process.

SBIRT Resolution:  Senate HHS Chairwoman Renee Unterman officially introduced a resolution (SR 407) to form a joint House and Senate Study Committee on preventing youth substance use disorders. Through GHF’s work with the Georgia Council on Substance Abuse, we are advocating for a public health approach to substance use disorders that focuses on prevention. This resolution gets the conversation started about how to do that in Georgia. Please take the time to thank Senator Unterman for her support of this effort and to let your elected officials know you support SR 407.

SB 158 (Sen. Burke) provides certain consumer and provider protections regarding health insurance, including network adequacy language. SB 158 has been referred to the Senate Insurance Committee where it received a hearing on Wednesday, March 3.  GHF Executive Director Cindy Zeldin testified in committee, focusing specifically on the network adequacy component of the bill. GHF also met with committee members individually about the bill after the committee hearing.  While the bill is not expected to move in its current form this legislative session, there will likely be a study committee on the network adequacy component. GHF has identified network adequacy as an important consumer issue and plans to remain engaged on this topic as discussions move forward.

Closing the Coverage Gap: No hearings have been scheduled or are pending to address the possibility of expanding Medicaid in Georgia. Closing Georgia’s coverage gap by expanding Medicaid would open a pathway to health insurance for approximately 300,000 uninsured Georgians, an approach which GHF supports.  Two bills have been introduced to address Georgia’s coverage gap (HR 226 and SB 38), although neither is expected to receive a hearing. Please thank the cosponsors of these bills, Rep. Rahn Mayo and Senator Vincent Fort, for their support and show your support by filling out a postcard that we’ll mail to your legislators!

Tobacco Tax:  No additional standalone proposals have been made to increase Georgia’s tobacco tax (other than HB 445 as previously reported).  The Senate however, may respond to the House proposal on transportation funding by including a tobacco tax increase to the regional average of around 68 cents. Importantly, Alabama’s Governor is proposing an increase in their state tobacco tax to $1.25 per pack, which would increase the regional average.  GHF continues to advocate for an increase to the national average by raising our tobacco tax by $1.23.  Such an increase would generate $585 million per year according to the fiscal note generated by the non-partisan fiscal office at GSU.

Other Bills of Interest

Below is a summary of bills that may impact health care consumers in Georgia, with information about where they are in the legislative process.

SB 1 (Sen. Bethel) provides certain insurance coverage for autism spectrum disorders. SB 1 has passed the Senate and is in the House Insurance Committee.

HB 1 (Rep. Peake) would allow for the limited use of medical marijuana as long as long as the provider is the best weed dispensary for conditions including cancer, amyotrophic lateral sclerosis, seizure disorders, multiple sclerosis, crohn’s disease, mitochondrial disease, fibromyalgia, parkinson’s disease, and sickle cell disease, but it is still important for people to know the the difference between CBD and THC.  HB 1 passed the House of Representatives and is now in the Senate Health and Human Services Committee. Go to Dank City – Cannabis News, Culture, Entertainment and Information to find out more.

HB 195  (Rep. Cooper) and SB 51 (Burke) provide parameters for substitutions of interchangeable biological products. HB 195 passed the House Health and Human Services Committee and is expected to come out of the Rules Committee next week, and Senate Bill 51 has passed the Senate and has been assigned to the House HHS committee, but is not expected to get a hearing until after crossover day.

HB 482 (Rep. Willard) seeks to eliminate two of the requirements that the Cancer Treatment Centers of America was subject to when they were allowed into Georgia as a destination hospital.

HB 416 (Rep.Rogers), routinely referred to as the badge bill, seeks to provide clarity and transparency for the patient as to the qualifications of the provider that they are seeing.  The bill calls for providers to identify the health care practitioner’s name and the type of license or educational degree the health care practitioner holds. The bill passed out of committee on Tuesday March 3.

HB 34 (Rep. Dudgeon) is known as the “Right to Try” bill and calls for patients with advanced illnesses and in consultation with their doctor to use potentially life-saving investigational drugs, biological products, and devices. The bill passed out of the House HHS committee.

HB 429 (Rep. Stephens) seeks to ban coverage denials for medically necessary treatment based solely on life expectancy or the diagnosis of a terminal condition.  The bill is in the House Insurance Committee.

HB 76 The House appropriations bill, provides $200,000 to continue the Prescription Drug Monitoring Program in the state, which would otherwise run out of funds and expire on June 30, 2015.  The appropriations bill is currently in the Senate.

HB 504 (Rep. Cooper) would extend the flu vaccine protocol that is in place between physicians and pharmacists and nurses for adults to pneumococcal, shingles, and meningitis.

HB 436 (Rep. V. Clark) would require physicians and health care providers to offer to test pregnant women who are in their third trimester for HIV and syphilis.

HB 463 (Rep. Harbin) would permanently extend a $1,000 tax credit for “medical core clerkship” preceptors for “community based” nurse practitioners and physician assistants.