At the end of July, the Department of Community Health (DCH) awarded the Medicaid redesign assessment contract to Navigant Consulting.  The purpose of the redesign process is to analyze options to manage Medicaid and PeachCare financing, as well as explore improvements in the delivery of affordable, quality, health care for the programs and their recipients.  As part of the contract, Navigant will hold up to 30 stakeholder focus groups across the state, in cities yet to be announced.   Part of the state environmental scan, the intent of these focus groups is to provide a forum for Georgia-specific input from providers, other agencies, advocates, and others affected by Medicaid and PeachCare to provide useful information to both Navigant and DCH as this process unfolds.  If you or your organization would like to participate in these focus groups, you can submit an application online here. The deadline for submissions is Tuesday, September 13th.

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Georgia’s Department of Community Health (DCH) recently received two federal grants from the Department of Health and Human Services to improve outreach and enrollment for Medicaid and PeachCare as well as improve the public health infrastructure in Georgia.  The first grant, worth $2.5 million, will allow DCH to use technology solutions to better coordinate enrollment and renewal in Medicaid and PeachCare programs.  The second grant, worth $499,738, will go to strengthening public health infrastructure for improved health outcomes and to help train and educate public health workers. To learn more about these grants, click here and here.

By Dr. Harry J. Heiman and Cindy Zeldin

This column was originally published in the Athens Banner-Herald on August 26, 2011.

The recent debt-ceiling debate and prime-time display of our elected leaders’ inability to work together epitomized the challenges of advancing thoughtful and impactful public policies. Following the deal in Congress, news coverage quickly moved to speculation about the “super committee,” tasked with slashing an additional $1.2 trillion in federal spending over the next decade. Lost in the coverage, and seemingly in the discussion, has been the potential impact of the committee’s decisions on vital services for the most vulnerable in our communities. At a time when the number of people without health insurance continues to rise, Medicaid and other programs that support health care access for low-income children, families, and the disabled remain at risk.

Reduced federal and state funding for Medicaid and the health safety net would be particularly traumatic for Georgia, which has been hit hard by the economic downturn and suffers from high poverty, high unemployment, and high rates of uninsured people. Nearly two million Georgians — one in five — are uninsured, and more than one in six live in poverty. These numbers are even worse in many of Georgia’s rural and inner-city communities. At 37 percent, Athens-Clarke County has one of the highest rates of uninsured people in the state. The consequence of these worsening economic indicators is increased distress experienced by Georgia’s most vulnerable citizens. This distress is reflected in Georgia’s dismal health indicators: high obesity rates, high infant mortality rates and overall poor health outcomes.

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The Georgia Department of Community Health Board met earlier this week and approved a .5 percent cut in reimbursement rates for providers participating in the Medicaid and PeachCare for Kids programs (final adoption of rules). The board also proposed increasing co-payments for Medicaid patients and adding co-payments for the first time for PeachCare for Kids patients ages 6 and older (initial adoption of rules). Both changes reflect decisions made by the General Assembly during the 2011 Legislative Session. However, there is concern among advocates and health care providers that these changes will diminish access to care. For more information about these changes, see a recent Georgia Health News article here and a recent AJC article here. For materials from the Department of Community Health board meeting and information about upcoming meetings, click here.

Gayathri Suresh Kumar, M.D
Georgia State Director, Doctors for America

The House’s proposed budget plan to reduce federal support for Medicaid by converting it into a block grant program is the most absurd idea.  As a physician at Grady Memorial Hospital in Atlanta, I provide care for many patients who are dependent upon Medicaid for their well-being. Without Medicaid, what would happen to my patients? Would they stop coming to their appointments or picking up their medications knowing they no longer can afford health care? What if their medical conditions spiral out of control and they seek help at a stage where it may be too late for me to provide meaningful care? (more…)

Georgians for a Healthy Future has a new fact sheet out today about how to access health insurance in Georgia. Please share with patients, consumers, providers, community organizations, or anyone for whom it can serve as a resource. The fact sheet can be downloaded by clicking here.

By Cindy Zeldin

This article originally appeared in the Atlanta Journal-Constitution.

Earlier this month, Gov. Nathan Deal signed an executive order creating the Georgia Health Insurance Exchange Advisory Committee, which is charged with determining whether Georgia should establish a state-based health exchange.

If well crafted, a Georgia insurance exchange has the potential to increase transparency, present clear and meaningful choices, and promote better value for consumers who don’t have access to a health plan at work.

The Affordable Care Act authorized state-level health insurance exchanges, providing a basic framework and initial funding. By 2014, each state’s exchange must be able to enroll individuals and small businesses into health insurance plans and certify that plans meet certain requirements, such as an adequate provider network and an essential benefits package. Within this framework, Georgia has considerable flexibility to fashion a structure that best meets our state’s individual needs like luxury. Luxurious cars, great clothes, Tahitian Necklace, and houses. When you want to have the most comfortable beds and mattress, avail the black friday casper mattress for maximum comfort.

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Guest Blog by Michelle Putnam, HealthSTAT

If you think you’d like to get a physical or a check-up in 2014, you better make your appointment now.  That’s what some would have you believe about the shortage of doctors come 2014, when health coverage will be expanded to about 33 million more people.  The truth is, Georgia has long experienced a workforce shortage, ranking behind most states in the ratio of patients to physicians, nurses, and physicians assistants.  The problem is three-pronged: we do not have enough health professionals choosing to practice primary care, we do not have an adequate collaborative care system, and our health professional students do not receive enough interdisciplinary education.

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HB 229 Tackles Problems of Backlogged and Unfair Medicaid Appeals

Both federal and state law grants Medicaid members and applicants the right to a fair hearing when Medicaid services are denied for reasons such as eligibility determination, frequency, or duration or intensity of services.  When a Medicaid member is denied coverage he or she may dispute the denial by filing an appeal and request for a hearing with the Department of Community Health (DCH), the state agency that administers the Medicaid program.  DCH processes the request and forwards it to the Office of State Administrative Hearings (OSAH) for a hearing before an administrative law judge (ALJ).  The ALJ listens to testimony, reviews the evidence, and reaches an impartial decision.  Federal law requires that when a Medicaid member requests an appeal a final decision must be made within 90 days, absent extenuating circumstances.

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Georgians for a Healthy Future ED Cindy Zeldin is interviewed by Milton Little, President of the United Way of Metro Atlanta, about health care access in Georgia and how the new health law can help.