Laura Colbert, executive director of Georgians for a Healthy Future, agreed the issues of drug prices and transparency, coupled with the role PBMs play in the equation, will come up…
More than 1 million Georgians have lost their health coverage due to job loss during the COVID-19 pandemic. If this is your situation, you can keep yourself and your family covered during this health crisis.
You have three main pathways to coverage:
- Affordable Care Act
- With financial assistance—half of Georgians who lose their insurance will qualify for ACA coverage with financial help to lower the premium they pay each month. In some cases, you may see lower deductibles & co-pays too.
- Without financial assistance—some Georgians, despite a job loss, will still make too much for financial help but you should still shop for coverage to see if there’s a plan that fits your new budget.
- Medicaid & PeachCare for Kids—About 25% of Georgians losing their health coverage may qualify for Medicaid. Georgians most likely to qualify for Medicaid coverage include children, low-income pregnant women, and very low-income parents. Other Georgians who qualify for Medicaid are people with disabilities, seniors, and low-income women with breast or cervical cancer.
- COBRA—in most cases, you will be able to find less expensive coverage from the ACA marketplace. COBRA may be the best option for you if it is important that you maintain a consistent provider (pregnant women, people with chronic or complex conditions).
Some Georgians who have lost their health coverage due to job loss will fall in Georgia’s coverage gap because the state has not expanded Medicaid. That means they can’t get financial help through the ACA and they also don’t qualify for Medicaid.
If you are in the coverage gap because you lost your job, please read the If you are uninsured section (click to go directly there). Then contact Georgians for a Healthy Future at 404-567-5016 x 4 to learn how you can share your story and help fix the problem!
Affordable Care Act (ACA) coverage
Financial assistance is available!
When you begin the shopping/enrollment process, healthcare.gov will ask you about your estimated income for 2020. With that information healthcare.gov will let you know if you qualify for financial help to lower your premiums and other costs. Most Georgians qualify for financial help!
When you estimate your income, include the money you made from your job before you were laid off, any unemployment checks that you expect to receive, and any money that you expect to make from getting re-hired/a new job later in the year. Do not count your stimulus check as income!
For free help with the enrollment process, contact Insure Georgia at insurega.org or 866-988-8246.
Coverage through the ACA marketplace covers testing for COVID-19. It will also cover part or all of the costs related to COVID-19 treatment. Contact your insurance company for more information.
Medicaid & PeachCare for Kids
You can enroll yourself, your family, or your children in Medicaid or PeachCare for Kids at any time, if you qualify. Enroll at gateway.ga.gov.
Children are most likely to quality for Medicaid and PeachCare. Pregnant women and some parents may be eligible for Medicaid coverage depending on your monthly income. (The amount of unemployment you get from Georgia counts as income but the additional $600 per week from the federal government does not.)
Click here to see if you can qualify as a parent and to see if your kids qualify. If you are pregnant, you must make less than these amounts to qualify for Medicaid:
Medicaid is required to cover COVID-19 testing and treatment for free. In addition, you do not have to pay any Medicaid or PeachCare premiums or co-pays during the COVID-19 national emergency.
If you have or enroll in Medicaid coverage, you cannot be disenrolled (kicked off) during the COVID-19 national emergency.
If you have questions about Medicaid and whether you qualify, call the Georgia Division for Family & Children Services at 877-423-4746.
You may also contact Atlanta Legal Aid (find the phone number for your county here) or Georgia Legal Services Program at 1-800-498-9469 with questions or concerns.
If you are uninsured/unable to get health coverage
Do not skip or avoid health care just because you are uninsured! You can get free or low-cost health services at:
- Community Health Centers—find the clinics closest to you here
- Charity Care Clinics—find the clinic closest to you here
- Health care over the phone/online (telehealth)—Giving Health offers free telehealth services to people who are uninsured. Visit givinghealth.org/how-it-works or call 866-662-1923.
- Check with your local hospital to see what financial assistance programs you may qualify for
References & resources
Every day four Georgians die from opioid overdose and recent data from the Centers for Disease Control and Prevention confirm that the epidemic shows no signs of slowing. Health care providers, public health professionals, community leaders, and families are all searching for effective strategies to slow and stop this growing public health crisis. Some initial steps have been taken by Georgia policy makers and others to increase access to life-saving drugs like naloxone, improve and expand the prescription drug monitoring program (PDMP) to prevent over-prescribing, and raise public awareness about the risks of opioids and other substances, but more is needed. Solutions must include evidence-based strategies that emphasize prevention and early intervention, as well as timely treatment and support for recovery.
An exciting development within Georgia’s Medicaid program gives health care providers an additional tool to aid in the fight against substance use disorders, especially among adolescents and young adults. Georgia’s Medicaid agency has activated the reimbursement codes for a tool called SBIRT, which stands for Screening, Brief Intervention and Referral to Treatment. SBIRT is a set of tools that identifies people who use alcohol or other drugs at harmful levels and guides follow-up counseling and referral to treatment before serious long-term consequences occur.
Ninety percent of adults who meet the medical criteria for addiction started smoking, drinking, or using other drugs before they were 18 years old. Because Medicaid and PeachCare for Kids cover half of all Georgia children, the activation of the Medicaid reimbursement codes for SBIRT is a powerful opportunity to identify youth substance use and intervene early. Studies show that simply asking young people about drugs and alcohol use can lead to positive behavior changes and that brief interventions reduce the frequency and amount of alcohol or other drug use by adolescents.
This policy change was the product of a sustained advocacy effort by Georgians for a Healthy Future (GHF) and the Georgia Council on Substance Abuse (GCSA). We anticipate it will lead to the screening of an estimated 145,000 Georgia youth annually and that 36,000 of those youth will present substance use behaviors that prompt a brief intervention with a health care provider. Initial data from Georgia’s Medicaid agency demonstrates that some providers are already making use of the SBIRT codes in their practices.
Notwithstanding these exciting results, we have committed to continue our efforts to improve access to screening, early intervention, and recovery services and supports for young people across Georgia. While the Medicaid reimbursement codes allow physicians, physician extenders, and advanced practice registered nurses to provide SBIRT services, we recognize that RNs, LPNs, licensed clinical social workers, and certified peer counselors can and should be able to provide SBIRT to youth and adults. Further, the codes allow SBIRT to be provided primarily in health care settings, but that excludes schools and other community-based settings where most young people spend their time.
We invite you to join our efforts to prevent substance use among young Georgians. Spread the word by giving our new fact sheet to the providers in your clinic, public health department, or hospital. If you are a health care provider, attend a training to develop the skills to implement SBIRT with the people that you care for. Join our on-going advocacy efforts to activate the reimbursement codes for more practitioner levels (including RNs and LPNs) and more settings by contacting us to let us know you are interested.
The opioid and substance use crisis that is sweeping Georgia and impacting communities nationwide will require a full spectrum of solutions that leverage the expertise of health care providers, public and private resources, and community and family supports. SBIRT is an evidence-based tool that can play a significant role in our collective efforts to reduce substance use and create a healthier Georgia for all of us.
To learn more, visit our Keeping Youth on a Healthy Path page.
For health care providers: download our new fact sheet here.
Georgians for a Healthy Future is excited to release our new enrollment toolkit! The toolkit is a comprehensive compilation of fact sheets, neatly organized, that are designed to walk consumers through each step of the enrollment process – from how to get health insurance (enrollment) to how to use health insurance once they have it (post enrollment). You can download it here.
Need more information like this? You’re in luck! GHF has created the GEAR Network for people just like you. GEAR is the new central hub of resources for Georgia’s enrollment assisters and community partners that are working with people to educate them on their health and health coverage options. We’ll send out weekly emails full of local resources and the information you need to know through OE3 and beyond. For more information on GEAR, check out this presentation.
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.
Federal funding for the Children’s Health Insurance Program (CHIP), known as PeachCare for Kids in Georgia, expires in September 2015. More than 200,000 Georgia kids rely on this program for access to health care services. The U.S. Congress has signaled that it is willing to consider extending CHIP funding. This is great news. However, some of the discussions include provisions that provide access barriers. Some concerning provisions include the removal of protections that were included in the ACA, an optional 12-month waiting period for coverage, and cuts to CHIP funding for certain groups of children in some states. (Click here for a full analysis of the draft plan.) You can help by telling your legislators to pass a clean renewal of CHIP funding that does not impose barriers to enrollment and coverage for kids. Here are some ways to get in touch:
- Write a letter or call your congressman. Click here to see suggested language from our partners, Voices for Georgia’s Children. Click here to find your congressman, senator and their contact information.
- Tweet at your representatives in congress. See the list below for their Twitter handles. Use the hashtags #ExtendCHIP #keepkidscovered and #CHIPWorks
- Share this image from Voices for Georgia’s Children (@georgiavoices) on social media to spread the word.
@SenatorIsakson 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
@sendavidperdue 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
Buddy Carter (1st District)
@RepBuddyCarter 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
Sanford Bishop Jr. (2nd District)
@SanfordBishop 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
Lynn Westmoreland (3rd District)
@RepWestmoreland 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
Hank Johnson Jr. (4th District)
@RepHankJohnson 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
John Lewis (5th District)
@repjohnlewis 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
Tom Price (6th District)
@RepTomPrice 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
Rob Woodall (7th District)
@RepRobWoodall 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
Austin Scott (8th District)
@AustinScottGA08 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
Doug Collins (9th ,District)
@RepDougCollins 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
Barry Loudermilk (11th District)
@RepLoudermilk 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
Rick Allen (12th District)
@RepRickAllen 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
David Scott (13th District)
@repdavidscott 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
Tom Graves (14th District)
@RepTomGraves 200,000 GA kids rely on PeachCare to receive the critical care they need. #ExtendCHIP so we can #keepkidscovered #CHIPWorks (Click here to tweet this)
During the 2013 Legislative Session, our state policymakers passed HR 107, which created a joint study committee on Medicaid reform. The purpose of the committee is to evaluate the state’s Medicaid program, examine best practices in other states, and plan for the future of the program. Many health care advocates monitored the legislation closely during the past Legislative Session because of the important role that Medicaid plays in providing health care services to our state’s most vulnerable citizens. The first meeting date for the study commission has been announced and will be held on August 28th from 10am – 12pm. The location for the meeting has not yet been announced, but more information about the committee is available here.
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.
The 2013 Georgia Legislative Session has ended. The 2014 state budget and dozens of bills now go to Governor Deal for his signature or veto (the governor does have the authority to line-item veto parts of the state budget). Bills that did not pass this year are still viable in the 2014 Legislative Session, which will be the second year of a two-year session. Below is a summary of bills that passed the General Assembly this year that could impact health care consumers. For a complete rundown of how health care-related legislation fared, see Georgia Health News’s recap.
Legislation that could impact Medicaid and PeachCare beneficiaries
The final 2014 budget eliminated proposed rate cuts for health care providers (a 0.74% rate cut had been proposed for non-primary care providers within Medicaid and PeachCare for Kids), eliminated a proposed coding change that would have resulted in cuts for certain providers, and included funds for enrollment growth in Medicaid. This is good news for access to health care services; however, Medicaid, PeachCare, and other public health programs have sustained deep budget cuts in recent years. In future years, if we are to improve the state’s health, additional investments in public health and health care delivery will be needed.
HR 107 would create a joint study committee on Medicaid reform that would study current Medicaid policies and procedures, models in other states, and other aspects of the Medicaid program and report to the General Assembly and the Governor by December 31, 2013 with recommendations. HR 107 passed both the House and the Senate.
SB 62 would create a Federal and State Funded Health Care Financing Programs Overview Committee, a joint committee of the General Assembly. SB 62 has passed both the House and the Senate.
SB 24, which would authorize the Department of Community Health to levy a fee on hospitals to continue drawing down federal funds to support Medicaid and PeachCare for Kids, was passed by both the House and Senate and was signed into law by the Governor back in February. The current hospital fee had been set to expire on June 30, 2013. The renewal of the fee was essential to ensuring Medicaid and PeachCare’s solvency and preserving access to hospital care in Georgia.
Legislation impacting health insurance consumer protections and access to insurance
SB 236 would require insurance companies to send concurrently with any statements sent to consumers that provide notice of premium increases an estimate of the portion of any premium increase that is due to the Affordable Care Act. How this is determined would be left to insurance companies to calculate, and they would not have to disclose their methodology. There would also be no requirement to present information about any other factors leading to premium increases or to notify consumers about available tax credits that may more than offset premium increases or about any cost savings or benefit enhancements they are receiving as a result of the Affordable Care Act. As such, this bill would result in consumers receiving incomplete and potentially misleading information. SB 236 has passed both the House and the Senate.
HB 198 would require licensing, certification, and training for health benefit exchange navigators and would restrict their ability to assist consumers. While ensuring that consumers receive accurate information from navigators about their health insurance options and protecting consumers is an important goal shared by Georgians for a Healthy Future, HB 198’s restrictive language and potentially duplicative training requirements could deter community-focused nonprofits, whose participation in the navigator program will be essential in reaching vulnerable populations who have historically faced barriers to enrolling in health insurance, from becoming navigators or from providing appropriate consumer assistance. Georgians for a Healthy Future looks forward to working with policymakers to ensure this bill is implemented in a manner that minimizes duplication and encourages participation from community-focused nonprofit organizations. HB 198 has passed both the House and the Senate.
HB 389 would allow insurance companies to terminate, cancel, or non-renew conversion policies or any health insurance policies offered through the health insurance assignment system when guaranteed issue becomes available (with a 90-day cancellation period and a 90-day open enrollment period into new health insurance options made available through the Affordable Care Act). HB 389 has passed both the House and the Senate.
The 2013 Legislative Session continues at a swift pace, with legislators in session today for day 17 of the 40-day session (the legislative calendar is available here). Here are some key health care updates:
- Yesterday, the Health Subcommittee of the House Appropriations Committee heard from the Commissioners of the state’s health-related agencies, including the Department of Community Health and the Department of Public Health, about their proposed FY 2014 budgets. Today, the subcommittee will meet again from 2 – 4pm in Room 506 CLOB to take public comment on the proposed budgets. If you would like to comment, you must sign up in advance in Room 245 of the State Capitol. The Georgia Budget & Policy Institute has released an analysis of the 2014 proposed budget for the Department of Community Health, available here.
- SB 24, which would authorize the Department of Community Health to levy a fee on hospitals to continue drawing down federal funds to support Medicaid and PeachCare for Kids, was passed by both the House and Senate and is expected to be signed into law by the Governor this morning. The current hospital fee is set to expire on June 30, 2013. The renewal of the fee is essential to ensuring Medicaid and PeachCare’s solvency and preserving access to hospital care in Georgia.
- HB 198 would require navigators to be licensed, place certain restrictions on their functions, and would give the Georgia Insurance Commissioner regulatory authority over them. Navigators are organizations or entities that apply for and receive federal grants authorized by the Affordable Care Act to provide individuals and small businesses with impartial information and assistance with enrollment in health coverage in the new health insurance marketplaces, or exchanges. While it is important that navigators are qualified to perform these functions and that there is adequate oversight to protect consumers, consumer advocates are also concerned that overly restricting navigators could have a chilling effect on the community-focused organizations whose participation in the navigator program will be critical in connecting hard-to-reach and vulnerable populations to coverage. Advocates worked with legislators to improve the bill, which passed the House Insurance Committee last week and was passed by the Rules Committee yesterday.
Last week, state agency heads presented Governor Deal’s proposed budgets for their respective agencies to the House and Senate Appropriations committees.
Access to care: the good news
Primary care providers will receive an increase in Medicaid reimbursement rates to parity with Medicare rates, funded entirely with federal dollars made available to Georgia through the Affordable Care Act. This can help preserve and strengthen access to care for Medicaid patients seeking primary care and prevention services.
Access to care: the bad news
The Department of Community Health’s proposed budget would reduce provider reimbursement rates within Medicaid by .74 percent for providers other than hospitals, primary care, FQHC, RHC, and hospice providers. This proposed rate cut, if implemented, could jeopardize access to care for Medicaid patients who require services such as dental care, obstetrics and gynecology, and oncology, among other non-primary care services.
Hospital fee renewal moves through the Legislature
SB 24, which would authorize the Department of Community Health to levy a fee on hospitals to continue drawing down federal funds to support Medicaid and PeachCare for Kids, has passed the State Senate and will be before the House of Representatives for a vote today. The current hospital fee is set to expire on June 30, 2013. The renewal of the fee is essential to ensuring Medicaid and PeachCare’s solvency and preserving access to hospital care in Georgia.