"These gaps really make it so that Georgians can't afford needed health care. If they receive health care, they're left with medical debt, or they have to make really tough…
A shorter version of this commentary originally appeared on the op-ed page of the Atlanta-Journal Constitution on March 2nd, coauthored by Pat Willis of Voices for Georgia’s Children and Cindy Zeldin of Georgians for a Healthy Future (available here).
The Georgia Department of Community Health is in the midst of a process to redesign the state’s Medicaid and PeachCare for Kids programs. Together, these two programs cover more than 1.7 million low-income children, families, and disabled Georgians. As advocates for Georgia’s children and for Georgia’s health care consumers, we view this redesign process as an opportunity to strengthen these programs to ensure they provide access to the services that children and families need to live healthy and productive lives.
The first phase of the Department’s redesign effort, an assessment of the Medicaid landscape in Georgia and in selected states around the country conducted by an outside consulting firm, was recently made public. In addition to a lay of the land, the report featured three major redesign options, each of which would move Georgians with disabilities from fee-for-service into managed care arrangements. There are questions about how well managed care may work for populations with complex health needs such as Disabled Access Lifts, and the Department should work with advocates for these vulnerable Georgia citizens to ensure any redesign system does not disrupt or impede care for this fragile population.
At the same time, we must not lose sight of the children who are already enrolled in managed care through Medicaid and PeachCare for Kids. Nearly a third of Georgia’s children are covered through these programs, and there are concrete steps that the Department can take now to bolster these programs for the future. We encourage the Department to adopt a best practices approach by focusing on three evidence-based themes as it redesigns these programs for children: first, coverage matters; second, ensuring access to care requires adequate network capacity and accountability; and third, ensuring quality of care requires system coordination.
Coverage matters. Numerous studies link continuous health insurance coverage to improved health outcomes. Georgia has made an intentional effort to cover more children in recent years: our uninsured rate for kids has steadily improved from 11 percent in 2008 to 9.8 percent in 2010. Still, about three-quarters of uninsured children in Georgia are eligible for Medicaid or PeachCare for Kids, and by leveraging new enhanced funding opportunities and program flexibilities at the federal level and by borrowing a page from successful initiatives in neighboring states like Alabama, which has reduced its uninsured rate for children to just six percent, we can get closer to the goal of providing health coverage to all of Georgia’s children. For example, Georgia could simplify the eligibility process for children by adopting a policy of 12 months continuous eligibility for kids (currently, some children fall through the cracks with a 6-month renewal policy). There are other administrative and technology system enhancements the Department can take to make it easier for kids to enroll and remain enrolled in coverage, and we encourage the Department to do so.
Ensuring Access to care requires adequate network capacity and accountability. Getting and keeping kids enrolled in Medicaid and PeachCare for Kids is critical, but it is only a first step to ensure that children have appropriate access to a well-coordinated and patient-centered medical home. Significant documented weaknesses in pediatric specialty networks exist in certain regions of the state. Georgia has two policy levers at its disposal to bring these networks up to standard: first, increase provider reimbursement rates for specialty care and second, monitor the contracts with the care management organizations to ensure compliance with policies to establish out-of-network arrangements. Where overall shortages in physician supply hinder access, the Department should work with the care management organizations to explore emerging solutions such as telemedicine, an approach that states like Texas have embraced with some success.
Ensuring quality of care requires system coordination. The Department of Community Health maintains strong quality standards, but performance measures show opportunities for improvement. For example, well-care visits and key screenings are below national averages, and less than half of Georgia’s children with behavioral health needs obtain the care they need. Promising care coordination practices in states like Texas, which uses an electronic health records system to share medical histories and ensure coordinated care for children in the state’s foster care system, and Rhode Island, which utilizes specially trained parent consultants, can inform Georgia’s efforts to develop a more coordinated system of care for children. The Department should also develop and enforce rigorous contracting standards to enhance quality.
We commend the Department of Community Health for its proactive efforts to modernize Medicaid and PeachCare for Kids and encourage best-practices based systems changes that incorporate these three themes. The health of Georgia’s children hangs in the balance.
In the on-going efforts to redesign Georgia’s Medicaid and PeachCare programs, the Department of Community Health (DCH)
is continuing to analyze and evaluate its options and has convened three taskforces to gather feedback from consumer advocates, providers and other stakeholders. The latest taskforce, focused on children and families will hold its first meeting on March 9th. GHF’s Outreach and Advocacy Director Amanda Ptashkin will be there to represent health care consumers who currently access these programs or who will gain access through the Medicaid expansion in 2014. Part of the charge of this taskforce includes identifying:
- Program features identified in the Navigant report that are most/least appealing to meeting the needs of families and children;
- Current features of the program that should be maintained;
- Largest unmet need of the current program;
- Better medical management and coordination for children in foster care;
- Additional insights not identified in the report; and
- Identification of critical design features needed to protect the needs of children and families
If you or your organization have thoughts on the above charge, please email Amanda Ptashkin. To learn more about the redesign process, visit www.healthyfuturega.org/issues/careforgeorgiaskids
The 2012 Legislative Session continues today as legislators meet for Day 27 of the 40-day Session. Crossover Day (Day 30), when a bill must pass at least one chamber to remain viable for the Session, will be March 7th. Here is what health care advocates are watching:
- The House and Senate have both passed versions of the Amended FY 2012 Budget (HB 741); since there are minor differences, HB 741 now heads to conference committee. Notably, the Senate version added $1.2 million in the Department of Public Health budget for the Children 1st program to replace the loss of Supplemental TANF funds. This program provides screenings for newborns. Also in the Senate version, funds were added to the Department of Community Health budget to reflect projected need in Medicaid but there were also cuts to reflect the rounding down of co-payments to the nearest dollar. Meanwhile, work continues on the FY 2013 budget. Click here for the Georgia Budget & Policy Institute’s analyses of the implications for the state’s health care agencies on the governor’s proposed 2013 budget recommendations.
- HB 1166, sponsored by Representative Atwood, would restore child-only health insurance policies to Georgia’s individual market. Georgians for a Healthy Future, along with a range of child health advocacy groups, is in strong support of this measure to provide this option for families who need coverage for their kids. The bill is expected to be before the House Insurance Committee on Wednesday. You can learn more about this issue by downloading our fact sheet.
- HB 801 and SB 418 were introduced by Representative Gardner and Senator Orrock, respectively, as companion bills to establish a health insurance exchange in Georgia. While leadership in the House and Senate have indicated that there will not be movement on an exchange this year, please thank Representative Gardner and Senator Orrock for their leadership on this important issue. You can learn more about how a Georgia exchange could work by downloading our issue brief here. All information from the Governor’s Health Insurance Exchange Advisory Committee, which met throughout the second half of 2011 to develop recommendations on this issue, is available here.
- HB 1159, sponsored by Representative Pruett, is known as the New Parent Information Bill and would create a Joint Study Commission on Education for Parents with Newborn Children to determine how best to gather information, raise funds and create a comprehensive informational video. The video would include but not be limited to information on the prevention of childhood obesity; how to prevent SIDS, shaken baby syndrome, and other forms of child abuse; how to prevent death and injury and additional information which would assist parents to raise safe and healthy children. The bill is expected to be before the House Health and Human Services Committee this week.
Don’t forget to download our Consumer Health Advocate’s Guide to the 2012 Georgia Legislative Session to help you navigate the Capitol! A limited number of hard copy guides are available. Please contact us if you’d like a copy.
Report spotlights ways to enhance health care for GA children
New study sponsored by Voices for Georgia’s Children, Georgians for a Healthy Future
ATLANTA, Ga. – Two of Georgia’s leading health care advocacy organizations issued a report saying the state could significantly expand medical care to more than 200,000 uninsured children with administrative practices, coverage policies and technologies already being used in other states. (more…)
Georgians for a Healthy Future is a non-profit, non-partisan health policy and advocacy organization that addresses health care issues through a consumer lens. Our 2012 policy priorities were developed with broad input from community stakeholders. We will work collaboratively with our community partners to advance these priorities.
Maximize opportunities and benefits presented by the Affordable Care Act for Georgia health care consumers. Georgians for a Healthy Future will continue to monitor legislation and agency-level activity to implement the ACA and support Georgia laws and regulations that establish structures and systems that maximize benefits for consumers in this process.
Preserve consumer protections for Georgians in private health insurance plans. State laws and regulations provide a basic level of protections and benefits to consumers who buy private health insurance plans. These protections ensure that consumers who purchase these plans obtain meaningful health insurance that covers essential medical services in the event they get sick. Georgians for a Healthy Future will continue to support efforts to preserve and strengthen consumer protections and oppose legislation that would place consumer protections at risk.
Modernize Medicaid and PeachCare by utilizing best practices to improve coverage rates, access to care, and health outcomes. The Medicaid and PeachCare for Kids programs provide health insurance for our state’s most vulnerable citizens. The Georgia Department of Community Health is currently weighing options to redesign these programs. Georgians for a Healthy Future will monitor this process as well as legislative activity and will support policy changes that facilitate continuous coverage and enrollment, preserve and expand access to care, and improve health outcomes. Georgians for a Healthy Future will oppose policy changes that restrict access to vital health care services for Medicaid and PeachCare beneficiaries.
Establish a consumer-friendly health insurance exchange. A well-designed health insurance exchange can add transparency to the health insurance marketplace, spur competition and choice, help make insurance more affordable and available, and give consumers the information they need to make optimal purchasing decisions. Georgians for a Healthy Future will support a health insurance exchange compatible with the American Health Benefit Exchanges (AHBE) authorized by the Affordable Care Act that provides consumers with the appropriate information, tools, and navigation assistance to make optimal purchasing decisions and a governance structure that can effectively and transparently oversee the exchange without conflicts of interest.
Restore child-only health insurance plans to the private health insurance market. Due to a recent change in federal law, insurance carriers in the individual market can no longer deny coverage to a child with a pre-existing condition. Even though insurers may still medically underwrite these policies, insurance carriers in Georgia stopped issuing these policies altogether. Georgians for a Healthy Future will support legislation to restore these plans to Georgia’s health insurance marketplace.
Strengthen Georgia’s public health system. Our public health system plays a critical role by vaccinating children, monitoring and preventing epidemics, ensuring safe food and water, and providing both clinical and community-based preventive services. Despite an increasing need for services, Georgia’s per capita public health spending is among the lowest in the nation. The establishment in 2011 of the new Department of Public Health presents an opportunity to rebuild our public health infrastructure and to place renewed focus on the critical role of public health. Georgians for a Healthy Future supports a robust, adequately funded public health system to meet the critical needs of our state.
Increase the tobacco tax. The current funding environment demands evidence-based policy solutions that both advance the health of our state and generate needed revenue. In recent years, even the most basic, vital, and cost-effective programs have been subject to deep budget cuts. Georgians for a Healthy Future opposes further cuts to these vital programs and supports budget solutions such as a substantial increase in the state’s tobacco tax. Tobacco taxes are a proven strategy with the dual benefit of bringing in additional state revenue and increasing the health of Georgians by reducing adult and youth smoking.
Over the last several weeks, Navigant, the consulting firm hired by the Georgia Department of Community Health to oversee the Medicaid Redesign assessment, has been conducting focus groups across the state as part of the environmental scan stage of the process. They have met with providers, consumers, advocates and vendors. For those throughout the state who were unable to participate in these forums, there has still been an opportunity to share your opinions and suggestions on how to improve our Medicaid and PeachCare system, but time for that feedback is running out. Currently on the DCH website, there is an online survey for consumers, patients, providers and vendors to weigh in on the process. The survey will close this Friday, November 11. Click here to access the survey.
Here is your opportunity to share your experiences in dealing with Medicaid–what works? what could be improved? how do we ensure adequate access to providers, particularly in rural communities? The compilation of this information is critical in determining how to redesign our current system to make it work for the most number of Georgians. Navigant will evaluate the survey responses from all across the state and incorporate them into their recommendations for redesigning the system. This stand up paddle boards is an easy opportunity to have a big impact and we hope that you will continue to promote health care coverage, access, and quality that all Georgians deserve.
Once this stage of the redesign process is complete Georgians for a Healthy Future and our partner organizations will work to ensure that consumer health advocates have the information and tools they need to continue to weigh in on this process. In a few days, Georgians for a Healthy Future will launch a web page where we will house timely and relevant information to help advocates like you exercise your voice in this process and we will be sure to notify you when that site goes live.
For more information, please visit the DCH website pages for the Medicaid & CHIP Redesign.
Thank you for all you do to ensure a healthy future for all Georgians!
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.
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.