Food for Thought on Georgia’s Medicaid Redesign

Although Georgia already spends less than most states on its Medicaid program, State leaders plan to “redesign” the program to save money.

The state’s consultant (Navigant, Inc.) conducted a review of Georgia’s current Medicaid program and issued a report in January with redesign options for the state to consider. The Department of Community Health (DCH), which runs the Medicaid and PeachCare programs, plans to roll-out its redesign proposal before thesummer, which does not give DCH enough time to properly develop its plan.

Several concerns have been raised about the plan’s recommendations and the condensed time frame to get this done:

  1. Navigant’s redesign report includes only a high-level overview of Georgia’s current program and doesn’t adequately analyze the current programs to see what works well, and what needs to be fixed. A thorough analysis of the weaknesses and strengths of the existing program would help the state chart its course forward. Without this, it will be unlikely to identify proper solutions.
  2. Georgia’s Medicaid program serves a diverse population of Georgians with a variety of health care needs. While most of Georgia’s Medicaid patients are served by private care management organizations (CMOs), Georgians who qualify for coverage due to a disability, need long-term care services, and need specialized health care aren’t served by the CMOs. The redesign report recommends moving all individuals not currently served by the CMOs into such plans, and proposes an aggressive timetable for implementation.This wholesale movement of Georgia’s Medicaid program to a managed care model is unprecedented and ignores lessons learned in the national scan Navigant conducted.Managed care is used extensively throughout the country to serve some Medicaid populations; however, the model’s limitations for serving other populations are well documented. Instead of quickly expanding the entire Medicaid program to managed care, DCH should carefully redesign the program to meet the unique needs of specific populations.
  3. Finally, two of the redesign goals are to enhance appropriate use of services and to improve health outcomes for enrollees. Cutting Medicaid spending runs counter to this intent and could make it difficult to increase access and improve health outcomes. In 2008, Georgia’s per-enrollee Medicaid spending ranked as the 3rd lowest in the nation. Instead of further cutting the program,Georgia should increase its investment in the program to achieve these other goals.

Although saving money is a central goal of DCH’s redesign efforts, state leaders should keep in mind that increasing investment in the Medicaid program is the best way to drive improvements that increase access to quality care that lead to better health outcomes.

As the redesign process moves forward, GBPI will provide information and analysis of state proposals and how these proposals will affect Medicaid patients, providers, and the state’s health care system as a whole.

Georgia’s Medicaid program is a vital part of the state’s health care system. The program brings in billions in federal funding for Georgia’s health care system and is a vital resource for low-income Georgians who have few, if any, alternative coverage.

In the end, Georgia’s Medicaid redesign should create a program that better serves the patients who rely on the program, and provide adequate resources to participating providers so that patients have consistent access to needed services. Hastily developing a redesign proposal will not adequately address the complexities of the program. Instead, the state should consider a more deliberate process to develop a plan that meets the needs of the Georgians participating in the program and the health care system that serves them.

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2 thoughts on “Food for Thought on Georgia’s Medicaid Redesign”

  1. Pingback: Lawmakers Need to Head off Medicaid, PeachCare Funding Cut | Georgia Budget and Policy Institute

  2. I am an RN Case Manager and I have been following the developments surrounding the Medicaid redesign. I did not see in the report if the consultants recommended to keep the current system of MCOs that Georgia has already: Amerigroup, Wellcare, and Peachcare.

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