State eyes major change in Medicaid

Print Friendly and PDF By: Andy Miller Published: Nov 5, 2012

State officials, in an abrupt shift, are moving toward creating a case management system for hundreds of thousands of Medicaid beneficiaries who are “aged, blind and disabled.’’

This summer, the Department of Community Health, citing the uncertainty about Medicaid’s future, stepped away from a proposal to place beneficiaries residing in nursing homes, as well as those with disabilities, into managed care plans.

But now, the Medicaid agency appears to envision a lighter form of managed care for those beneficiaries.

Medicaid covers 1.7 million Georgians who are poor or disabled. The majority of Medicaid recipients are children, who, along with pregnant women, are already in managed care plans.

The state’s decision may be at least partly linked to the financial crunch that Medicaid faces.

Gov. Nathan Deal recently noted that for the 2013 and 2014 budget years, the state faces a $700 million shortfall in its Medicaid program.

The aged, blind and disabled population represents about 25 percent of Medicaid beneficiaries in Georgia but accounts for about 55 percent of Medicaid costs here.

The agency replied to a query from GHN on the case management proposal with an emailed statement. “DCH is currently reviewing opportunities to provide case management and care coordination services to the fee-for-service (FFS) population within a FFS payment model,” the statement said.

Pat Nobbie, deputy director of the Georgia Council on Developmental Disabilities, who has been briefed on the state’s plans, told GHN on Monday that Medicaid officials envision having a single company deliver the care coordination services, and would pay that vendor a per-member, per-month fee to do the work.

The new setup will include a provision allowing the Medicaid beneficiaries to opt out of the care management arrangement, said Nobbie, who met with state officials last week about the move.

A contract for case management is likely to draw great interest from management care companies.

Overall, Nobbie said, the state is moving in “a good direction.’’

Many people with disabilities who have Medicaid don’t receive the coordination and support to get necessary care, she said. These patients often can’t find occupational, speech or physical therapists, durable medical equipment and other services, she said.

The state will focus on the frequent use of hospital emergency rooms by some beneficiaries.

“Coordination is really important,’’ Nobbie said. “People who aren’t connected to a provider go the ER.’’

The state’s target for implementing the new system is October 2013, she said.

“They told us better care is the first goal,’’ Nobbie told GHN. “They said they don’t expect any savings till two to three years down the road.’’

“I am hopeful that we will have a really substantial dialogue about this,’’ Nobbie said.

A leading figure in the nursing home industry, a politically powerful sector, said Monday that his group is awaiting details of the state’s move.

“The Georgia Health Care Association looks forward to hearing DCH’s plan and working to make Georgia more cost effective with better health outcomes,’’ said Jon Howell, president and CEO of the association, in an email to GHN.

Nobbie said state officials have incorporated some recommendations of a task force of advocates and government and industry officials created by the state earlier this year in its effort to “redesign” Medicaid.

A state-funded report by a consulting firm had recommended an ‘‘enhanced managed care’’ program for Georgia Medicaid and PeachCare, including placing the elderly and people with disabilities in managed care for the first time.

The state has been planning to put foster children into a single designated ‘‘care management organization’’ to improve continuity of care.

 

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