The state’s Department of Community Health is asking for additional state funds to cover projected Georgia enrollment for Medicaid and PeachCare, which for the...

The state’s Department of Community Health is asking for additional state funds to cover projected Georgia enrollment for Medicaid and PeachCare, which for the first time will exceed 2 million.

Clyde Reese

Clyde Reese

The budget proposal also requests $23 million to cover the high cost of drugs to treat hepatitis C patients in both the midyear fiscal 2016 budget and in the 2017 plan.

The budget plans, approved by Community Health’s board Thursday, now go to Gov. Nathan Deal and then to the Georgia General Assembly for approval.

It would be the second straight year that the agency will not have to cut its base budget, said Community Health Commissioner Clyde Reese. The agency’s current budget is roughly $3 billion in state funds.

Hepatitis C drugs have an astronomical cost, averaging more than $30,000 per patient per month in retail price. But states, including Georgia, can get a discount on that price for their Medicaid programs that could reach 40 percent.

The Georgia Medicaid program has covered these pharmaceuticals for more than 1,000 patients over the past three years, and projects more than 400 new patients to qualify for these drugs. Hepatitis C patients typically get a three-month drug treatment.

Not everyone with hepatitis C in Medicaid gets the drugs; patients must first meet certain criteria.

Community Health also projected that the health plan that covers state employees and schoolteachers will have a deficit of $42 million in fiscal year 2017. That shortfall is expected to balloon to $300 million the next year.

Those projections may trigger major changes in the benefits and premium structure of the State Health Benefit Plan. But such revisions would be a hot-button issue for Georgia lawmakers, as the SHBP covers more than 600,000 members, which include school personnel, retirees and dependents.

Separately, Reese reiterated that the Grady Health System proposal for a “waiver” to cover uninsured Georgians was “cost-prohibitive’’ to the state.

He said Grady had submitted revised information to the agency about its waiver plan.

 


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