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Health Reform

State health agency outlines spending increases

A state health agency is budgeting an extra $24 million this fiscal year, and a similar amount next year, to pay for costly hepatitis C drugs in Georgia’s Medicaid program.

clipboardThe state is also expected to pay $14.1 million more this year, and $37.9 million in fiscal 2016, for lengthening the time between eligibility reviews for Medicaid and PeachCare beneficiaries, as required by the Affordable Care Act.

Those were among the financial projections made in a budget presentation Thursday for the board of the Georgia Department of Community Health, which runs the Medicaid and PeachCare programs in the state, as well as the state employee health plan. The presentation is the beginning of a long budgeting process for the agency.

The Community Health board approved the budget requests.

The hepatitis C drugs are considered breakthrough medications for patients. One drug, Sovaldi, has a 90 percent cure rate for newly infected patients — much better than previously available treatments for hepatitis C. full story

Medicaid increase, uninsured data show Ga. impact

Federal figures show Georgia’s Medicaid and PeachCare enrollment jumped 16 percent since October – the highest percentage increase among states that have rejected the expansion of Medicaid under the Affordable Care Act.

clipboardThe Georgia jump greatly exceeds that of the second-highest increase among non-expansion states: 9.5 percent in Montana.

Expanding Medicaid involves extending enrollment in the government program to many low-income people who had not previously been eligible.

As a group, the states not pursuing expansion saw enrollment in Medicaid and their Children’s Health Insurance Program rise by 4 percent. (The children’s program is called PeachCare in Georgia.) States embracing Medicaid expansion saw an average increase in enrollment of 18.5 percent since October, when open enrollment on the health insurance exchanges began.

The enrollment data from the Department of Health and Human Services, released Friday, are part of various studies underscoring the insurance changes created through the ACA. full story

State says it’s hard at work on Medicaid backlog

A state health agency says it’s working though the application backlog for Medicaid that recently provoked federal scrutiny.

clipboardThe Department of Community Health has made decisions on eligibility for up to 70 percent of the 88,854 “account transfers” from Georgia’s insurance exchange, the agency said Friday.

The backlog in Georgia is linked to the thousands of people expected to join Medicaid and PeachCare this year as a result of the Affordable Care Act.

These new enrollees are not coming in because of expansion of Medicaid, as is happening in some states, because Georgia has declined to pursue expansion. But Georgia is reported to have tens of thousands of people who are already eligible for Medicaid or PeachCare but have not been getting it. Their names have emerged through the enrollment process in the ACA’s insurance exchange.

“We have been in the process of comparing the information in the account transfers to our various eligibility databases for several weeks,’’ said Pam Keene, Community Health spokeswoman, in an email to GHN. “Those who were found eligible are already receiving benefits. Those who were deemed ineligible have been notified and referred to the [exchange] where appropriate.”

An estimated 18,000 of the transfer files processed have been enrolled in Medicaid or PeachCare, Community Health said. But because the account transfers represent families with possibly more than one person eligible, the number enrolled would be higher. full story

Insurers to pay $11 million in Georgia rebates

A federal rule on health insurers’ spending will bring $11 million in rebates to Georgia individuals and employers this summer.

Federal figures released Thursday show that 304,000 Georgians will benefit from the refunds, with an average rebate of $53 per family, as a result of the “Medical Loss Ratio” (MLR) rule on 2013 insurance plans.

1088819262-1249Created by the Affordable Care Act, the MLR standard generally requires health insurers to spend at least 80 percent of the premium dollars they collect on medical care or activities to improve the quality of health care.

In Georgia, $5.5 million will go to refunds to 180,000 individual consumers, while $5.4 million will go to employers in the small-group market. In both these sectors, the required threshold is 80 percent.

The large employer market, where the minimum requirement is 85 percent, accounts for just $270,000 in refunds in Georgia for last year’s health plans.

Humana plans in Georgia will have to pay the highest amount in rebates — $4.5 million combined in the small-group and large employer market. full story

Exchange subsidies draw conflicting court rulings

More than 190,000 Georgians are enrolled in the health insurance exchange created by the Affordable Care Act.

But if a D.C. federal court ruling announced Tuesday on exchange subsidies is ultimately upheld, that Georgia number could shrink precipitously.

Healthcare Cost

The U.S. Court of Appeals for the District of Columbia ruled Tuesday that the language of the ACA allows subsidies, or discounts, only for people who obtain coverage through exchanges run by the states, and not by the federal government.

Georgia is among 36 states whose insurance exchanges are federally run.

About 95 percent of Georgians enrolled in health plans in the exchange have received subsidies to help them afford their premiums, according to the state insurance department.

The 2-to-1 ruling by a three-judge panel of the court — if not overturned on appeal — would be a tremendous setback for President Obama’s health care law.

Without subsidies, the price of health insurance for millions of people in Georgia and the 35 other states with federally run exchanges would rise sharply, making it generally unaffordable.

The judges suspended their ruling pending an appeal by the administration. The Obama administration said it would appeal to the full circuit court, a process that could take up to six months, and stressed the ruling would have no impact on consumers receiving monthly subsidies now, Reuters reported.

Also Tuesday, a three-judge panel of the 4th U.S. Circuit Court of Appeals in Virginia ruled unanimously to uphold the subsidies provision, saying the wording of the law was too ambiguous to restrict the availability of the funds. The ruling was announced shortly after the D.C. decision.

 

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