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Medicaid

Nursing home rate change put on hold

A health agency commissioner Thursday pulled off the table a controversial rate change that would benefit the state’s nursing home industry.

DCH Commissioner Clyde Reese

Clyde Reese

It was designed to pay extra money to companies that bought Georgia nursing homes between Jan. 1, 2012, and June 30 of this year, because of the costs that new owners bear in upgrading the facilities.

Clyde Reese, commissioner of the Department of Community Health, told the agency’s board that he wants to spend more time reviewing the rate hike.

The payment idea, Reese said, has “definite merit.’’ But he said he would like to change the methodology so that it would reward a broader range of nursing homes, with faster reimbursement, for upgrades they make. full story

Freestanding ERs target suburbs, rural panel told

Freestanding emergency departments have been proposed in Georgia as a potential solution for struggling rural hospitals, or newly closed ones, that want to remain operational in downsized form to help patients in need.

Healthcare CostBut the trend toward such standalone emergency rooms nationally is totally different from that picture, members of the Georgia Rural Hospital Stabilization Committee were told Monday.

Freestanding EDs are actually proliferating in suburban areas, targeting high-income patients who have private insurance, said Charles Horne of accounting firm Draffin & Tucker. The prevailing emphasis is on patient convenience, not need, he told committee members at a meeting in Cordele.

Earlier this year, Gov. Nathan Deal backed a change in state licensing rules that would permit a stand-alone emergency department and some other services in rural areas that have a financially ailing – or closed – hospital.

But so far, no organization has applied to create such a facility in the state.

Meanwhile, four rural hospitals have closed in the past two years in Georgia, and others are having severe financial problems. full story

Hotline helps connect Georgians to benefits

“My medicines cost $200 per month. I wasn’t able to get them although I had had two prior heart attacks. Now I can get my medication because of . . . Medicaid. I would have given up without your help.”

The person quoted above is one of hundreds of Georgians helped by a benefits hotline run by the Georgia Legal Services Program.

220px-Cisco7960GThe program has operated at a time that Georgians have faced “incredible barriers getting through to DFCS” to receive benefits, says Vicky Kimbrell of GLSP.

DFCS has suffered backlogs over the past year in applicants getting both food stamps and Medicaid coverage. The agency phone number has been overwhelmed with demand, Kimbrell says, after it switched over to an online system for benefits renewals and notices.

“Seniors and people with low incomes don’t have access to computers,’’ says Callan Wells of Georgia Legal Services, who helps run the hotline. “They are asking that renewals be completed online. Homebound seniors without computers are disadvantaged by that system.” 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

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