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Medicaid

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

Feds to scrutinize Georgia’s Medicaid backlog

A federal agency says it will review Medicaid eligibility and enrollment processes in Georgia and six other states due to “a substantial backlog of pending applications.”

The July 9 letter from the Centers for Medicare and Medicaid Services does not indicate how much of a backlog Georgia has or the reasons for it.

smslogoThe Georgia review will also cover the state’s PeachCare program for uninsured children.

The other states getting this backlog letter were Arkansas, Illinois, Indiana, North Carolina, Virginia and Wyoming, according to Inside Health Policy.

(Besides these seven states, CMS had previously notified another six states to submit plans to fix their Medicaid enrollment snags.) full story

Medicaid change on long-term care delayed

A state health agency Thursday delayed approval of a change in the Medicaid eligibility system for people in long-term care whose incomes are above the government program’s thresholds.

The Department of Community Health’s board had been set to approve a switch for some lower-income Georgians — who now use “Qualified Income Trusts” (QITs) to qualify for Medicaid — to a “medically needy” eligibility program.

These people make too much money to qualify for regular Medicaid, but not enough money to pay for their health care needs.

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But consumer advocates have expressed concerns that the change in eligibility methods would help only people in nursing homes and institutional hospice programs — and not those with Medicaid “waivers’’ who live in community settings. The new policy could also limit people’s choices in long-term care arrangements, the advocacy groups say.

Department of Community Health (DCH) officials said Thursday that in delaying the board vote, they sought additional time before implementation. “We want to make sure it’s done right rather than fast,’’ said Jerry Dubberly, the Georgia Medicaid director. full story

Restart of rural South Georgia hospital fizzles

A rural hospital that reopened recently after a February closure has once again closed its doors.

Lower Oconee Community Hospital, in the Wheeler County town of Glenwood, suspended operations again late last month. Phone calls to the hospital Monday were not answered.

Wheeler County

Wheeler County

A sign posted on the hospital door said Lower Oconee “will reopen in the very near future under reorganization,” WMAZ reported.

Several employees and doctors had told WMAZ that they had not been paid in a month.

Andy Cone, operations manager for the EMS company serving Wheeler County, told GHN on Monday that with Lower Oconee closed again, emergency patients were being transported to hospitals in Vidalia, which is 24 miles away, and Dublin, 33 miles away.

Lower Oconee’s closure in February made it the fourth rural hospital in the state to close in two years. But the South Georgia hospital reopened under new ownership the next month. full story

Experts on a roll … to help rural doctors

“Meaningful use.”

It’s another confounding term in the often opaque lexicon of health care. But it represents a concept that is important for health care providers’ bottom lines.

The basic idea is that Medicare and Medicaid will pay incentives for hospitals and doctors to demonstrate “meaningful use” of electronic health records (EHRs) to improve patient care.

And to help rural doctors get up to speed with education and technical assistance on meaningful use, a two-day bus tour swept through central and eastern Georgia last week.

Technical assistance is given at Taylor Regional Medical Center.

Technical assistance is given at Taylor Regional Medical Center.

Experts on board the bus came from GA-HITEC at Morehouse School of Medicine in Atlanta; the state Department of Community Health; HP Medicaid; the Georgia Health Information Network; the Medical Association of Georgia; and HomeTown Health. They visited Thomaston, Hawkinsville, Eastman, Fitzgerald, Baxley, Springfield and Swainsboro to provide hands-on help to physicians and others.

“There have not been many resources out in rural areas,’’ Kathy Whitmire of HomeTown Health, an organization of rural hospitals in the state, told GHN. She said the experts consulted with physician practices representing more than 120 eligible doctors, physician assistants and nurse practitioners. full story

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