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Medicaid

Georgia exchange applications hit 220,000

Georgia insurers received more than 220,000 applications for health coverage in the Affordable Care Act’s exchange as of the official federal deadline of March 31, state officials said Wednesday.

Ralph Hudgens

Ralph Hudgens

Insurance Commissioner Ralph Hudgens, though, said premiums have been received for only 107,581 of those policies, which cover 149,465 people.

“Many Georgians completed the application process by the deadline, but have yet to pay for the coverage,” Hudgens said in a statement Wednesday.

March 31 was the official deadline for individuals to get insurance coverage or face a financial penalty under the ACA. Yet because of the deluge of last-minute shoppers, federal officials relaxed the rules for those who reported having trouble with the exchange, and gave them into this week to sign up.

Given that extra time, there have presumably been more Georgians both signing up and paying for their premiums in April. They would not be included in the figures released Wednesday. full story

Standalone rural ERs face a serious hurdle

Gov. Nathan Deal’s plan to help financially ailing rural hospitals, announced last month, has drawn strong praise from legislators and health industry leaders.

DCH Commissioner Clyde Reese

Clyde Reese

Deal proposed a change in licensing rules to permit a struggling rural hospital, or one that recently closed, to offer downsized services that would include an emergency department.

But a drawback has emerged – one that, if unchanged, may lower the chances of these freestanding ERs being built.

Such facilities, as proposed, would not be able to bill Medicare or Medicaid at the current hospital rates, but would have to bill those programs at a lower “provider’’ rate.

Clyde Reese, commissioner of the Department of Community Health, told GHN on Tuesday that it may take legislation, or regulatory approval from federal health officials, to create a format so these freestanding rural facilities would draw higher reimbursements than is now possible. full story

Medicaid expansion: A tale of two Southern states

Annie Jones says she works hard and tries to keep fit, but she has high blood pressure, a condition that doctors have told her she inherited from her father.

The Sparta resident, who turned 60 this year, is worried about health care. Jones won’t reach Medicare age for another five years. She earns $10,000 a year as a part-time home health care worker and can’t afford her blood pressure medicine as well as the regular monitoring she needs.

Jeanna Buckler of Kentucky has qualified for Medicaid under expansion.

Jeanna Buckler of Kentucky has qualified for Medicaid under expansion.

Jones is one of up to 600,000 Georgians defined as the working poor  – those adults who earn less than 100 percent of the federal poverty level (FPL). (In 2014, that’s $11,670 for an individual and $23,850 for adults in a family of four.)

For the first time ever in Georgia, these adults would be eligible for Medicaid if the state expanded the program as authorized by the federal Affordable Care Act (ACA), also known as Obamacare.

The ACA originally made Medicaid expansion virtually mandatory for states. But the U.S. Supreme Court, while upholding the ACA in general, ruled that expansion must be optional. That made things complicated, because some other provisions of the law presupposed that Medicaid would be expanded.

Now the issue of expansion is being hashed out in the individual states.

In Georgia, Gov. Nathan Deal refuses to expand Medicaid, saying the state cannot afford it. The Republican-controlled General Assembly agrees with Deal and has even gone a step further. It passed legislation during the 2014 session that requires the Legislature, not just the governor, to approve any Medicaid expansion.

“They’re telling me I don’t deserve it,” Jones said of Medicaid. “When they say Georgia is just fine without expanding Medicaid, well, it’s just fine for them. I need some type of help. I can’t get it anywhere. It’s very stressful.”

If Jones made more than $11,670, she would be eligible for federal subsidies to buy private insurance through Georgia’s health care exchange, which is operated by the federal government as part of the ACA.

“I didn’t get enough money working part time, making minimum wage,” Jones said. She assists two home health care clients for 22 hours a week and is trying to get more work. “A lot of people are just like me, trying to make it. Where do you go?” full story

Key part of hospital provider fee still unresolved

Last year, a bill that would renew a financing mechanism for the state’s Medicaid program hurtled irresistibly through the Georgia General Assembly. Gov. Nathan Deal signed it into law almost as soon as it was passed.

The high priority the measure received was easy to understand. The funding mechanism, known as the hospital provider fee — called by opponents a “bed tax’’ — was designed to fill a nearly $500 million hole in the state’s Medicaid program.

smslogoThe main part of the provider fee was eventually approved by the feds last year.

But a second part of that provider fee, aimed at helping hospitals that were financial “losers’’ under the original distribution formula, has still not been approved by the U.S. Centers for Medicare and Medicaid Services (CMS).

Talks have gone on between the state and CMS since the fall of 2012 over what’s called “Tier II.” It’s designed to even out the losses for organizations such as Piedmont Healthcare and Northside Hospital, two large health care systems.

At stake is about $30 million in federal money for hospitals, according to the Department of Community Health, which runs Medicaid in the state. full story

Letter to Editor: Gov. Deal’s views incorrect

As a retired health care executive and former state employee, I appreciated the GHN interview with Gov. Nathan Deal. So much so that I would like to comment on a few of the remarks he made.

Jack Bernard

Jack Bernard

He indicates that Medicaid expansion would add 620,000 people to our Medicaid rolls, implying it would clearly be a disaster for the state. Georgia’s uninsured rate, by the way, has been estimated at up to 22 percent, one of the highest in America.

The figures Deal cites regarding the cost of expansion are skewed. Expansion will create 70,000 jobs (mostly private sector). Deal fails to mention the objective Georgia State University study that made this projection. He further ignores the taxes that will be collected by the state, cities and counties as a result of this increased economic activity.

In fact, the Georgia Budget and Planning Institute has stated that, when these factors are taken into account, the net cost of expansion would be only $25 million a year, a very small amount when considering Georgia’s multibillion-dollar state budget. full story

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