Subscribe to The Pulse

Rural Health

State outlines arguments against Medicaid ‘waiver’

The state’s Medicaid agency has all but ruled out Grady Health System’s “waiver’’ proposal to cover more uninsured Georgians.

Photo of the Georgia Capitol Building“We’re not going to move forward on this at this time,’’ Clyde Reese, commissioner of the Department of Community Health, said at an agency board meeting Thursday.

He cited “significant costs to the state” to implement the proposal.

Reese added that federal officials indicated they would consider the waiver proposal only if Georgia was willing also to expand its Medicaid program. That is something Georgia political leaders have emphatically declined to do.   full story

Most Georgia hospitals face readmission fines

Two-thirds of Georgia hospitals will receive Medicare fines for having too many discharged patients return within a month for additional care, federal data show.

The 67 percent of Georgia hospitals facing penalties is higher than the national average of 54 percent, according to a Kaiser Health News analysis.

Piedmont Henry Hospital

Piedmont Henry Hospital

The readmission penalties, launched as part of the Affordable Care Act, seek to encourage hospitals to pay closer attention to what happens to patients after discharge.

Since the fines began, national readmission rates have declined, but roughly one of every five Medicare patients sent to the hospital ends up returning within a month of being released, Kaiser Health News’ Jordan Rau reported this week.

The fines will be applied to Medicare payments when the federal fiscal year 2016 begins in October. In this round, the average Medicare payment reduction is 0.61 percent per patient stay. Georgia’s average penalty is 0.47 percent.

The maximum possible fine is 3 percent. Piedmont Henry Hospital in Stockbridge will get the highest fine in Georgia, at 2.59 percent.  full story

Poll finds big gaps in rural health care

Most rural Georgia residents in a new survey say they have experienced problems with the affordability of health insurance and the cost of health care.

Healthcare CostWhen asked the biggest problem facing local health care, 68 percent named cost, with quality of care and access to care trailing far behind, according to the survey of 491 people. It was conducted by Opinion Savvy and commissioned by Healthcare Georgia Foundation.

The poll may be the first to focus entirely on rural health care issues in Georgia. It comes in the wake of four rural hospital closings in the state since the beginning of 2013.

Those hospitals closed due to financial problems, and the economic and medical effects of their loss have drawn the attention of Georgia’s political leadership.

Across America, rural residents generally lag far behind people in other areas when it comes to health and quality of medical care.  full story

State studying design for Medicaid waiver plan

The state’s main health agency says it’s analyzing a new plan to cover more uninsured Georgians through a special Medicaid “waiver’’ program.

Clyde Reese

Clyde Reese

Gov. Nathan Deal “has asked us to work on it,’’ Clyde Reese, commissioner of the state Department of Community Health, said Thursday.

The plan for a Medicaid waiver was generated by Grady Health System as an alternative to Medicaid expansion under the Affordable Care Act, a step that has been firmly rejected by Deal and state legislative leaders.

The Grady plan focuses on using federal matching Medicaid dollars to help set up pilot sites that would give coverage to the uninsured, then manage their care and potentially improve their health.

Grady in Atlanta, Memorial Health in Savannah, and a small group of rural hospitals are seen as the initial sites in the coverage plan, which has generated much interest and speculation within the state’s health care industry.

Meanwhile, a safety-net health system in Cleveland, Ohio, told GHN that a similar program there –- cited as a model for the Grady plan -– helped improve many patients’ health and was carried out at costs below budget estimates. full story

Grady outlines plan to transform care for uninsured

Grady Health System realized it couldn’t count on Medicaid expansion anytime soon, so it went looking for a different path.

Expansion, already implemented in a number of other states, would have extended coverage to hundreds of thousands of low-income Georgians – turning them into paying patients. By doing that, it would have helped Atlanta’s Grady Memorial and other hospitals offset deep federal cuts looming from the Affordable Care Act.

But Gov. Nathan Deal and the Republican-led Georgia General Assembly stood firmly opposed to expanding Medicaid because of the cost.

Grady Memorial Hospital

Grady Memorial Hospital

So Grady officials began to envision a smaller-scale insurance program that could avoid the political and financial pitfalls that accompany a Medicaid initiative.

What they and state officials are proposing is a plan where federal matching Medicaid dollars would be used to help set up pilot sites that would give coverage to the uninsured, then manage their care and potentially improve their health.

Grady in Atlanta, Memorial Health in Savannah, and a small group of rural hospitals are seen as the initial players in the coverage plan. full story

  • Sign up for our mailing list.