A health agency board Thursday gave final approval to the voluntary switch of thousands of children now covered by the state employee benefit plan...

A health agency board Thursday gave final approval to the voluntary switch of thousands of children now covered by the state employee benefit plan into PeachCare, Georgia’s insurance program for kids in lower-income families.

The state anticipates that about 40,000 children will move to PeachCare. That would save the state $32 million for fiscal 2012 by allowing federal matching funds in PeachCare to pay part of the costs, according to Georgia officials.

PeachCare could attract these kids because premiums and copays for their care would be much cheaper for many parents than if their children continued in the State Health Benefit Plan.

“It’s cheaper for the family and it’s cheaper for the state,’’ Scott Frederking, budget director of the state Department of Community Health, said Thursday at the agency’s board meeting.

Frederking said statewide physician organizations raised concerns about the change, noting that doctors are paid lower rates under PeachCare than under the state employee plan. The pay differential amounts to about 12 percent, he said.

Frederking said the state has considered offsetting that pay reduction to doctors, dentists, hospitals and other providers.

A second concern raised, he said, was whether the current network of doctors and other medical providers would be sufficient to handle the new load of patients. PeachCare currently covers about 200,000 Georgia children.

The State Health Benefit Plan covers about 700,000 people, including state employees,  teachers, state retirees, and school personnel, as well as dependents.

Tim Sweeney, senior health care analyst at the Georgia Budget and Policy Institute, said parents of eligible children will benefit from lower premiums and copays in PeachCare, in comparison to the state employee plan.

“It’s a good thing that it’s an option for families’’ rather than a required move, he said.

But Sweeney also said that access to physicians, especially specialists, may be more limited in PeachCare for these families because of the lower payments to medical providers in that program. The state should increase the pay for medical providers in the Medicaid and PeachCare programs, he said.

Separately, the Community Health board gave initial approval of slightly different copays for Medicaid and PeachCare.

The board in July approved raising copays for Medicaid beneficiaries, and launching — for the first time — copays for children on PeachCare who are 6 years of age and older.

Some of the former copays, though, were in unusual amounts, such as $3.74 for an outpatient hospital service. But the new copays are all in increments of 5 cents.

Jerry Dubberly, the state Medicaid director, noted that if patients say they can’t pay the copay, the medical provider cannot force them to do so. So, in effect, it becomes a cost that the medical provider will have to cover, he said.


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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