New group gains role in state’s Medicaid planning

A task force working with state officials on restructuring Medicaid has given rise to a new group — one that’s specifically concerned with mental health and substance abuse issues.

Members of the new group say it offers them an unusual opportunity to help shape requirements for what is likely to be a huge state health care contract.

“It seems like an opportunity to take a public health approach [to] substance abuse and mental health,’’ says Neil Kaltenecker, executive director of Georgia Council on Substance Abuse. She’s a member of the new panel.

The state is contemplating a whole new structure for Medicaid and PeachCare. The Department of Community Health is working on a ‘‘redesign’’ of how the two government insurance programs are run. The process has drawn intense interest from stakeholders, policymakers and health insurance companies expected to bid on contracts.

State officials will soon put together  a request for proposals (RFP) that it will give to potential bidders on the Medicaid contract. The new group will provide input on how that RFP is worded, which is potentially very important.

A well-crafted RFP can place more emphasis on screenings for early detection of problems and on treatment, Kaltenecker says. “It can ultimately save money.’’

The Department of Community Health said last week that the new group is composed of representatives from professional mental health and substance abuse associations, and from consumer advocacy groups and another state agency.

The mental health/substance abuse group arose out of the task force on the aged, blind and disabled, one of three giving input to Community Health officials.

Medicaid and PeachCare together cover about 1.7 million Georgians, and the numbers may jump. The 2010 federal health reform law, if upheld by the Supreme Court, is expected to add more than 650,000 Georgians to the Medicaid rolls.

A recent state-funded report by a consulting firm recommended an ‘‘enhanced managed care’’ program for Georgia Medicaid and PeachCare. The recommendations include placing the elderly and people with disabilities in managed care for the first time — and the ‘‘disabilities’’ category apparently would include people with addiction and mental illness.

The idea of managed care for mental health ‘‘makes me squirm,’’ says Sherry Jenkins Tucker, executive director of the Georgia Mental Health Consumer Network, and a member of the new advisory group. “I’m not familiar with a lot of successes. I’m familiar with train wrecks.’’

But she adds, “We’re coming to the table to focus on what we can build’’ to help people with mental illness.

She and other advocates hope any new design the state chooses will include a focus on individuals’ recovery — through programs such as supported housing and employment. (Here’s a recent article in GHN on supported housing.)

The new advisory panel allows mental health and substance abuse advocates to work together on issues that involve both areas. Many people with an addiction are also battling mental illness.

Ellyn Jeager, public policy director of the consumer group Mental Health America of Georgia, says the mental health/substance abuse work group offers a rare chance for those outside government to have input in state decision-making.

“It’s a major undertaking,’’ she says. “We cannot complain about this, because this is an opportunity to participate.’’

The group “has already and will continue to provide valuable input’’ as the state moves through the Medicaid redesign, says Pam Keene, a Community Health spokeswoman.

Kaltenecker says a final report is expected by the end of June.

“All care is ‘managed’ to some degree,’’ she says. “It all is going to come down to what’s in the contract.’’