The state Department of Community Health, citing the uncertainty about Medicaid’s future in the wake of a recent U.S. Supreme Court ruling, said Friday that...

The state Department of Community Health, citing the uncertainty about Medicaid’s future in the wake of a recent U.S. Supreme Court ruling, said Friday that it “would not be prudent at this time’’ to pursue a wholesale restructuring of the government insurance program.

The decision means that a major recommendation in a consulting firm’s report will not, at least for the foreseeable future, be implemented. The state-commissioned Navigant report in January had recommended putting Medicaid beneficiaries in nursing homes, as well as those with disabilities, into managed-care plans.

The redesign process has drawn intense interest from the medical and insurance communities, as well as patient advocacy organizations.

DCH Commissioner David Cook pointed to the many unanswered questions in the wake of the June court ruling on the Affordable Care Act (ACA), also known the health reform law. The court, by invalidating a federal enforcement clause in the ACA, increased states’ flexibility to choose not to expand their Medicaid programs.

Cook also noted that the results of this fall’s elections could have a significant impact on the future direction of Medicaid and PeachCare, which cover 1.7 million Georgians. Republicans nationwide hope to make sufficient electoral gains to be able to repeal the ACA, which would further change the situation confronting policymakers.

“We’ll continue to look at . . . these options going forward,’’ Cook said Friday. “We’re going to need a lot more clarity from Washington.’’

But Cook did announce some changes to the programs, including putting foster children into a single-designated ‘‘care management organization’’ to improve continuity of care. He also said Medicaid would encourage movement toward patient-centered medical homes, an arrangement where primary care doctors direct the care of patients.

“I am very proud of the process we have used during this redesign initiative,” said Cook in a statement. “As a result of our efforts, we will implement numerous initiatives to improve services in a cost-effective manner.’’

DCH will emphasize what it’s calling a value-based purchasing model, which the agency says will improve quality and contain costs.

Cook also said DCH will create a web portal to reduce administrative burdens and make it easier for medical providers to serve patients. The portal will give providers more comprehensive, accurate and up-to-date data about their members and their medical history, streamline their credentialing process, and present key performance metrics, DCH said.

The agency said it will also establish a common pharmacy preferred drug list among insurers and will continue its home-based and community-based services initiatives.

“The redesign process has been a great benefit for the department,” Cook added. “It has allowed us to start a meaningful dialogue with the health care community, take a comprehensive look at options, receive recommendations on improvements, and solicit feedback on numerous ideas. We will continue the process as we look at more ways to improve Georgia’s Medicaid program.”

Cook pointed to uncertainty about Medicaid funding in federal budget talks scheduled to take place later this year.

And if Georgia had opted to put the ‘‘aged, blind and disabled’’ into managed care, as was considered, the state would have had to offset the loss of Upper Payment Limit funding.

Georgia could lose roughly $175 million to more than $220 million in federal funding annually for the program if it made the managed care switch, based on figures for the last two fiscal years, GHN recently reported. Children and pregnant women are already in managed care plans in Georgia.

The decision by the state to postpone the major restructuring had been predicted by many health industry experts, especially after the Supreme Court ruling.

Jon Howell, president of the Georgia Health Care Association, which represents the nursing home industry, commended DCH for taking “a measured approach to the redesign effort.’’

“I applaud Commissioner Cook and his team for putting the citizens of Georgia that depend on these health services at the forefront of the decision-making process,’’ Howell said.

Pat Nobbie, deputy director of the Georgia Council on Developmental Disabilities, said deferring the restructuring is a good move. “It’s better than moving ahead with something they’d have to back away from later,” she said.

Nobbie  said a delay would give Georgia an opportunity to study the option of expanding Medicaid under health reform. She also praised the state’s decision to better manage the care of foster children and to continue programs to facilitate people living in their communities rather than in nursing homes.

Containing costs was one major goal of the restructuring process, the state had said. The Medicaid program has often had problems  with insufficient funding.

DCH said recently that it has a projected $300 million hole to fill in next year’s budget for Medicaid and PeachCare.

The projected $308 million shortfall for fiscal 2013 stems mostly from growth in the program’s spending, plus the delay of a month’s payment to the care management organizations that deliver services to children and pregnant women.

The programs’ financial crunch also includes $245 million more in future claims from medical providers for services rendered but not yet billed.


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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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