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.
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.
It’s not expanding Medicaid, and it could prove to be “more cost-effective” than the Affordable Care Act, Grady CEO John Haupert said in an interview Thursday.
The goals, he said, would be “to better coordinate care and save money” in serving these individuals, who often turn to expensive emergency rooms for medical services.
“We would heavily care-manage these patients,’’ he said, serving them “at less cost than they are doing today.” It would inject “a great deal of accountability for outcomes and [bending] the cost curve,” he said.
“It could work as the Georgia solution’’ to the uninsured problem, Haupert added.
The state has a high rate of people who lack health insurance – roughly one in five.
Under the Grady plan, the new coverage program would be kicked off through a “1115 waiver,” an experimental plan that the feds approve to give states flexibility to improve their Medicaid programs by using a new approach.
The waiver would bring more federal matching dollars into Georgia, with minimal impact on the state budget. Federally qualified health centers would be a part of the project, Grady said.
Details haven’t been ironed out, and a waiver approval could take a year or more.
Haupert of Grady points to a similar program in Cleveland, Ohio, where federal officials in 2013 approved a Medicaid waiver plan to provide a medical home and health coverage for up to 30,000 uninsured residents of Cuyahoga County.
It was designed to provide high-quality services and reduce overall health spending.
Matt Hicks, a Grady vice president, said the Georgia plan would be replicable elsewhere in the state. “It’s a way of transforming care to the uninsured,” Hicks said, adding that “it would minimize the burden on the state’s budget.
Gov. Deal told the AJC on Thursday that the waiver would “explore the possibilities of covering people who are now uninsured.”
“Grady has put together a team working with other hospitals in the state to pursue the 1115 waiver, which will give us some flexibility,” he said. “That’s the main ingredient that governors like me have been saying all along. If you give us some flexibility then we could provide greater coverage and more coverage.”
Haupert said the federally qualified health centers and the philanthropic community helped generate ideas behind the initiative.
The waiver idea, reported in an AJC article Thursday, already has generated much conjecture and debate within the health care community.
Will feds resist?
Jimmy Lewis of HomeTown Health, an organization of rural hospitals, said the state’s rural hospital stabilization project has been already working on something similar in four communities in Georgia. That project’s purpose, he said, “is to transform the delivery system for rural health care.”
Lewis said there could be synergies in what the state is doing with its rural hospital project and what Grady is proposing.
Yet Bill Custer, a health insurance expert at Georgia State University, told GHN that the waiver proposal may face an uphill climb to get CMS approval. He said the feds may question why Georgia isn’t doing this experiment statewide – or why it isn’t expanding Medicaid. (The U.S. Supreme Court has upheld the right of states to reject Medicaid expansion, but the federal government continues to press them to implement it.)
The new Georgia effort comes as federal health officials are wrangling with Florida and other states over continuing federal funding to hospitals to care for the uninsured.
Cindy Zeldin of Georgians for a Healthy Future, a proponent of Medicaid expansion, said Friday that the Grady idea has some merit.
“Developing and implementing an innovative model designed to improve health care outcomes for a defined population is an important and valuable goal,” she said.
But Zeldin added, “There is no substitute for coverage, and too many Georgians fall into the coverage gap.” Those are the hundreds of thousands of Georgians who don’t qualify for Medicaid without expansion, yet make too little income to qualify for subsidies in the health insurance exchange.
Tim Sweeney, health policy director of the Georgia Budget and Policy Institute, said that standing pat on the uninsured problem “is not a good option.”
“I have no doubt that something at a regional level can increase access to care and improve health,” he said. But Sweeney added that “a piecemeal approach raises some equity concerns.”
Expansion has proved to be positive for states, patients and medical providers, Sweeney said. “It’s working.”
Grady officials said the waiver proposal is in the hands of the governor’s team and the Department of Community Health.
Haupert said that if the program is successful in making health care more efficient, it could be extended to the overall Medicaid population.
“It may end up being a really wonderful solution for the state,’’ he said.