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.

The MetroHealth Care Plus program lasted just one year, though. It was superseded when the state of Ohio decided to go forward with Medicaid expansion.

More than a year away

Reese said Thursday that Community Health discussed the Grady plan with Deal and representatives of Grady and Memorial earlier this week.

“We’re just at the beginning stages,’’ Reese said, and he emphasized that “this is not Medicaid expansion.”

Community Health will determine if the plan is feasible and who the potential participants will be. “I’d like to get back to the governor [with an analysis of the plan] within a month,” Reese said.

He said he does not foresee a waiver program starting earlier than July 1, 2016.

The new coverage program would be kicked off through an “1115 waiver,” an experimental plan that the feds approve to give states flexibility to improve their Medicaid programs by using a new approach.

An 1115 waiver “is good for three years, and can go to five years,” Reese said. He added that believed legislative approval would not be required for the state to submit a waiver plan to the federal government.

Grady officials, in an interview with GHN last week, said the goals of the waiver plan are to coordinate care better and save money while serving low-income individuals, who often turn to expensive emergency rooms for medical services.

Federally qualified health centers would be a part of the project, Grady said, adding that local philanthropic groups have supported the idea.

“So far, the reaction has been very encouraging,’’ Matt Hicks, a Grady vice president, told GHN on Thursday. “We’re beginning to have discussions with a lot of different stakeholders.

Maggie Gill
Maggie Gill

“This is a conversation, and it will take some months to complete it,’’ Hicks added. “There will be plenty of opportunity for the conversation to evolve.”

And Maggie Gill, CEO of Memorial Health in Savannah, said Thursday that she believes such a project can “bend the cost curve [and] transform the health care system for this group of Georgians.”

She said Memorial Health has had experience in lowering costs for a specific population by better coordination of care. “We think this is doable,’’ Gill said. “It can be a model used around the state.”

A lot of uninsured people

Georgia has a high rate of people who lack health insurance — roughly 20 percent, according to a recent Gallup survey. Only Texas, another non-expansion state, fared worse in the survey.

Loren Anthes of MetroHealth in Cleveland said this week that its 2013 waiver was aimed at covering the uninsured in Ohio’s Cuyahoga County and providing them with a primary care medical home to offer services.


At the time MetroHealth started planning the waiver, the Affordable Care Act was still being challenged in the courts, Anthes said. The U.S. Supreme Court ruled on the law in 2012, upholding its main provisions while strengthening the right of states to decline Medicaid expansion.

The MetroHealth waiver plan in 2013 covered a total of 36,000 residents, who came to the program because they were longtime patients or visited the emergency room or clinics.

Federally qualified health centers and MetroHealth care centers participated in the program.

Anthes said many of the patients had initial mental health or dental problems that needed care. “Many people were delaying medical procedures,’’ he said.

Patients’ diabetes, hypertension and other conditions were improved compared with those before the program, Anthes said.

The Care Plus costs “were 30 percent below budget estimates,’’ Anthes said.

The agreement with the feds was only for one year, but MetroHealth had the ability to extend it.

MetroHealth saw its uncompensated care decrease during the year of Care Plus, while the experiment “gave us experience in population health management,” Anthes said.

Consumer advocacy organizations in Georgia see a waiver program as an insufficient alternative to full-scale Medicaid expansion, which could cover hundreds of thousands of people in the state.

And Bill Custer, a health insurance expert at Georgia State University, told GHN recently that the waiver proposal may be hard to sell to federal officials. He said the feds may question why Georgia isn’t doing this experiment statewide –- or why it isn’t expanding Medicaid.

State leaders say they oppose expansion due to its long-term costs.