A good omen for Georgia Medicaid waiver plan?

An Ohio program that gave insurance to thousands of low-income patients helped them improve on health measures and also produced unexpectedly low costs, according to a study published Tuesday.

MetroHealth Medical Center in Cleveland
MetroHealth Medical Center

Those findings may have a significant impact in Georgia.

State officials are considering a proposal from Grady Health System in Atlanta to extend coverage to uninsured Georgians through a special Medicaid “waiver.’’ Grady officials say the waiver program would be modeled after the Cleveland MetroHealth Care Plus program.

The study, in the journal Health Affairs, analyzed the impact of the Care Plus program, which gave 28,295 Cuyahoga County residents Medicaid coverage for 11 months in 2013. 

The study focused on Care Plus patients with high blood pressure or diabetes and on patients who had the same conditions but remained uninsured. Compared with the uninsured group, Care Plus patients with diabetes during 2013 improved more on quality-of-care standards such as receiving recommended eye exams.

High blood pressure also was better controlled among Care Plus patients than among those who remained uninsured, though the difference was not statistically significant.


The MetroHealth System, a safety net provider, and two federally qualified health centers provided care to the patients. MetroHealth accepted some financial risk, which meant that if the total costs of care were higher than allowed by the federal officials, the organization would have to absorb the extra expense.

But there was no need to pay such a penalty, because the 28.7 percent savings by Care Plus for all enrollees totaled more than $41 million, the study found.

Matt Hicks, a Grady Health System vice president, said Tuesday that the study’s findings “are encouraging.”

“One of our goals was to test different models in the Georgia policy environment,’’ Hicks said. “This study shows we’re on the right track in considering this approach.”

The Grady system has teamed up with five federally qualified health centers in Fulton and DeKalb counties and a philanthropic consortium that includes the Tull Foundation, the Community Foundation for Greater Atlanta, and Kaiser Permanente of Georgia, Hicks said.

Grady generated the waiver plan as an alternative to Medicaid expansion in Georgia under the Affordable Care Act. Expansion has been firmly rejected by Gov. Nathan Deal and state legislative leaders, who say it would cost too much.

The proposal 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, Memorial Health in Savannah, and a small group of rural hospitals are seen as the initial sites in the coverage plan.

Praise from a participating doctor

In Ohio, a MetroHealth family physician, Dr. James Misak, called the Care Plus program “an unqualified success.”

He said patients’ medical, dental and mental health needs were met after they were assigned to a primary care physician in a “patient-centered medical home.”

Dr. James Misak
Dr. James Misak

That medical home concept was instrumental in the success of the Cleveland program, Misak said.

“They were able to afford medications and see specialists,’’ Misak told GHN. “Coverage helps people access care at the most appropriate place,’’ and not at the emergency room, he added.

The patients “were very grateful,’’ he said. “They felt so much better.”

Care Plus lasted only about a year in Ohio,because the state decided to expand Medicaid. The patients involved in the waiver program transferred into regular Medicaid in 2014. Misak said expansion has been a big success in the Buckeye State.

The Health Affairs study concluded that “the advent of these new models provides cause for optimism that the favorable results described here may underestimate the results that are possible, especially in settings with a prepared safety net and financial forces that are better aligned for better care, better health outcomes, and lower per capita costs.”