A new insurer in Georgia, CareSource, currently has zero enrollees. But starting July 1, it will suddenly have at least 200,000 people in its... Nonprofit insurer CareSource jumping into Ga. Medicaid market

A new insurer in Georgia, CareSource, currently has zero enrollees.

But starting July 1, it will suddenly have at least 200,000 people in its health plan here.

caresourceThat’s because CareSource has been promised a minimum of 200,000 Medicaid or PeachCare enrollees, as it joins three other health insurers delivering care to more than 1 million Georgians.

Ohio-based CareSource is ramping up its employment in the state, with 200 new jobs scheduled here and another 100 at its Dayton headquarters to service the Georgia contract.

The “care management organization” (CMO) contract is worth an estimated $4 billion over six years, with the overall figure being split among the four insurers.

Open enrollment is going on this month for Medicaid and PeachCare members – a new process for the government programs. If a member does not choose a CMO during open enrollment, that individual will be automatically enrolled in one. These members will have the option of changing to a different health plan from July 1 through Sept. 30.



CareSource officials in Georgia realize the challenge they face in getting ready.

“We will go from zero” to 200,000, Bobby Jones, president of the CareSource Georgia operation, told GHN recently. “We want to do this right.”

The insurer is busy building a network of hospitals and doctors in the state. That work is more than 80 percent completed, Jones said.

CareSource differs from the other three care management organizations serving Medicaid in that it’s a nonprofit insurer. Incumbents WellCare, Peach State and Amerigroup are all for-profit companies.

“Providers have been receptive that we’re nonprofit,’’ Jones said.

Graham Thompson, executive director of the Georgia Association of Health Plans, said Monday that CareSource has a solid track record in Ohio. “As they’re building up their network, they’re being educated on the challenges in [medical] provider contracting’’ in Georgia, Thompson added.

exchange2017Company officials say CareSource is evaluating the possibility of joining the Georgia insurance exchange in some future year.

If that happens, it would be bucking the current trend for the state’s exchange, which has seen giant insurers Aetna and UnitedHealthcare depart, with Humana set to leave next year.

CareSource has both Medicaid and exchange offerings in Ohio, Indiana and Kentucky, along with Medicare Advantage plans in those states.

In Georgia, though, the focus now is on the Medicaid business and the ramping up of its call center, provider network and member services, said Jason Anavitarte, director of CareSource state development and advocacy.

“We’re happy to be in Georgia,’’ Jones added.

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Andy Miller

Andy Miller is editor and CEO of Georgia Health News

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