Georgia looks to revamp Medicaid amid uncertainty

Georgia is planning to overhaul its Medicaid program over the next couple of years even as federal health care reform remains uncertain.

Georgia is looking to revamp its $7.8 billion Medicaid program that covers nearly one in five people in the state – 1.7 million overall – even with the uncertainty around the Patient Protection and Affordable Care Act. Provisions of that federal reform were challenged in court and are pending review by the U.S. Supreme Court this year.

The presidential and congressional elections in November could also signal changes as Republicans have vowed to overturn it or at least defund it. Even with all of that, the state is trying to move forward, said Commissioner David Cook of the Georgia Department of Community Health, which administers the state’s Medicaid program.

“I think we’re going to be in an
uncertain time for a significant amount of time, for some years to come, but we also wanted to plan for that,” he said. “We wanted to plan for and to make sure we’re doing the very best job we can to have the best Medicaid program right now and going into the future even given these uncertainties.”

For instance, the reforms would significantly increase Medicaid eligibility beginning in January 2014, when Georgia hopes to implement its new Medicaid program, that would eventually add about 650,000 new enrollees, about a 40 percent increase, Cook said. Whether or not that happens, and the fiscal impact despite initial federal funding of it, is one reason the state is looking for a “scalable” solution, Cook said.

“We wanted to look at a program that would be nimble enough to accommodate the future here,” he said.

Among the options Georgia is considering is keeping its Georgia Families managed Medicaid program but expand it to others on Medicaid not currently under it, the aged, blind and disabled, to another option where some Medicaid enrollees would be purchasing their own health insurance. The idea is to set incentives and rules to find the “sweet spot in providing the appropriate level of care for good care,” said Deputy Commissioner Blake Fulenwider.

Some options, such as putting the Medicaid enrollees under more of a “commercial” managed care model with things like co-pays, would require a waiver from federal rules for certain Medicaid populations. But that has already been discussed with the regional staff of the Centers for Medicare and Medicaid Services, said Medicaid Chief Jerry Dubberly.

“They have been very generous in offering their support with any of the options we may choose to pursue,” he said.

The state hopes by April or May to have a recommended model and to put out a request for proposals in the summer, with an eye toward implementing the new system in January 2013 and launching in January 2014. In addition to the Medicaid expansion, January 2014 is also when about a dozen major provisions of the Affordable Care Act kick in, such as the launching of the state-level Health Insurance Exchanges and the individual mandate to buy health insurance.

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