As he squirmed around in his Spider-Man bathrobe in bed at the Children’s Hospital of Georgia, clicking away with a borrowed camera, he talked nearly nonstop about superheroes and Dragon Ball Z and about what he likes to do.
“I like to wrestle,” he said, grinning.
“Beating up on his brother,” said his mother, Heather.
“I like to flip on my bed,” Aidan said. “I can do a whole back-flip.”
Medicaid is covering almost all of his very expensive care – a bill for three months came to more than $114,000. But when his brother Drake needs his Medicaid managed care coverage for even routine things, it is a different story, Tidwell said.
“It’s a headache,” she said.
Getting better coverage for children in Georgia is one aim of a statewide coalition that proponents say is the first of its kind in the country.
The Pediatric Health Improvement Coalition is joining 1,500 pediatricians in Georgia and the state’s five children’s hospitals.
Though the hospitals in Augusta and Atlanta enjoy long histories, they are
mostly separate, said Dr. Bernard L. Maria, the chairman of pediatrics and the pediatrician-in-chief of the Children’s Hospital of Georgia, formerly the Medical College of Georgia Children’s Medical Center.
“There was really no example of collaboration and interchange between the two largest children’s hospitals, let alone the ones in Savannah, Macon or Columbus,” he said. That competitiveness probably hurt advocacy efforts for children.
“One of the challenges has been how can we come together with a single voice,” said Maria, who was recently named the coalition’s chief medical officer.
The group has been advocating for better care from the Georgia Department of Community Health and the state’s Medicaid programs.
More than half of Georgia children are born into the Medicaid program, and 1.3 million are covered by Medicaid or PeachCare for Kids, the state’s Children’s Health Insurance Program.
Georgia Medicaid spends about $2,200 per child, “which is about a fourth of what Massachusetts spends and about half of what North Carolina spends per kid,” Maria said.
In 2011, the Commonwealth Fund State Scorecard on Child Health System Performance ranked Georgia 43rd on key indicators of child health. It is even worse in many counties of the state, where the infant mortality rate is four times the national average, Maria said.
The 350,000 children in south Georgia
are in particularly bad shape because the bottom third of the state does not have a children’s hospital and many counties lack even primary care pediatricians, much less specialists, he said. Nor will Medicaid managed care companies allow children to cross the line to use services in Florida, Maria said.
“They’ve got huge access problems,” he said.
The group is working on an initial project on creating better asthma care by promoting a single, effective protocol, Maria said.
“The idea is that by working together we’ll use a single protocol and we’ll keep kids out of our emergency rooms and out of the hospital, where most of the spending takes place,” he said. Georgia commits about $200 million a year to asthma care for children, but that can probably be spent more wisely, Maria said.
“If we can better manage those resources, we can free up some dollars that can be used to support some of the other child health challenges,” he said.
The state might one day recognize that the kind of effort the coalition is putting forth could work for adults, too, Maria said.
“Maybe this will be some kind of model going forward if we can deliver on the promises of higher quality care that is cost-effective,” he said.
For Aidan, who was in the hospital to receive IV antibiotics, Medicaid is now compliant, but that wasn’t the case when he first got on the program.
“They didn’t want to cover anything,” Tidwell said. “They gave me a hard time about his shots.”
With Aiden facing his third year of chemotherapy, his mother said he has already been through so much in his six years.
“He’s defeated a lot of odds,” she said. “We try to make his life as normal as possible. We try to make each day count.”