Medicaid might hinder exams

Problems with Georgia's Medicaid system might spill over into required school health exams and could soon create a nightmare for parents who want to use local health departments.

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Problems began to crop up immediately after April 1, when the state switched to Affiliated Computer Services to handle its electronic Medicaid claims. The company couldn't process the billings, and payments have been delayed for weeks and months, creating hardships for providers throughout the state.

As part of the new system, health departments were informed that they would need an authorization number for Medicaid patients if they wanted to bill for the vision, hearing and dental exams required for first-time admission to Georgia schools. That could create a huge headache in coming weeks when families begin showing up at the health departments to get the exams, said Phyllis Roland, the facility administrator at the Columbia County Health Department.

"Normally, they flock to us or they flock to their private provider," said Ms. Roland, who estimated the health departments do "several hundred" before each school year. "If they're on Medicaid or PeachCare, we cannot do it without an authorization number from their private provider.

"There's a potential for a lot of hassle for the schools, a lot of hassle for the parents, and that's not the intent of any of this," she said.

The health departments and the regional East Central Health District office in Augusta are contacting providers, to whom the patients are assigned by Medicaid, to work out a written agreement that would allow the health departments to do the exams. Ms. Roland said she had talked to seven or eight practices and all had been cooperative.

The Medicaid managed care program requires a referral for some services not provided by the primary care doctor, but it was not clear whether the exams would fall into that category, said Andy Boisseau, a spokesman for the Department of Community Health, which oversees Georgia Medicaid.

The authorization requirement does not appear to affect the mandatory shots, said Mike Chaney, the manager of the Georgia Immunization Program.

"Immunizations are handled a little differently," he said.

Parents can call providers to get the authorization before coming to the health department for the exam, Ms. Roland said. The cost is normally $19 for the exam, but the health departments charge a sliding scale fee of as little as $7 with proof of household income.

Reach Tom Corwin at (706) 823-3213 or tomc@augustachronicle.com.

--From the Saturday, July 19, 2003 printed edition of the Augusta Chronicle