Originally created 08/24/04

Perdue pushes private plans



ATLANTA - More than a million Medicaid recipients would end up on private plans resembling health maintenance organizations under a plan being pitched by Gov. Sonny Perdue.

The proposal, which Mr. Perdue will unveil today to groups affected by the change in a meeting at the Governor's Mansion, would take effect by 2006 and could become a contentious issue in next year's legislative session.

Medicaid recipients who aren't part of the state programs for AIDS, the blind and disabled or long-term care would be moved to private plans as part of an effort to tamp down growth in the massive health care program, which is expanding at a 10 to 12 percent clip each year.

Officials promised Monday that the state would keep an eye on the "care maintenance organizations" and require them to provide the same services as Medicaid.

"They have to provide at least the Medicaid services - they may provide more," said Tim Burgess, the commissioner of the Department of Community Health, which oversees Medicaid in Georgia.

The proposal would split the state into six regions of roughly the same size, though officials noted that a metro Atlanta region might be larger simply because of the area's population. The state would try to make sure that at least two contractors offer coverage in each region to give recipients a choice.

Doctors would choose whether to join one or both plans in their region, and some providers could join together to try to bid for one of the contracts in their area.

In addition to saving the state money, Mr. Burgess said the plan would make the care provided by Medicaid more efficient - for example, by getting patients to avoid trips to the emergency room when a trip to the doctor would do. It would also cut down on the possibility of a patient getting multiple and possibly contradictory prescriptions from separate doctors.

Exact figures on how much the plan would save weren't available because the plan wasn't complete, Mr. Burgess and others said. But those patients excluded from the plan still account for 60 percent of the program's cost.

Medicaid recipients in the AIDS, blind and disabled and long-term care programs would be kept under the program's traditional arrangement because the state would likely have to seek a waiver from the federal government if they were included, Mr. Burgess said.

The changes would have to be approved by the state Legislature, either in legislation authorizing the change or through the state budget process.

A group of legislators was briefed on the plan Monday afternoon.

State Sen. Regina Thomas, D-Savannah, said the plan was privatization by a different name. Ms. Thomas said she had a list of concerns about the changes, including how quickly the program would take effect and how many state employees might lose their jobs.

"We need to take our time with this," Ms. Thomas said. "It's not going to save the state any money." She also said it looked as though the state focused more on saving money than on helping patients.

But Rep. Ben Harbin, R-Evans, said he supported the idea, though he noted there was still work to be done.

"I think the governor's on the right track," Mr. Harbin said. "We've got a Medicaid (system) that is eating up most of our new revenue."

Reach Brandon Larrabee at (404) 681-1701 or brandon.larrabee@morris.com.

Perdue

Sonny Perdue's proposed changes to Medicaid would have to be approved in some form by the state Legislature. If approved, they would take effect by 2006.