Children could be among the hardest hit by proposed increases in co-pays for Medicaid enrollees and the creation of co-pays for families in the state's PeachCare for Kids health care program starting this fall.
A plan to double existing co-pays for inpatient hospital services to $25 is also among the changes proposed by the Georgia Department of Community Health that would save the state an estimated $4.2 million. Co-pays for prescription drugs, vision care and other services would also climb under the plan outlined at a department board meeting Thursday.
Children ages 6 and older enrolled in PeachCare would be the most dramatically affected by the changes, which would take effect Sept. 1, since those families don’t currently have co-pays, said Jerry Dubberly, the state’s Medicaid division chief. PeachCare provides health care to more than 200,000 children through age 18 who don’t qualify for Medicaid and have family incomes up to 235 percent of the federal poverty level.
Advocates worry the co-pays could discourage some families from getting needed care or seeking preventive treatment. The proposed co-pays vary from 66 cents to $3.74 depending on the service, excluding the inpatient hospital fee.
The changes may not look like much, but “we’re talking about people with very low incomes,” said Tim Sweeney, a health care analyst with the nonpartisan Georgia Budget and Policy Institute.
PeachCare families already pay monthly premiums ranging from $10 to $70, Sweeney said. Georgia would also lose out on millions of dollars the federal government provides in proportion to the state's contribution, he said. Medicaid and PeachCare provide health care to roughly 1.7 million low-income Georgians and cost the state $1.7 billion yearly. The federal government adds in roughly $5 billion.
The board is expected to vote on the proposed changes next month.
Also on Thursday, board members approved a planned 0.5 percent cut in reimbursements to medical providers for Medicaid and PeachCare -- saving the state nearly $5.1 million. The General Assembly approved the co-pay and Medicaid payment changes earlier this year.
Some board members expressed concerns about what impact the decreased payments may have on physicians’ decisions whether to accept Medicaid patients. Some doctors have already capped how many Medicaid recipients they will see, and others have stopped seeing those patients altogether.
“It’s a fragile network,” said William Wallace, a board member from Acworth. “I’m concerned I don’t know where the tipping point is.”
The new and increased co-pays will likely be an added burden for doctors, who will be responsible for collecting the fees, said Joann Yoon with the nonprofit Voices for Georgia’s Children.
Department officials aren’t proud about the decrease, but it’s necessary, Dubberly said.
Medicaid is facing a projected $180 million shortfall this fiscal year. Some $77.6 million in state Medicaid dollars were also used to bolster the State Health Benefit Plan.
Meanwhile, officials expect to add 600,000-plus Medicaid enrollees under the federal health care overhaul starting in 2014, which could cost the state an additional $2.1 billion by the end of this decade.
PeachCare coverage
PeachCare for Kids provides health care to children through the age of 18 who do not qualify for Medicaid and whose family incomes are up to 235 percent of the federal poverty level. For a family of four, that equals an annual income of $52,523, according to the state Department of Community Health. Monthly premiums are required for children ages 6 and older -- ranging from $10 to a maximum of $70 for households with two or more children. There is no cost for kids under age 6.
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