A nearly year-long effort to reshape Georgia's Medicaid program has largely been put on hold amid uncertainties surrounding the U.S. Supreme Court's recent health care law decision and effects of the November elections.
Georgia Department of Community Health Commissioner David Cook said Friday it would be imprudent for the state to make sweeping changes to the massive health care program for low-income Georgians with so many unknowns in play.
The state was widely expected this summer to announce plans to dramatically expand its use of for-profit insurance companies to manage the care of hundreds of thousands of elderly and disabled Georgians -- some of Medicaid's most complex and expensive patients. The goal: companies would help hold down runaway costs to taxpayers by focusing on prevention and better coordination of care.
Doctors, hospitals and advocates for Medicaid patients have expressed concern about the fallout of such a shift.
The health care law adds too much complexity to proceed with a major revamp now, Cook said, though some other changes will move forward.
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While upholding the law, the Supreme Court ruled last month that states could opt out of the 2014 Medicaid expansion that is a pillar of the Patient Protection and Affordable Care Act. Meanwhile, Republicans hope to gain control of Congress in November and repeal the law. And presidential candidate Mitt Romney has vowed he would act to repeal the law on his first day in office if he wins the election.
"We're facing increasing uncertainty in Washington," Cook said. "There are a number of major new options that are on the table or could be on the table, and we want to be sure we consider those as we go forward."
Georgia's Medicaid and PeachCare for Kids programs cover 1.7 million people, most of them pregnant women and children, and cost roughly $7.8 billion a year. The state's share totals about $2.3 billion with the feds paying the majority.
The program now faces a $300 million shortfall that is expected to grow to more than $600 million annually in the next few years.
The decision to put off a wholesale restructuring echoes a separate decision by Gov. Nathan Deal to wait until after the November elections to decide whether to expand Georgia's Medicaid program under the law. An expansion would add an estimated 650,000 new enrollees.
The delay is a smart, strategic move considering the unanswered questions, said Russ Toal, a former Georgia Medicaid director who is now a health policy expert at Georgia Southern University.
"No state can really afford to make critical decisions right now," Toal said. "To make the right decision, you have to know what your options are."
State health officials, medical providers and advocates for the elderly and disabled have been meeting for months to debate various options to redesign Medicaid. Many voiced concerns that the department was moving too quickly to make major changes that could disrupt care for some of Georgia's most vulnerable citizens.
Cook said the input has been a great benefit, adding the process will continue with the state weighing its options.
The state does plan to move forward with some elements of the redesign.
Foster children will be brought under a single care management organization to better track their care no matter where they are living. The department is encouraging movement toward medical homes where the primary care doctor coordinates all of a patient's care.
Changes will also include emphazing a value-based purchasing model to improve care while containing costs, creating a centralized Web portal designed to cut down on administrative burden for providers and establishing a common pharmacy preferred drug list.
There are a lot of questions as to how best manage care for the elderly and disabled, so it's good the department isn't rushing the process, said Tim Sweeney, a health care policy analyst for the nonpartisan Georgia Budget and Policy Institute. But the state needs to continue to consider options and eventually address the problem, not put it off, he said.
It gives everyone time to create a strategy that's going to serve the state well, said Pat Nobbie, deputy director of public policy at the Georgia Council on Developmental Disabilities. Her group worries that insurers hired to manage Medicaid might not be able to provide non-medical services such as transportation and housing support. The group has worked with Cook's agency to have those issues addressed.
"We did all that work and now we're prepared for anything," she said. "We've done our homework."
The Atlanta Journal-Constitution first laid out the state's ambitious plans to overhaul management of the Medicaid program to reign in runaway costs. Our stories have pointed out that many Georgia families - including many in the middle class - eventually turn to this safety net program for help. For instance, Medicaid covers 72 percent of the state's nursing home residents, most of whom must deplete their life savings before resorting to Medicaid to pay the bills. For people with disabilities and mental illness, Medicaid pays for social services that can extend a bridge to a life outside of an institution.