The Georgia Department of Community Health is redesigning the state’s Medicaid and PeachCare for Kids programs. These programs cover more than 1.7 million low-income children, families and disabled Georgians. As advocates for children and health care consumers, we view this process as an opportunity to strengthen these programs to ensure they provide access to the services that children and families need to live healthy, productive lives.
There are concrete steps the department can take to bolster these programs for the future. We encourage the department to adopt a best-practices approach by focusing on three evidence-based themes as it redesigns these programs for children: first, coverage matters; second, ensuring access to care requires adequate network capacity and accountability; and third, ensuring quality of care requires system coordination.
Coverage matters. Numerous studies link continuous health insurance coverage to improved health outcomes. Georgia’s uninsured rate for kids has steadily improved from 11 percent in 2008 to 9.8 percent in 2010. Still, about three-quarters of uninsured children are eligible for Medicaid or PeachCare for Kids. By leveraging new funding opportunities and program flexibilities at the federal level and by borrowing a page from successful initiatives in states such as Alabama, which has reduced its uninsured rate for children to 6 percent, we can get closer to providing health coverage to all children. For example, Georgia could simplify the eligibility process by adopting a policy of 12 months continuous eligibility for kids (currently some fall through the cracks with a six-month renewal policy).
Ensuring access to care requires adequate network capacity and accountability. Significant documented weaknesses in pediatric specialty networks exist in each region of the state. Georgia has two policy levers at its disposal to bring these networks up to standard: first, increase provider reimbursement rates for specialty care; and second, monitor contracts with care management organizations (CMOs) to ensure compliance with policies to establish out-of-network arrangements. Where shortages in physician supply hinder access, the department should work with the CMOs to explore emerging solutions such as telemedicine.
Ensuring quality of care requires system coordination. The department maintains strong quality standards, but opportunities exist for improvement. For example, well-care visits and key screenings are below national averages, and less than half of Georgia’s children with behavioral health challenges obtain the care they need. Promising care coordination practices in states such as Texas, which uses an electronic health records system in the state’s foster care system, and Rhode Island, which utilizes specially trained parent consultants, can inform Georgia’s efforts to develop a more coordinated system of care for children. Taking these steps will pay dividends long into the future.
Pat Willis is executive director of Voices for Georgia’s Children. Cindy Zeldin is executive director of Georgians for a Healthy Future.
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