Medicaid/PeachCare Managed Care
The
Georgia Department of Community Health required nearly a million Medicaid
and PeachCare members to enroll in care management organizations (CMOs)
during 2006, most of them children. DCH has divided the state into six
regions and has at least two CMOs serving each region (three in the Atlanta
Region). They are Amerigroup, Peachstate, and Wellcare. The overall plan is
called Georgia Healthy Families.
Enrollment is mandatory for low-income families, pregnant women, newborns, and women eligible for Medicaid due to breast and cervical cancer. Taken together, these groups have the lowest costs in the Medicaid program. (Seniors and people with disabilities may not enroll in the CMOs. DCH has a different plan to provide disease management for this population with higher medical expenses.) The plan has generated much controversy. DCH has estimated savings of 8% for the CMO plan.
The results of major managed care initiatives in other states have been mixed. Georgia already had costs per enrollee that are among the lowest in the country. Furthermore, per-enrollee cost increases have been in single digits in every eligibility category in contrast to the double-digit increases experienced by private health plans. Under these circumstances, advocates say it is hard to see how CMOs will save the state 8% while making a profit without cutting payments to providers, services to patients, or both.
The CMOs have been in place only a short time in most of the state. Complaints have surfaced about slow or no payment to some providers, worsened access to pediatric specialists, denials of therapy services, and increased refusal of some providers to take Medicaid because of payment issues and paperwork approval burdens. The Department of Community Health attributes most of the problems to start-up “glitches,” but providers and advocates have growing concerns about the CMOs and what the end results will be.
View PowerPoint Presentation —
Georgia Medicaid & PeachCare:
Moving Patients into Managed Care