Amanda Ptashkin, JD Outreach and Advocacy Director, Georgians for a Healthy Future May 4, 2012 Redesigning Medicaid and PeachCare

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it is the only thing that ever has. --Margaret Mead Picture Courtesy of:

About Georgians for a Healthy Future Georgians for a Healthy Future (GHF) is a nonprofit health policy and advocacy organization that provides a voice for Georgia consumers on vital and timely health care issues. Our mission is to build and mobilize a unified voice, vision and leadership to achieve a healthy future for all Georgians.

Why Health Care is Changing The status quo is unsustainable -Health care spending is growing faster than the economy and wages Health status and outcomes are inadequate -They drive increased costs -United Health Foundation study ranks Georgia in the bottom of the nation: 43rd overall (2009) Americans have insufficient access to health insurance coverage -Adds to the system’s inefficiency -Leads to worse outcomes and higher costs Georgians Have Insufficient Access to Coverage (Non-elderly Georgians in )

Builds on current system to expand coverage –The tax-preference for employer coverage remains –Expands existing programs to cover lowest-income Americans (Medicaid) –Provides subsidies for small businesses & middle-income individuals without employer coverage Increases coverage for preventive care Invests in health care infrastructure Pilots projects for payment reforms Individual Mandate State-based Health Exchanges Employer-based “carrots” and “sticks” to increase health increase coverage Patient Protection and Affordable Care Act, March 2010

Medicaid Eligibility Changes in Georgia Selected PopulationsCurrent EligibilityNew Eligibility Children (6-18 years-old) % FPL Peachcare for Kids with a premium Medicaid with no premium Adults with ChildrenMedicaid available for those at or below 29% FPL Medicaid available for those at or below 133% FPL Adults with no childrenNoneMedicaid available for those at or below 133% FPL ~650,000 to 900,000 newly eligible for public insurance. Source: Georgia Health Policy Center

Medicaid Expansion Costs for GA New state funds average $120 million for the first six years New state funds ≈ 2.7% increase above baseline without reform ($’s in millions) Source: Kaiser Commission on Medicaid and the Uninsured

Medicaid Redesign Earlier this year the Department of Community Health (DCH) began evaluating Medicaid and PeachCare for Kids™ and assessing how other states manage these programs. The assessment aims to address three main goals through this process: 1)improve health care outcomes for members, 2)enhance the appropriate use of services by members, and 3)achieve long-term sustainable savings in services

Medicaid Redesign DCH issued a Request for Proposal for a comprehensive assessment and recommended redesign of Georgia's Medicaid Program and Children's Health Insurance Program (CHIP/PeachCare for Kids®). The redesign initiative will focus on solution planning, innovation and strategic options for managing the care and financing of Georgia's Medicaid and CHIP populations. On July 26, 2011, DCH awarded the consulting contract to Navigant Consulting, Inc. Reasoning? Partly because the CMO contracts are up for renewal in a year Partly because of the upcoming Medicaid expansion in 2014

Medicaid Redesign DCH issued a Request for Proposal for a comprehensive assessment and recommended redesign of Georgia's Medicaid Program and Children's Health Insurance Program (CHIP/PeachCare for Kids®). The redesign initiative will focus on solution planning, innovation and strategic options for managing the care and financing of Georgia's Medicaid and CHIP populations. On July 26, 2011, DCH awarded the consulting contract to Navigant Consulting, Inc. Reasoning? Partly because the CMO contracts are up for renewal in a year Partly because of the upcoming Medicaid expansion in 2014

Navigant’s Report Navigant Consulting has concluded the assessment phase of the redesign process and released its Strategy Report to DCH. The Strategy Report includes a national and Georgia-specific environmental scan of the Medicaid and CHIP programs, as well as three delivery options for DCH to consider as it moves into the Procurement and Implementation Phases of the redesign process. These options build upon one another, with each adding features beyond the one before it: 1.Georgia Families Plus 2.Georgia Families Plus Transitioning to “Commercial Style” Managed Care Program – Enrolls 3.Georgia Families Plus Transitioning to “Commercial Style” Managed Care Program that Requires Inclusion of Accountable Care Organizations (ACOs) and Patient-centered Medical Homes (PCMHs)

DCH Task Forces In order to assist DCH in selecting the right redesign option for the state, they have convened three separate task forces and one working group to consider all options. -Provider task force -ABD task force -Children and families task force -Substance Abuse, Mental Health workgroup

Care for Georgia’s Kids: Modernizing Medicaid and PeachCare Voices for Georgia’s Children and Georgians for a Healthy Future commissioned a study with the purpose of putting a special focus on opportunities to improve insurance coverage and health care services. The report, titled “Modernizing Medicaid and PeachCare for Kids: Promising Program Design Options for Georgia’s Children”, shows us that Georgia can greatly increase the number of children covered and keep children covered while also trimming administrative costs and improving quality outcomes. To read the report in its entirety, visit and-peachcare-redesign. and-peachcare-redesign

Care for Georgia’s Kids: Modernizing Medicaid and PeachCare 1.Simplify Eligibility 2.Improve Access to Specialty Care 3.Ensure Access to Coordinated Care 4.Strengthen Accountability 5.Use All Available Resources

CARE-M Coalition to Assure Redesign Effectiveness for Medicaid A key suggestion from the Navigant report includes including the ABD(aged, blind, disabled) population into Medicaid Managed Care—right now it is strictly fee-for-service. Several advocate groups across the state have a vested interest in the ultimate redesign of Georgia’s Medicaid and PeachCare systems. Many of these groups have been following DCH and Navigant’s progress and have drafted recommendations and policy papers on the topic.

CARE-M Coalition to Assure Redesign Effectiveness for Medicaid Over the past several months, members of CARE-M have been meeting with our three current CMOs as well as potential bidders for the redesign contract. These coalition members want to ensure that specific populations are being thoughtfully examined and that the right redesign option is applied for these groups.

Substance Abuse and Mental Health Work Group Illicit drug use in America contributed to an estimated $193 billion in crime, health, and lost productivity costs in 2007 (ONDCP National Drug Council Strategy, 2012) There is a net savings of $2,500 per person per year in Medicaid costs associated with treatment (Wickizer, T.M., Krupski, A., Stark, M.D., Mancuso, D., & Campbell, K.,2006,The Milbank Quarterly, 84(3), ) Substance Abuse treatment yielded a con­servatively estimated $252 per person per month in cost reductions associated with medical care and state and community psychiatric hospitalizations (Estee, S., & Nordlund, D.J.,2003, Washington State Department of Social and Health Services) In 2007, over 494,000 or 6.5% of Georgians needed but did not receive treatment for alcohol use, another 212,000 or 2.8% needed but did not receive treatment for illicit drugs. One out of thirteen Georgians is under some form of correctional supervision, and approximately 70% of these offenders have a substance use disorder.

Substance Abuse and Mental Health Work Group Georgians for a Healthy Future along with the Georgia Council on Substance Abuse have been given a grant to work on substance abuse disorder policy. This is a 10-month health care initiative to develop a continuum of comprehensive services that address the needs of people at risk of and who have a substance use disorder. Goal: Ensure Quality Coverage that Supports Sustainable Recovery

Opportunities Advocate for assertive outreach and enrollment, reach as many as possible to minimize the uninsured population To share detailed opinions, visit the DCH website at for a link to their Feedback Tool, or you might go directly to the tool at To share a brief comment, you can DCH at

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