Medicaid managed care coming to Georgia

ATLANTA - Georgia's managed care program for Medicaid patients is open for business after two delays.

Gov. Sonny Perdue and health officials inside and outside of government held a news conference on Wednesday to urge the 1.2 million Georgians enrolled in Medicaid or the state's PeachCare for Kids program to sign up with Georgia Healthy Families.

The program, which kicks off in the Atlanta region - including Gwinnett and Barrow counties - and middle Georgia on June 1, seeks to provide a primary care doctor for Medicaid patients, many of whom are accustomed to going to hospital emergency rooms to seek treatment for whatever ails them.

"Many Medicaid and PeachCare patients have never had a doctor of their own,'' Perdue told a crowd assembled in the lobby at Atlanta's Grady Memorial Hospital, which serves more Medicaid recipients than any other hospital in Georgia by far. "These organizations are incentivized to create a medical home.''

The organizations the governor alluded to are "care management organizations,'' the Medicaid equivalent of HMOs.

The state has hired three CMOs to bring managed care to Medicaid, a joint state-federal health care program for the poor and disabled that historically has relied on fee-for-service coverage.

The state Department of Community Health is relying on the CMOs to bring the same savings to the Medicaid population that HMOs have brought to private sector health care.

Indeed, the initiative is projected to save taxpayers $80 million during the fiscal year that starts July 1.

The initiative's budget ramifications have prompted fears from critics that Medicaid managed care will cut corners in an effort to maximize savings.

But Perdue and other speakers at Wednesday's event emphasized the benefits they expect the program to bring to Medicaid patients as well as what it will do for the state's bottom line.

Prevention and wellness are key to the program, health care components that can be delivered best to patients who have a regular doctor, said Dr. David Satcher, a former U.S. surgeon general and interim president of Morehouse School of Medicine.

"A medical home is an important concept ... having a relationship with a physician who knows you, who knows your record,'' he said. "There is no substitute.''

The program originally was to have begun in January. But it was delayed until April and again until June to give patients more time to choose a health plan.

Those who don't make a selection by the deadline will be assigned a plan. But Perdue said that he and the health officials running the program would rather let patients make that decision.

The program is maintaining both a toll free phone line and Web site to help enrollees obtain information and enroll in a plan.

After the June startup in metro Atlanta and middle Georgia, the program will go statewide on Sept. 1 in four remaining regions: East, North, Southeast and Southwest.