ATLANTA - Advocates for a strong safety net get worried whenever Georgia lawmakers take it upon themselves to make major changes to a state program during the budget process.
But it's not just lobbyists for social services spending who raised an outcry last week when House budget writers proposed to move aged, blind and disabled Medicaid patients into managed care.
The head of the state agency that oversees Medicaid, appointed to her post by Gov. Sonny Perdue, called the plan "premature" and unrealistic, given the short time frame envisioned by House leaders.
The $20.2 billion 2008 budget passed overwhelmingly by the House on Friday includes $30 million in projected savings that would be achieved by expanding Georgia's year-old Medicaid managed care program to aged, blind and disabled enrollees. The move would take effect at the beginning of next year and be limited to patients in the Atlanta region.
The Department of Community Health launched Medicaid managed care last June by moving about 600,000 low-income adults and children in metro Atlanta and Middle Georgia into HMO-like companies called "care-management organizations." The program was expanded to the rest of the state in September, covering another 600,000 enrollees.
Perdue and DCH Commissioner Rhonda Medows said the CMOs would both save taxpayer dollars and offer Medicaid patients consistent health care from regular doctors.
The agency's plan all along has been to expand the program to the entire Medicaid population, including about 100,000 aged, blind and disabled enrollees, Rep. Ben Harbin, chairman of the House Appropriations Committee, said Friday as he went over the budget with his colleagues.
"Our department was heading there anyway," he said. "We're just asking them to move ahead."
But Medows said it's too soon to expand Medicaid managed care because the DCH doesn't have a firm grip yet on how the more limited version of the initiative is working.
"We have less than one year experience with the current program and have not had the first year's data to analyze regarding quality of service delivery and appropriate savings," the commissioner said Friday in a prepared statement.
Social services advocates are skeptical of the proposal because the House budget committee seemingly pulled it out of nowhere after neither the governor nor the DCH asked for it.
Alan Essig, executive director of the Georgia Budget and Policy Institute, argued that such major changes in policy usually are reviewed for months by the various parties interested in the outcome.
He questioned the motivation behind proposing such an important step during the budget process.
"Are we doing this in the interest of consumers or to save money?" he asked. "If you're going to do this, it has to be for the right reasons."
Essig said there's a reason the state chose to limit the program to low-income adults and children instead of including aged, blind and disabled Medicaid patients from the start.
"This is the most vulnerable part of the Medicaid population," he said. "The mothers and kids are pretty healthy."
But Senate Majority Leader Tommie Williams turned that argument around.
Williams, R-Lyons, who has been a strong supporter of the CMO initiative, said aged, blind and disabled enrollees are the most important to move into the program.
"It's the aged, blind and disabled who are costing us the most money per capita," he said. "A lot of people out here are just going to the emergency room (for treatment). It's very expensive."
But Williams said aged, blind and disabled patients also would get better health care through CMOs because they would have regular doctors to keep track of them.
"These are people who have significant diseases, such as diabetes," he said. "If nobody makes them take their medication, they're going to end up in the hospital."
Beyond the arguments over whether managed care would benefit these patients, however, is the time element.
Medows said there's no way the program could be expanded to the aged, blind and disabled by Jan. 1 because the change would require federal approval. She said the waiver process that would entail would take two years.
Democrats raised the same issue on the House floor during Friday's debate on the 2008 budget.
Harbin said he would be flexible with the timetable if it becomes necessary.
"If we see it's not a real deal, we can move it back," he said.
The House proposal also faces an uncertain fate as the 2008 budget moves to the Senate.
While Williams said Friday that he likes the idea, he wouldn't predict whether senators would leave it in their version of the budget.