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State looking to boost payments to doctors

ATLANTA - The state agency in charge of Medicaid wants to use savings from an enrollment slowdown to increase payments to doctors and hospitals and boost community-based health care services.

Enrollment in the joint state-federal health program for the poor and disabled fell by 100,000 during the past year and is projected to increase only slightly in the coming year, Carie Summers, the Department of Community Health's chief financial officer, told members of the agency's governing board Thursday.

As a result, the department can afford to earmark a 2 percent spending increase authorized by Gov. Sonny Perdue to increase Medicaid reimbursements to doctors and hospitals for the first time in several years and serve additional Georgians seeking community-based care, she said.

"This has been a lot easier this year than in years past," Summers said. "I hope this sticks as we go through the process."

Board of Community Health members heard the agency's fiscal 2009 budget proposals for the first time Thursday.

The board will vote on the recommendations in two weeks. The budget request then will go to the governor, who will outline his spending proposals to the General Assembly in January.

Summers said the decrease in Medicaid enrollment, bringing the total down to just fewer than 1.2 million Georgians, was primarily the result of an improving economy and stricter enforcement of eligibility requirements, including a ban on services to illegal immigrants.

"We are only serving the people who are truly qualified," she said.

Summers said the agency is projecting only a 2 percent growth in enrollment during the coming year, matching the overall increase forecast for Georgia's population.

She said such slow growth will allow the department to dedicate nearly $40 million to new spending.

"For once, we don't have to use this 2 percent to cover growth," she said.

Proposals Summers outlined to the board would:

n Increase reimbursements to Georgia's 14 trauma care hospitals and non-trauma hospitals at a different rate, with trauma centers receiving a higher percentage of their costs

n Increase reimbursements for physician and physician-related services

n Enroll an additional 50 patients with significant physical disabilities in a program that provides community-based care

n Move an additional 100 patients now housed in institutions into community-based care

n Increase per-visit payments to providers of home health services

Joseph Parker, president of the Georgia Hospital Association, said the 2009 budget recommendations mark the first time the state would reimburse trauma care hospitals at a higher rate than other hospitals.

"It's good news for a change," he said after Summers' presentation. "Certainly, the add-ons for trauma are a step in the right direction."

But Linda Lowe, an Atlanta-based consumer health advocate, said she's concerned that the agency's new spending proposals would come at the expense of needy Medicaid enrollees.

She said many qualified families are being caught up in the state's eligibility crackdown.

"We're not talking about non-citizens being turned away," Lowe said. "What this is is children and pregnant women who are having difficulty getting proof of citizenship and identity."

The reimbursement increases would account for the lion's share of the new spending, $33.6 million, compared to $6.2 million for the rest of the package.

SideBar: At a glance

Most of nearly $40 million in new state spending proposed Thursday by the Georgia Department of Community Health would go to boost reimbursements to providers serving Medicaid patients:

Item/Amount

Increase reimbursements for inpatient hospital services/$16.8 million

Increase reimbursements for outpatient hospital services/$6.8 million

Increase reimbursements for physician and physician-related services/$10 million

Total/$33.6 million

Source: Georgia Department of Community Health