Lawmakers hear earful on Medicaid managed-care move
Parents, health care providers blast program

ATLANTA - Gov. Sonny Perdue's cost-cutting move to convert most of Georgia's Medicaid program to managed care has been a nightmare for patients and health care providers, dozens of speakers complained Tuesday.

Representatives of hospitals, doctors, dentists and therapists told members of two legislative committees of inadequate and delayed payments for services rendered.

Parents described endless hassles with insurance company bureaucrats to get needed health care for their children.

"Providers should be paid for the services they provide," said Vicki Madden of Clayton County, mother of a child with Down syndrome, to thunderous applause from the audience gathered inside a Capitol meeting room. "Children should be given the opportunity to develop to their full potential."

At issue is the state's decision last year to hire three HMO-like companies to oversee Medicaid and PeachCare coverage for about 950,000 low-income Georgians, mostly women and children.

The Department of Community Health has paid out $2.3 billion to the companies since launching the first phase of the initiative in June 2006. During fiscal 2007, which ended last June 30, the move saved the agency $78.5 million.

DCH officials kicked off a two-day hearing before the House and Senate budget subcommittees on health spending by presenting statistics on the need for Georgia to move away from fee-for-service delivery of Medicaid to managed care.

According to the numbers, the state's Medicaid budget was threatening to soar out of control.

Left unchecked, Medicaid spending would have eaten up half of all new state revenue during this fiscal year and 60 percent by fiscal 2011. The goal of the managed-care initiative was to connect as many Medicaid and PeachCare patients as possible with a primary-care doctor, both to improve the quality of their care and to keep them away from expensive hospital emergency rooms.

But during the public hearing that followed the agency's presentation, Earl Rogers of the Georgia Hospital Association said the "care-maintenance organizations" the state brought in aren't keeping that promise.

"We have little evidence that the CMOs have hired the necessary personnel to achieve that goal," he said.

Instead, one health care provider after another told lawmakers the companies are saving money by denying services and cutting and/or delaying payments.

Kay Nelson, an occupational therapist from Gwinnett County, said it can take weeks of repeated phone calls and faxes to gain permission to see a child.

"Sometimes, we're paid. Sometimes, we're not," she said. "We're still trying to collect money owed to us from June of last year."

Kathy Driggers, chief of managed care and quality for the Department of Community Health, conceded that the switch to managed care has been "traumatic" for the various parties involved. But she said the agency is keeping a close eye on the CMOs and will ensure that the companies live up to their contractual obligations. She noted that the CMOs are required to submit 58 different reports to the department.

"We don't just sit there and check these off on a checklist when they come in," Driggers said. "There's a huge amount of monitoring going on between us and the plans."

It will be the CMOs' turn to defend themselves when the hearing resumes today. Representatives of all three companies are expected to appear before the subcommittees.