Georgia Invoice Goals to Restrict Income of Medicaid Managed-Care Corporations


ATLANTA — Georgia lawmakers will contemplate a invoice that might power the state’s Medicaid managed-care insurers to repay hundreds of thousands of {dollars} if their spending on medical care doesn’t attain a sure threshold.

The bipartisan invoice, launched Jan. 26 by the highly effective Georgia Home Speaker David Ralston, a Republican, is concentrated on bettering the state’s psychological well being care system.

Tucked contained in the laws is a provision that may require the Medicaid managed-care corporations to refund funds to the state in the event that they don’t spend sufficient on medical care and high quality enhancements for sufferers.

Georgia Well being Information and KHN reported in September that Georgia was one in all only some states that doesn’t mandate a minimal stage of medical spending for its Medicaid insurers.

Every year, Georgia pays three insurance coverage corporations — CareSource, Peach State Well being Plan, and Amerigroup — a complete of greater than $4 billion to run the federal-state medical health insurance program for low-income residents and other people with disabilities. For 2019 and 2020, the businesses’ mixed income averaged $189 million per 12 months, in keeping with insurer filings reported by the Nationwide Affiliation of Insurance coverage Commissioners.

“As an alternative of making certain satisfactory well being care networks for Georgia’s kids, Georgians with disabilities, and Georgians in nursing amenities, tons of of hundreds of thousands of {dollars} go as an alternative to the Georgia [insurers’] backside traces,” mentioned Roland Behm, a board member for the Georgia chapter of the American Basis for Suicide Prevention.

Behm, who suggested lawmakers on the invoice, mentioned the KHN and Georgia Well being Information article helped carry the problem to the eye of legislators crafting the invoice.

Georgia is amongst greater than 40 states which have turned to managed-care corporations to run their Medicaid packages — and ostensibly management prices. In accordance with an August report from the U.S. Division of Well being and Human Providers’ Workplace of Inspector Basic, 36 of these states and the District of Columbia set a benchmark “medical loss ratio” for the minimal spending by insurers on medical care. In addition to Georgia, the report mentioned, the 5 states not requiring a managed-care spending threshold had been Kansas, Rhode Island, Tennessee, Texas, and Wisconsin.

Republican state Rep. Todd Jones, a co-sponsor of the brand new invoice, informed KHN that Georgia lawmakers ought to set up a robust benchmark for insurers to fulfill. “We should always take a look at what different states are doing,” he mentioned.

Most states with a spending requirement set that ratio at a minimal of 85% of premium {dollars} that insurers are paid. So when a Medicaid insurer spends lower than that on medical care and high quality enhancements, it should return cash to the federal government.

The Georgia invoice additionally requires setting the edge at 85%. If the invoice is permitted, the Medicaid insurers would face the medical spending requirement in 2023.

If the benchmark had been in place lately, it might have compelled a recoupment from the Peach State firm, which has the biggest Georgia Medicaid enrollment of the three insurers. State paperwork present it failed to achieve the 85% mark from 2018 to 2020, KHN beforehand reported.

Andy Schneider, a analysis professor at Georgetown College’s Middle for Youngsters and Households, known as the 85% mark “a win for taxpayers, for Medicaid suppliers, and for Medicaid beneficiaries.” He additionally mentioned it will be greater than truthful to the Medicaid insurers, which might preserve 15% of what the state pays them for administrative prices and revenue.

As a result of Ralston is the lead sponsor of the invoice within the Home, it’s anticipated to go that chamber.

However the insurance coverage trade doubtless will work to take away the medical spending provision.

An trade official, Jesse Weathington, govt director of the Georgia High quality Healthcare Affiliation commerce group, declined to touch upon the laws.

Fiona Roberts, a spokesperson for the state Division of Group Well being, which oversees the Medicaid program, mentioned the company wants time to overview the measure earlier than commenting on it.

The primary provisions of the invoice require insurers to supply protection for psychological well being care or substance use remedy on the identical stage as different bodily well being wants.

The laws would supply training mortgage assist for folks coaching within the fields of psychological well being and substance use problems and search to increase behavioral well being companies for youngsters. It might additionally facilitate “assisted outpatient remedy” — when a choose might order an individual with a severe psychological sickness to comply with a court-ordered remedy plan locally.





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