Health officials hope to save the state’s ailing Medicaid program millions of dollars and improve the health of some of Georgia’s most vulnerable children by hiring a for-profit company to oversee their care.
Pediatricians and children’s advocates say the transition to so-called “managed care” for more than 27,000 kids in Georgia’s foster care, adoption assistance and juvenile justice systems could bring coordination that’s long been lacking.
But they say it will only succeed if improving kids’ health — not saving money — is the state’s priority.
The move is part of a larger effort by the state to move more Georgians on Medicaid, including the elderly, disabled and mentally ill, into managed care. Next year, roughly 430,000 so-called “aged, blind and disabled” members will move into a more limited, and voluntary, form of managed care.
A report for the state earlier this year found that three companies already providing managed care to certain Medicaid populations met state standards but failed to significantly improve patients’ health.
Care for foster kids is often sporadic and haphazard, health officials say. Moving among families or group homes means frequent changes in doctors. Fragmented medical records can leave doctors in the dark about existing problems or presciption medications that could be dangerous if mixed with a new drug.
Under a managed care set up, foster children will have one primary care physician and an electronic health record doctors can easily access no matter where they live. It can also help cut down on problems such as the overprescribing of psychotropic drugs, officials say.
“It was apparent that the medical continuum of care was severely lacking,” said Clyde Reese, commissioner of the state Department of Community Health, which oversees Medicaid. “Their physicians were changing. Their records were lagging behind them.”
Moving to managed care starting Jan. 1 is expected to save the government Medicaid health program for the poor as much as $27.5 million over five years by emphasizing prevention and keeping kids healthier, department estimates have shown. The program will be optional for children on adoption assistance.
The state plans to hire one of the three existing care management organizations, or CMOs, that already oversee the care of roughly 1.2 million mostly children and pregnant women on Medicaid. The CMOs received roughly $2.7 billion from the state in fiscal year 2010.
The companies, Peach State, WellCare and Amerigroup, receive a set monthly amount for each member they care for and must then figure out how to make a profit.
Advocates worry whichever company is chosen may limit services for foster kids — whose care is much more complicated and expensive than the general Medicaid population’s — to make a profit.
Nearly 90 percent of kids entering child welfare have health problems, often more than one, and roughly half have significant emotional and behavioral problems, national statistics show.
“It’s a relatively small number of kids,” said Dr. Bob Wiskind, president of the Georgia chapter of the Amercian Academy of Pediatrics. But, “they eat up a lot of time, effort and money because of the lack of coordination.”
Managed care can be cost effective, Wiskind said. But he questioned whether a CMO will actually be able to show improvement in kids health.
“I don’t think Georgia has done managed care (well) thus far,” Wiskind said. “But I’m hopeful we’ll learn from our experience.”
Jerry Dubberly, who heads the community health department’s medical assistance plans, said a quality oversight committee of officials from various state agencies will meet regularly to discuss issues and review what’s being accomplished. Advocates will also be asked to continue offering input.
“We’re going to do this right versus doing it fast,” Dubberly said.
In Texas, moving foster care children into managed care led to a more than 30 percent decrease in the use of psychotropic medications for 60 or more days. Maryland reports a 20 percent rise in foster children receiving a health risk screening.
Managed care for foster children makes sense if done right, said Dr. Moira Szilagyi, a pediatrician in New York state and head of the American Academy of Pediatrics Council on Foster Care, Adoption & Kinship Care.
But states have to make sure they don’t lose important services, such as mental health, parent education and other non-medical types of services, in the switch, Szilagyi said. New York recently began moving foster kids into managed care but is doing so in phases.
“It’s not easy,” she said. “The kids are transient. Some kids are in and they’re out the door before you can blink.”
D’Arcy Robb, public policy director for the Georgia Council on Developmental Disabilities, said the state must lay out in the contract exactly what it expects from a managed care company and have ample staff to enforce it, Robb said.
“Managed care is the direction we’re all going,” she said. “If we do this right, the positive consequences are just tremendous.”