The state’s Department of Community Health busted its budget last fiscal year by $32 million, a mistake the agency’s chief said won’t be repeated.
State officials laid out plans Thursday to cut tens of millions of dollars from the DCH budget. Proposed changes include a 0.74 percent Medicaid reimbursement reduction for some health care providers — a move consumer advocates fear could threaten access to care for poor Georgians.
“It is the last option that we wanted to choose but frankly had to,” DCH Commissioner David Cook told board members.
A state audit report revealed the $32 million problem, which equates to roughly one day of Medicaid spending. A spike in claims for hospital stays contributed to the overspending.
The biggest worry now is not receiving adequate Medicaid funding from the state, Cook said. Lawmakers in the House of Representatives are looking at trimming $1.2 million from the department’s proposed amended fiscal 2013 budget.
“It’s evident that we have a very underfunded Medicaid program,” said Tim Sweeney, a health care policy expert at the Georgia Budget & Policy Institute think tank. “The budget is so tight it’s hard to make it work.”
The government health care program for the poor provides health care to roughly 1.7 million low-income Georgians, mostly pregnant women, children, the elderly and disabled. Medicaid is still facing a nearly $400 million budget hole even with the changes being proposed. The program’s once robust reserves were drained dry to help fill state budget holes during the recession.
“We have zero money in reserves,” Cook said.
Health officials estimate the Medicaid payment cuts to providers, excluding hospitals and primary care doctors, will save nearly $13 million next fiscal year.
DCH is also proposing a change in how some procedures are coded, which would result in providers being paid less for the same service, Sweeney said. That could force some providers to raise prices for patients with private insurance to make up the loss, he said.
Sweeney added that some providers of pediatric specialty services have said the code change will equate to a roughly 25 percent rate cut for them.
The cut is a major concern and could hurt access to health care, said David Tatum, vice president of government affairs at Children’s Healthcare of Atlanta. Many doctors already don’t accept Medicaid or have limited the number of Medicaid patients they see because the program doesn’t pay enough to cover the actual cost of care.
Further reimbursement cuts could spur more doctors to drop the program, Tatum said. He added that he hopes the DCH will reconsider and not go through with the reductions.
“Access to care is always a concern of ours,” said Vince Harris, the DCH’s chief financial officer.
Officials say another change being proposed would not just save money but also improve access to and the quality of care.
The department is looking to hire an organization that will manage the care of its most costly and vulnerable Medicaid patients, known as the aged, blind and disabled population. The group accounts for 38 percent of the DCH budget, but makes up just a quarter of Medicaid’s membership.
The case management will focus on medical issues, but also on social problems that may be preventing patients from getting the care they need.
Are they going to emergency rooms — the most expensive setting for care — because they need a warm blanket or live alone and want some companionship? Do they lack transportation to get to their doctor for checkups?
“Are there services people are not getting,” said Medicaid chief Jerry Dubberly. “It’s really taking a holistic look.”