Georgia Medicaid, PeachCare Beneficiaries To Enroll in HMOs Friday Despite Concerns

Friday, September 01, 2006
Georgia Medicaid, PeachCare Beneficiaries To Enroll in HMOs Friday Despite Concerns Over Partial Rollout of Plan

Georgia's Medicaid and PeachCare programs on Friday will enroll hundreds of thousands of beneficiaries in HMOs "despite complaints that the program has become an administrative and medical nightmare in areas where it has been tried so far," the Florida Times-Union reports (Larrabee, Florida Times-Union, 8/31). Gov. Sonny Perdue's (R) reform plan was implemented on June 1 in the Atlanta, Columbus and Macon areas, where about 600,000 beneficiaries were moved from fee-for-service plans to HMOs. The HMOs are being administered by Amerigroup, Centene and WellCare (Kaiser Daily Health Policy Report, 4/28). State officials on Wednesday said the complete rollout of the program will occur on Friday as planned, although the total number of Medicaid and PeachCare beneficiaries enrolled in HMOs will be fewer than the 1.2 million originally predicted. Officials said the total number will be only 847,000, in part because the state began checking beneficiaries' citizenship status and incomes in January. The Atlanta Journal-Constitution reports that "[m]any doctors have cited payment and patient-care problems experienced when the managed care program started in metro Atlanta and central Georgia, and they fear they will surface as the program expands this week" (Miller, Atlanta Journal-Constitution, 8/31). A group of Georgia physicians last month filed a lawsuit against the HMOs alleging that they have not paid providers for millions of dollars in outstanding claims (Kaiser Daily Health Policy Report, 8/17). Critics of the program also say the HMOs have been slow to grant permission for medical treatments (Florida Times-Union, 8/31).









We are interested in hearing from Medicaid Recipients in Broward County and Duval County. Please contact us by email at medicaidreform@pobox.com or by calling Gloria Weiner at the Advocacy Center for Persons with Disabilities,Inc - (954) 967-1493.

www.floridamedicaidreform.org

Early Experiences of Medicare Beneficiaries in Prescription Drug Plans

Report from the Kaiser Foundation.

"....SHIP directors who participated in the focus group reported significant casework related to data system errors resulting in beneficiaries being enrolled in a plan other than the one they had selected, being enrolled into multiple plans, or inadvertently disenrolled from a plan...."

"...Other issues include concerns about marketing practices by some Part D plans, prior authorization requirements, beneficiaries’ limited knowledge of Medicare Advantage products, emerging concerns related to the "doughnut hole," and problems with the automatic enrollment of the dual eligible population...."

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Sun Sentinel: Funding gap leaves thousands of severely disabled residents on waiting list

News Article

By Bill Hirschman
South Florida Sun-Sentinel
Posted August 27 2006

Thousands of severely disabled people are not getting the care they need because a state in-home assistance program that could help them maintain their independence hasn't been adequately funded.

More than 3,100 people have been on a waiting list since 2004, a figure that outraged some legislators who say they were never told about the list and didn't know the program was in trouble.

The Disabled Adult Medicaid Waiver provides a nurse or aide to directly help Floridians between ages 19 and 59 living on their own and struggling with debilitating illnesses ranging from stroke to multiple sclerosis. Aides also provide respite for relatives caring for disabled adults. For some clients, the alternative is a state-funded nursing home or assisted living center.

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