Department of Community Health

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Department of Community Health The Uninsured
Dr. Rhonda M. Medows, MD, FAAFP Commissioner
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Department of Community Health

• Medicaid
• Peach Care
• State Health Benefit Plan
• Health Improvement Programs
• Volunteers in Medicine

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Mission Statement
The Department of Community Health Champions

• Access to affordable, quality health care in
  our communities
• Responsible health planning and use of health
  care resources
• Healthy behaviors and improved health outcomes.

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Top 5 DCH Initiatives for FY2007

• Medicaid Transformation
• Consumerism
• Integrity Of Our Programs Safety Net
• Health Improvement Resolving Disparities
• Uninsured Community Solutions

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The Uninsured Georgias Healthcare Coverage
Project
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Georgia Health Insurance Coverage 2005
Source  U.S. Census Bureau, Current Population
Survey, 2006 Annual Social and Economic
Supplement. Table HI05. Health Insurance Coverage
Status and Type of Coverage by State and Age for
All People 2005
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What is the Georgia Healthcare Coverage Project?

• Health Resources Services Administration
  (HRSA) Grants awarded to the Georgia Governors
  Office in July 2002 and September 2004.
• Provides the state with resources to collect
  data, evaluate policy options and plan pilot
  projects.
• Goal Reduce the number of uninsured in Georgia.

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How Many Georgians Are Uninsured?

• More than 1.7 million people in Georgia are
  uninsured
• Those 1.7 million people represent approximately
  17 of the States population
• Approximately 27 of Georgians have some type of
  public coverage, such as Medicaid, Medicare,
  PeachCare for Kids and Tricare.

Source US Census Bureau, Current Population
Survey , 2006
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Sources of Insurance Coverage
Source US Census Bureau, Current Population
Survey , 2006
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Employment Status of Uninsured

• Most uninsured individuals in Georgia work or
  are dependent on someone who works.
• 68 of the currently uninsured population in
  Georgia is employed or self-employed
• Retirees and students make up 6 of the
  uninsured population
• Other individuals who are not working or not able
  to work are their dependents account for only 26
  of the population

Source Georgia Health Care Coverage Project 2003
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Employment Status of Uninsured
Source Georgia Health Care Coverage Project 2003
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Health Status of the Uninsured

• The uninsured in Georgia are more likely to
  report their health status as fair or poor (17
  vs. 10).
• They are less likely to report their health
  status as excellent or very good (52 vs. 63).

Source Georgia Health Care Coverage Project 2003
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Health Status of the Uninsured vs. All Georgians
Source Georgia Health Care Coverage Project 2003
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Key Economic Facts Relating to the Uninsured

• About 5 of Georgias health expenditures are
  for care for the uninsured.
• An average family of 3 with private coverage
  pays about 969 per year for the uninsured.
• Cost are borne across taxes, premiums, and
  out-of-pocket expenditures.
• Source Georgia State University, Health Policy
  Center

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Innovative Strategies Addressing The Uninsured

• Key Projects include
• Supporting local access projects.
• Creating partnerships
• with homeless shelters
• offering primary care to the uninsured
• Working with small businesses
• Developing a three share model program,
• Combining funds from employers, employees,
• and the community.

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Local Access Project - Medbank

• Medbank in Savannah offers
• Discounted or free medication
• For uninsured residents with
• chronic illnesses.
• Medbank relies on
• Grant funding
• State support,
• Local community support
• Corporate donations

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Homeless Partnerships

• Partnership DCH and the Department of Community
  Affairs
• Provide homeless and respite services to
  individuals across the
• state that are homeless.
• Supported by state grant funds.
• DCA provides for infrastructure, and shelter
  operations
• DCH contributes funds for providing primary care
  services at the
• shelters.

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Small Business Partnerships

• Partnerships addressing the issue of the working
  uninsured
• Communities in Northwest Georgia
• Central Georgia
• The Coastal Area
• Working with the Georgia Health Policy Center
• Designing a modified Three Share Program
• Contributions from employers, workers,
  providers.

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Conclusion

• DCH supports the work of free clinics across
  the state.
• We applaud the contributions being made by
  volunteers- by both health professionals and lay
  persons.

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Georgia Medicaid

• Health Care Services
• Benefits
• 1. 5 Million Georgians
• Total Budget of 10
• Billion
• State and Federal
• Jointly Financed

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Georgia Medicaid is

• Medicaid Population
• PeachCare Population
• Medicaid Mandatory Services
• Medicaid Optional Services
• Medicaid Services Expenditures
• Medicaid Program Initiatives

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Georgia Medicaid
WHO?
Demographics, Age Aid Category
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Medicaid Demographics
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PeachCare For Kids Demographics
Percentage by Race Race
Percentage African-American
28.84 Asian 3.31 Caucasian 46.37 Hispani
c 11.85 Native American 0.00 N/A
3.58 Other 6.05
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PeachCare For Kids Demographics
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Medicaid Eligibles by Age (FY05)
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Medicaid Population By Aid Category (FY05)
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Georgia Medicaid
WHO?
Mandatory Services, State Optional Services
Service Category
Expenditures
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Mandatory Services

• Inpatient Hospital Services
• Skilled Care/ Nursing Facility
• Outpatient Hospital Services
• Physician Services
• Health Check Services (EPSDT)
• Durable Medical Equipment Services
• Independent Laboratory Service

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State Optional Services

• Pharmacy for Adults
• Health Check Dental
• Non-Emergency Transport
• Hospice
• Psychological Services
• Emergency Ground Ambulance Services
• Adult Dental Program
• Pharmacy DME Supplier
• Vision Care
• Podiatry
• Prosthetics/Hearing
• Etc.

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State Optional Services
Waivers Home Care Services

• Community Care (CCSP)
• Independent Care (ICWP)
• Mental Retardation (MRWP)
• Community Habilitation Support
• Traumatic Brain Injury (TBI)

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Medicaid Services Distribution (FY 05)
Source DCH-DSS Analysis Unit
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Medicaid Services Distribution (FY 05)
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Georgia Medicaid
HOW?
Delivery System Programs Initiatives
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Medicaid Initiatives

• Health Care for 1.2 million Georgians
• Medicaid PeachCare for Kids
• 3 Care Management Organizations
• AmeriGroup, Peach State, WellCare
• Sept.1, 2006 Statewide

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Medicaid Initiatives
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Medicaid Initiatives
Member Enrollment Atlanta Central Regions
After enrollment (by choice or assignment)
members still have 90
more days to change to a different plan.
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Medicaid Initiatives
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Medicaid Initiatives
Administrative Services Organizations

• Aged, Blind Disabled Programs
• Components
• Eligibility Quality Assurance
• Eligibility Data Broker
• Medicaid Program Integrity
• Level of Care
• Clinical Programs
• Beginning Fall 2006

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Medicaid Initiatives
Nursing Home Quality Initiative

• Collaboration DCH Nursing Homes
• Monitor Quality of Care Indicators
• All Georgia nursing homes participate

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New Horizons
Opportunities Issues

• Learning from what was what is
• Deficit Reduction Act 2005
• Long Term Care
• Health Information Technology
• Front Loading Wellness Prevention

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Growth in Medicaid Patients (in millions)
Source DCH-DSS Analysis Unit
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Growth in Medicaid Expenditures (in millions)
Source DCH-DSS Analysis Unit