DCH picks Navigant for Medicaid revamp

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The Department of Community Health has retained Navigant Consulting Inc. of Chicago to review and possibly help revamp the state’s Medicaid and PeachCare health insurance programs.

DCH officials announced Monday they are awarding the $3.3 million contract to Navigant, which will examine how other states provide medical services to low-income families and then recommend changes in Georgia’s programs.

“During our review, we will be learning what is working around the nation and how we can make it work even better here in Georgia,” DCH Commissioner David Cook said. “We will be looking for opportunities to ease administrative burdens, enhance efficiencies, promote access and improve outcomes in a fiscally responsible way.”

The hiring of Navigant is an indication that DCH could jettison or drastically modify the managed-care model that Gov. Sonny Perdue implemented in 2005 for Georgia’s health insurance programs, which consume about $6 billion a year in state and federal funds.

Under Perdue’s privatization scheme, DCH moved about 1 million people receiving Medicaid benefits into managed care programs administered by three private healthcare firms.

Perdue said he was privatizing Medicaid and PeachCare in an effort to control the state’s expenditures on healthcare services, a cost that was increasing at an estimated 10 percent or more a year.

The Perdue initiative resulted in the shift of large state payments to private managed care firms. During fiscal year 2010, according to DCH figures, the state paid $1.26 billion to WellCare of Georgia, $713.5 million to Peach State Health Plan (a subsidiary of Centene Corp.) and $590.4 million to Amerigroup for their managed care services.

The privatized version of Medicaid generated numerous complaints from physicians and hospitals about long delays in getting reimbursed for their services. The Perdue initiative also came under criticism from such legislators as former senator Preston Smith of Rome and Reps. Mickey Channell (R-Greensboro) and Butch Parrish (R-Swainsboro).

DCH officials said they were looking for new ways to handle Medicaid in part because of concerns about the growing number of Georgians who will become eligible for the program under the federal healthcare reform act.

“In light of a growing Medicaid population, increasing expenditures and the potential Medicaid expansion as called for under the amended Patient Protection and Affordable Care Act, we are solidly committed to providing continued quality health care to the people of our state,” said Jerry Dubberly, head of the state’s Medicaid program.

DCH said the number of Medicaid recipients is projected to increase by about 650,000 between 2014 and 2020, which will require an additional $25 billion in state and federal funding to cover this expanded user base.

© 2011 by The Georgia Report

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Tags: DCH , managed care , Medicaid , Navigant , PeachCare , privatization , Sonny Perdue