Georgians will be paying about $101 million more in Medicaid costs next year. According to the state Department of Community Health (DCH), the additional expenses are due to changes to the program under the Affordable Care Act.
“The financing of ACA even for a non-expansion state is a significant thing for us to be aware of,” Jerry Dubberly of the DCH explained Wednesday to members of a state Senate committee looking at Medicaid funding alternatives.
Dubberly said those changes include the federal government charging premium taxes, transferring some children from Peachcare to Medicaid, increasing primary care physician payment rates and extending eligibility review timelines from every six months to every 12.
The department also projects there will be a significant increase in people enrolling in Medicaid because of what Dubberly called “the woodwork effect.” People who have been eligible for Medicaid, but who have never enrolled are expected to come out of the woodwork because of all the recent outreach efforts encouraging people to get health coverage. The state project an additional 65,000 people will enroll in Medicaid coverage by Fiscal Year 2015.
About 19 percent of the state’s population is currently enrolled in Medicaid. Dubberly estimated that will increase to more than 21 percent in 2020.
“We’ve kept the trend and growth rate in Georgia below the national average. We worked to manage the program appropriately, but we still have to make sure that we do something very different then we’re doing today because this type growth is not sustainable,” said Dubberly.
That is why some state legislators have been trying to get ahead of the problem by getting input from stakeholders.
“The main thing that we’re doing as lawmakers is balancing the budget and understanding what numbers we have to fit into slots and unfortunately, when you have to generate new money for a new program such as the Affordable Care Act, the money has to come from someplace else,” said state Senator Renee Untermann, R-Buford. “It’s very difficult decisions to have to make, but they’re decisions that are imminent in January.”
The state will face yet another tough decision in January 2015.
Under the ACA, the federal government increased Medicaid reimbursements to primary care physicians to 100 percent.
“Our doctors are very happy about the enhanced rate for primary care,” said David Tatum of Children’s Healthcare of Atlanta.
That happiness, however, may be short-lived. The federal government will not fund that reimbursement rate after December 31, 2014.
“If you’re going to give them a rate increase and at the end of 14 months from now, take that away, you’re going to have a lot of physicians that say, ‘Look, I’m just not going to take Medicaid anymore.’ And if that happens and those Medicaid beneficiaries lose their medical home, they will turn to another provider for care. That’ll be the hospital emergency room.”
Tatum said ER care costs considerably more than regular doctor visits. But the state will be in a difficult position because DCH estimates it would cost Georgians $70 million per year to maintain the 100 percent Medicaid reimbursement rate for primary care physicians.