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As Medicaid shortfall reaches $300M, program administrators make privatization push

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As the Peach State’s 1.7 million Medicaid enrollment roster swells by another 600,000, a new report by a state health official has revealed the program is facing a massive shortfall north of $300 million.

Georgia’s Department of Community Health will lobby the General Assembly next legislative session for $308.2 million to plug fiscal 2013′s budget gap, its top financial officer said this week.

The program’s fiscal outlet has precipitated more serious consideration of shifting more patients from fee-for-service coverage to managed care.

“Right now we’re at about 16 percent of the state budget,” DCH Commissioner David Cook told Atlanta public radio WABE. “That’s projected to grow to 17 and 18 percent in just the next year or two. The numbers are not sustainable.”

State health officials are expected to finalize a overhaul scheme by summer’s end, at which time the DCH will entertain the bidding of private health care providers.

Already 1.2 million of the state’s Medicaid enrollees receive managed care from one of three private outfits.

But the program’s greatest expense is owed to the care of the blind, aged and disabled. It’s this group, whose per-patient costs register $9,500 annually, that relies on fee-for-service

Cook told WABE he’s hopeful a shift to managed care will benefit both the state and its disabled enrollees: “There’s a lot of talk about how we implement that. We can coordinate care so that we don’t do unnecessary tests; more communication between providers; more nurse follow-up on making sure people are taking their medication.”

- James Richardson