Medicaid on the OR table
November 14, 2006 at 5:29 pm by Web Editor in NewsThe Republicans won a fight on Election Day in Georgia, but there’s another fight going on in the emergency rooms and clinics and on the streets and apartments where poor women and children can’t pay for health care — even when Medicaid supposedly covers them.
If they can’t get coverage for X-rays or CT scans, they’re on the Georgia Legislative Black Caucus’ radar screen anyway. This is a situation that’s been building, with numbers of discontented marchers swelling down at the Capitol in the last few months.
Inside, they’re starting to hear those voices.
At a Nov. 4 caucus breakout meeting chaired by Rep. "Able" Mabel Thomas, D-Atlanta, in the Embassy Suites Hotel, African-American community leaders agreed there are significant problems with the new privatization portion of how Medicaid is administered statewide, and vowed to raise the issue with Gov. Sonny Perdue.
Doctors and nurses described a situation in which the state’s three privately contracted Care Management Organizations (CMOs), which process claims for people who are on Medicaid, are not providing good service. According to Dr. Thaddeus Chapman, the CMOs regularly tell him they can’t process the claims of Medicaid patients because the claims aren’t clean. When he requests payment, he says there’s always a backlog.
Doctors don’t have to take Medicaid patients, but hospitals do. The consequence in Atlanta means that Grady Hospital has been hit hard.
Chapman said the CMOs’ work to date represents a broken-down privatization model: state contract received in the boardroom, a faceless person dissed on the ground level.
"The system has to be evaluated," confirms Dr. Lawrence Sanders of Atlanta.
The Rev. Tim McDonald of the Iconium Baptist Church attended a "Save Medicaid" March at the Capitol on the same day of the Black Caucus meeting. In a telephone interview last week, he said he is receiving complaints from parishioners, including parents of children with disabilities who depend on therapy, some of them as often as three times per month. Since the governor’s CMOs — Peach State, Amerigroup and WellCare — were hired and went into effect this past summer ostensibly as a cost-saving measure, these patients’ coverage has been cut by up to 50 percent, McDonald says.
"It’s a mess," the church leader complains. "I don’t think you can privatize these types of medical services. We should go back to the old plan. I think the reason the state went with the CMOs is simply because they are trying to stop ‘illegals’ from getting services."
McDonald says that since the state went live on Medicaid managed care, children have been "turned away from hospitals because doctors are not qualifying them."
Kelly McCutcheon of the conservative Georgia Public Policy Foundation concedes that so far the privatization plan is off to a "rocky start." "Doctors are up in arms about not getting paid on time," McCutcheon says.
A representative from Peach State attended the Black Caucus meeting and expressed dismay over the horror stories she heard. "The state is supposed to hold us accountable," said Wendi L. Clifton, a representative of Peach State Health Plan. "From a corporate standpoint we would want to be evaluated. We want to provide services. If you don’t provide services you don’t hold the contract." The Department of Community Health is constitutionally responsible for state oversight.
But that won’t be enough, as far as this group was concerned.
Thomas said she would move with community support to engage the governor on the issue in the coming weeks. "I’ve seen the effects of people who don’t have benefits," the lawmaker said. "They’re saving taxpayers money by cutting taxpayers off health care."
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